The paths from research to improved health outcomes

The paths from research to improved health outcomes E vidence-based medicine aims to provide clinicians and patients with choices about the most effective care based on the best available research evidence. To patients this is a natural expectation. To clinicians this is a near impossible dream. The US report Bridging the quality chasm has documented and drawn attention to the gap between what we know and what we do. 1 The report identified 3 types of quality problems-overuse, underuse, and misuse. It suggested: ''The burden of harm conveyed by the collective impact of all of our health care quality problems is staggering.'' While attention has focused on misuse (or error), a larger portion of the preventable burden is likely to be the evidence-practice gaps of underuse and overuse.