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Glenn L. Laffel, MD, PhD; Donald M. Berwick, MD, MPP

JAMA. 1993;270(2):254-255.

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

There is a fragile connection between the new knowledge generated by medical research and the care given to patients at the bedside. Physicians may not hear about or accept new findings; they may not know how or when to use them; and the health systems in which they practice may not support the implementation of new knowledge.

In the past year, several research groups confirmed the existence of this gap. For example, Listernick's group¹ reported the cases of 10 children who presented to the emergency department of a tertiary care pediatric hospital with clinical manifestations of a disease (three had 21-hydroxylase deficiency and seven had hemoglobinopathy) for which their mothers had received proper antenatal screening and for whom the state screening laboratory had notified physicians about the abnormality. Delays in treatment were caused not by the lack of medical knowledge, but by breakdowns in the follow-up process.

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Author Affiliations
Brigham and Woman's Hospital, Boston, Mass; Institute for Healthcare Improvement, Boston, Mass

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