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The Continuing Challenge

C. David Naylor, MD, DPhil

JAMA. 1998;279:1392-1394.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Understanding of the links between medical knowledge and clinical practice has evolved considerably over the last 4 decades. Notwithstanding the accelerated pace of medical progress after World War II and early evidence suggesting opportunities to improve the quality of clinical care, few researchers focused on knowledge-behavior relationships during the 1950s and 1960s. It was tacitly assumed that medical advances diffused appropriately into practice after publication in the clinical literature. Perhaps naively, many observers implicitly accepted the concept that physicians could maintain high-quality care by browsing a few journals, attending occasional continuing education events, interacting with their peers, and filtering promotional information from drug and device manufacturers.

By the 1980s, researchers had repeatedly shown that the traditional approach sometimes galvanized dramatic shifts in clinical behavior, but was seldom sufficient to cause consistent and optimal transfer of evidence into practice. Active dissemination of high-quality clinical guidelines was . . . [Full Text of this Article]

From the Institute for Clinical Evaluative Sciences, the University of Toronto Clinical Epidemiology and Health Care Research Program (Sunnybrook Unit), and the Departments of Medicine and Health Administration, University of Toronto, Toronto, Ontario.

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