outlines a continuum of scholarly inquiry that may be conducted in a health care or promotion setting (eg, community hospital, academic health center). The figure depicts a line representing a research continuum targeting three areas: laboratory initiated work (the bench), the point of clinical practice (the bedside), and prescribed practices mediating cost, hospital quality, and patient outcomes (system policy). Dotted curved arrows at each end of the continuum presume a reciprocal process whereby advances at one end of the continuum facilitate the other-policy may beget bench advances, policy may inform agenda for basic science research.
The figure further specifies five different types of research or scholarly inquiry: basic sciences, translational sciences, comparative effectiveness research, implementation sciences, and quality improvement. Collectively, our research enterprise simply: (1) clarifies fundamentally normal and abnormal human function (basic sciences), (2) posits an appropriate intervention to improve health (translational research), (3) clarifies the preferred intervention among alternatives (comparative effectiveness) per patient preference and values (patient-centered outcomes research), (4) identifies the best means by which to integrate the preferred intervention (implementation sciences), and (5) evaluate care delivery processes to ensure the preferred intervention meets or exceeds outcome expectations; insights collectively facilitate optimal patient care and subsequent patient wellness. Ultimately, these research strategies, independently and collectively, provide insights relative to cost, quality and access. While each research area has an epistemological primacy target, we frame our research enterprise as a continuum, not siloed scholarly endeavors; each research area is arguably dependent on the other, providing insights derived from, or impacting, bench, bedside, or system policy. Thus, the illustration is not intended to advocate the preeminence of one research agenda over the other.
also depicts dotted circles overlapping the domains of translational research, CER, implementation science and quality improvement. This illustration intends to simulate the conceptual overlap between what care innovators may do to improve health (translational research) and what is best to do (CER). Likewise, there is arguably conceptual overlap between identifying the best way to implement the best procedure (implementation sciences) and considering how to improve the strategy (quality improvement). The dotted circles also intend to simulate a methodological overlap among these four research strategies. Data collection approaches, such as survey, case study, focus group, and chart review, are not exclusive to any of these general research strategies. Consequently, data collection methods used in one research strategy may simultaneously, and subsequently, inform another. Ultimately, these research strategies, independently and collectively, may provide insights relative to cost, quality and access.