Evaluation of ARRA Comparative Effectiveness Research Dissemination Contract Efforts

Wave 2 Clinician Survey Findings

4.1 Demographics of Clinician Respondents

Respondents were asked to provide basic demographic information and describe their clinical practice area (go to Appendix C: Clinician Survey Questionnaire, questions 1-12). The questionnaire asked respondents to report the following demographic variables: age, sex, race, ethnicity, and state of residence. In additional to these characteristics, the questionnaire asked respondents to describe their clinical practice, including clinician type (physician, physician assistant, nurse practitioner, nurse, pharmacist, or other). Only physicians, physician assistants and nurse practitioners were included in the sample. Respondents also reported the number of years they had been in clinical practice (including time in residency or fellowship), the type of site in which they practice, and the number of clinical staff providing direct care at their primary facility. Physicians additionally reported their primary clinical specialty and their clinical subspecialty. Lastly, the questionnaire asked respondents to report the average number of hours per week spent on direct patient care. Only those clinicians with 8 or more hours per week in clinical practice were eligible to complete the remainder of survey.

Exhibit 18 summarizes the key demographic variables by clinician type. The respondents mean age was 46.8 years. Most of the sample was female (70 percent). However, more physicians were male than female (53 percent compared to 47 percent), while the majority of physician assistants (66 percent) and nurse practitioners (93 percent) were female. The majority of the sample was non-Hispanic (94 percent) and White (84 percent). Clinicians from all 50 states responded to the survey. Distribution of clinician survey respondents by the U.S. Department of Health and Human Services' regions is included in Appendix N.

On average, clinicians had been practicing for 14.6 years, with physicians, on average, having more years of experience (16.1 years) than physician assistants (15.5 years) and nurse practitioners (14.6 years). Among the 468 physicians, 34 percent indicated that they specialized in family medicine, 29 percent in general internal medicine, 20 percent in pediatrics, 10 percent in obstetrics/gynecology, and seven percent in another specialty.

Across all the respondents, just over one third (37 percent) worked in a private practice office; ten percent worked in an ambulatory care clinic of a hospital or medical center and twelve percent in a hospital. The remaining half of clinician respondents worked across the variety of practice sites listed. Across all participants, the median clinician and non-clinician staff size was ten. Respondents spent an average of 35 hours per week in direct patient care.

Exhibit 18. Demographic Characteristics of the Clinician Survey Respondents

Demographic Category	Clinician Type
	Physician (n=468)		Physician Assistant (n=558)		Nurse Practitioner (n=542)		Total* (n=1,568)
	Freq.	%	Freq.	%	Freq.	%	Freq.	%
Age (in years)
Mean	47.04		45.37		47.92		46.75
Standard Deviation	12.45		11.47		11.01		11.66
N	468		558		542		1,568
Sex
Female	219	46.7	369	65.9	507	93.2	1,095	69.6
Male	250	53.3	191	34.1	37	6.8	478	30.4
Total	469	100	560	100	544	100	1,573	100
Hispanic or Latino/a
No	445	94.5	514	92.4	520	95.8	1479	94.2
Yes	26	5.5	42	7.6	23	4.2	91	5.8
Total	471	100	556	100	543	100	4,570	100
Race
American Indian or Alaska Native	5	1.1	6	1.1	7	1.3	18	1.1
Asian	91	19.3	25	4.5	25	4.6	141	9
Black or African American	23	4.9	21	3.8	32	5.9	76	4.8
Native Hawaiian or other Pacific Islander	0	0	3	0.5	2	0.4	5	0.3
White	355	75.4	494	88.2	481	88.4	1,330	84.4
No response provided	5	1.1	18	3.2	4	0.7	27	1.7
Years in Practice
Mean	16.13		15.54		12.34		14.62
Standard Deviation	12.31		9.68		9.29		10.54
N	469		560		534		1,563

* Respondents could choose not to answer any question; base sizes reflect the number of respondents who answered the question.

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4.2 Clinician Level of Awareness

4.2.1 Unaided Awareness of CER among Clinicians

To elicit information on clinicians' unaided awareness of CER, the questionnaire provided a brief description of the research and asked respondents if they recall seeing or hearing about it. Specifically, the questionnaire asked clinicians if they "had ever heard about types of research that are designed to help you make treatment decisions with your patients by comparing the benefits and harms of different treatment options." When asked if they had ever heard about research that fit this description, 41 percent of clinician respondents indicated that they had, while approximately one third (29.6 percent) indicated they had not. Twenty-nine percent were unsure if they had heard of research that fit this description.

For those who answered yes to the initial unaided question, a follow-up open-ended question asked clinician respondents to identify what this type of research is called. The IMPAQ team compiled and reviewed the verbatim responses to develop a set of codes, which the team used to code and analyze all responses. Those respondents who indicated that they had heard of this type of research (n=619) were asked to identify what the research was called. Each respondent could mention one name, multiple names, or indicate "don't know" or provide no response. All responses were coded; thus, the number of responses exceeds the number of respondents. Respondents identified 792 names for the research from the 619 respondents in the dataset. Across respondent types, "evidence-based" (n=409) was most commonly used phrase to describe this type of research. Within this category, 268 of the 409 responses included the term "evidence-based medicine," 57 listed "evidence-based" with no further description, 45 included "evidence-based research," 39 referenced "evidence-based practice or treatment," and 55 mentioned a methodology-related to the collection or analysis of the evidence. Less commonly used were the terms "comparative effectiveness" (n=58) or "patient-centered" (n=42). Thirty-five individuals indicated that they were unsure or did not remember the name of the research.

4.2.2 Aided Awareness of CER among Clinicians

To assess aided awareness, the questionnaire provided the names of several types of research and asked respondents if they recognize each type. The IMPAQ team used a four-point scale to measure familiarity with terms of interest (i.e., "not at all familiar/never heard of it," "have heard the name but not familiar," "somewhat familiar," and "mostly/very familiar"). For analytic purposes, the four-point scale was collapsed into two awareness categories: aware ("somewhat familiar" and "mostly/very familiar") and unaware ("not at all familiar/never heard of it" and "have heard the name but not familiar").

As shown in Exhibits 19 and 20, when the IMPAQ team asked respondents to indicate their familiarity with several types of research that help them make treatment decisions based on comparisons of benefits and harms of different options, fewer than 20 percent of the respondents were familiar with the term "comparative effectiveness research (CER)." Over half (52 percent) reported they had never heard of or were not familiar with the term, while slightly more than a quarter (29 percent) reported they had heard the term but were not sure of its meaning.

Clinicians indicated greater familiarity with the terms "evidence-based medicine," "patient-centered outcomes research," or "PCOR" than CER. Ninety-four percent were mostly or very familiar with evidence-based medicine (EBM). Forty-nine percent of clinicians were mostly or very familiar with PCOR; 21 percent reported that they had never heard of or were not familiar with the term. Approximately one-third (31 percent) reported they had heard the term but were not sure what it meant.

Exhibit 19. Aided Awareness of CER, PCOR, and EBM by Clinician Respondent Type

Types of Research	Clinician Type
	Physician		Physician Assistant		Nurse Practitioner		Total*
	Freq.	%	Freq.	%	Freq.	%	Freq.	%
Comparative Effectiveness Research
Aware	114	25.7	68	13.1	109	21.1	291	19.7
Mostly/ Very familiar	30	6.8	11	2.1	20	3.9	61	4.1
Somewhat familiar	84	18.9	57	11	89	17.2	230	15.5
Unaware	330	74.3	452	86.9	407	78.9	1,189	80.3
Have heard the name but not familiar	132	29.7	152	29.2	139	26.9	423	28.6
Not at all familiar / never heard of it	198	44.6	300	57.7	268	51.9	766	51.8
Total	444	100	520	100	516	100	1,480	100
Patient-Centered Outcomes Research
Aware	197	44	222	42.4	309	59.5	728	48.8
Mostly/ Very familiar	57	12.7	66	12.6	116	22.4	239	16
Somewhat familiar	140	31.3	156	29.8	193	37.2	489	32.8
Unaware	251	56	302	57.6	210	40.5	763	51.2
Have heard the name but not familiar	152	33.9	175	33.4	130	25	457	30.7
Not at all familiar / never heard of it	99	22.1	127	24.2	80	15.4	306	20.5
Total	448	100	524	100	519	100	1,491	100
Evidence-based Medicine
Aware	426	93.6	496	93.6	499	94.2	1,421	93.8
Mostly/ Very familiar	349	76.7	359	67.7	424	80	1,132	74.7
Somewhat familiar	77	16.9	137	25.8	75	14.2	289	19.1
Unaware	29	6.4	34	6.4	31	5.8	94	6.2
Have heard the name but not familiar	17	3.7	25	4.7	12	2.3	54	3.6
Not at all familiar / never heard of it	12	2.6	9	1.7	19	3.6	40	2.6
Total	455	100	530	100	530	100	1,515	100

*Respondents could choose not to answer any question; base sizes reflect the number of respondents who answered the question.

Exhibit 20. Aided Awareness of CER, PCOR, and EBM by Clinician Respondent Type

As indicated in Exhibit 21, respondents were asked to indicate their familiarity with several other types of research that help them make treatment decisions based on comparisons of benefits and harms of different options. For example, 89 percent of respondents were unfamiliar with the term "health technology assessment." Respondents were also unfamiliar with the two items included to measure "ghost" awareness: comparative treatment analysis (78 percent) and risk benefits research (66 percent).

Exhibit 21. Aided Awareness of Other Types of Research by Clinician Respondent Type

Types of Research	Clinician Type
	Physician		Physician Assistant		Nurse Practitioner		Total*
	Freq.	%	Freq.	%	Freq.	%	Freq.	%
Health Technology Assessment
Aware	51	11.6	41	8	67	13.3	159	11
Mostly/ Very familiar	11	2.5	8	1.6	14	2.8	33	2.3
Somewhat familiar	40	9.1	33	6.5	53	10.5	126	8.7
Unaware	387	88.4	469	92	436	86.7	1,292	89
Have heard the name but not familiar	123	28.1	133	26.1	130	25.8	386	26.6
Not at all familiar / never heard of it	264	60.3	336	65.9	306	60.8	906	62.4
Total	438	100	510	100	503	100	1,451	100
Comparative Treatment Analysis
Aware	94	21.6	97	18.8	124	24.3	315	21.6
Somewhat familiar	71	16.3	75	14.6	100	19.6	246	16.8
Mostly/ Very familiar	23	5.3	22	4.3	24	4.7	69	4.7
Unaware	342	78.4	418	81.2	386	75.7	1,146	78.4
Not at all familiar / never heard of it	212	48.6	238	46.2	241	47.3	691	47.3
Have heard the name but not familiar	130	29.8	180	35	145	28.4	455	31.1
Total	436	100	515	100	510	100	1,461	100
Risk Benefits Research
Aware	145	32.5	145	27.8	218	41.9	508	34.1
Somewhat familiar	98	22	111	21.3	149	28.7	358	24.1
Mostly/ Very familiar	47	10.5	34	6.5	69	13.3	150	10.1
Unaware	301	67.5	377	72.2	302	58.1	980	65.9
Not at all familiar / never heard of it	169	37.9	214	41	156	30	539	36.2
Have heard the name but not familiar	132	29.6	163	31.2	146	28.1	441	29.6
Total	446	100	522	100	520	100	1,488	100

* Respondents could choose not to answer any question; base sizes reflect the number of respondents who answered the question.

As shown in Exhibit 22, among those who reported having heard of or read about CER, the most common sources of exposure were an article in a medical or science journal (24 percent), conference or professional meeting (17 percent), a continuing education course (11 percent), and colleagues (9 percent). Approximately ten percent could not remember where they had heard of CER.

Exhibit 22. Sources of Awareness of CER by Clinician Respondent Type

Source	Clinician Type
	Physician		Physician Assistant		Nurse Practitioner		Total
	Freq.	%	Freq.	%	Freq.	%	Freq.	%
Nowhere-never heard of CER	216	45.9	306	54.6	261	48	783	49.7
I've heard of it before, but don't know where	55	11.7	49	8.8	45	8.3	149	9.5
Article in a medical/science journal	130	27.6	115	20.5	133	24.4	378	24
Advertisement in journal or trade magazines	15	3.2	13	2.3	12	2.2	40	2.5
Web site	36	7.6	27	4.8	40	7.4	103	6.5
Conference or professional meeting	84	17.8	76	13.6	111	20.4	271	17.2
Colleagues	49	10.4	41	7.3	54	9.9	144	9.1
Employer	5	1.1	13	2.3	18	3.3	36	2.3
Advertisement on TV, radio, or in a store	3	0.6	2	0.4	4	0.7	9	0.6
Educational visit at your place of practice by a trained professional	10	2.1	13	2.3	15	2.8	38	2.4
Article in a newspaper or magazine or story on TV news	13	2.8	9	1.6	4	0.7	26	1.7
Through a continuing education course	46	9.8	54	9.6	75	13.8	175	11.1
Other	11	2.3	7	1.3	22	4	40	2.5
No response provided	8	1.7	19	3.4	11	2	38	2.4

4.2.3 Awareness of AHRQ and the EHC Program among Clinicians

Over one-third (38 percent, n=592) of the clinicians were aware of AHRQ. We described the EHC Program for respondents before probing their awareness. The description read: "The Effective Health Care Program funds individual researchers, research centers, and academic organizations to work together with the Agency for Healthcare Research and Quality (AHRQ) to produce effectiveness and comparative effectiveness research, types of patient-centered outcomes research, for clinicians, consumers, and policymakers." As indicated in Exhibit 23, the vast majority of clinicians (88 percent, n=1,368) were unaware of the EHC Program. We also asked respondents if they were aware of the EHC Program's Web site, and, interestingly, 17 percent of respondents reported that they "had heard of" the Web site.

Exhibit 23. Awareness of AHRQ, EHC Program, and the Eisenberg Center

Agency, Program, or Product	Clinician Type
	Physician		Physician Assistant		Nurse Practitioner		Total*
	Freq.	%	Freq.	%	Freq.	%	Freq.	%
AHRQ
Aware	164	35	139	25.1	289	53.4	592	37.9
Mostly/ Very familiar	42	9.0	18	3.2	90	16.6	150	9.6
Somewhat familiar	122	26.0	121	21.8	199	36.8	442	28.3
Unaware	305	65	415	74.9	252	46.6	972	62.1
Have heard the name but not familiar	169	36.0	225	40.6	191	35.3	585	37.4
Not at all familiar / never heard of it	136	29.0	190	34.3	61	11.3	387	24.7
Total	469	100	554	100	541	100	1,564	100
EHC Program
Aware	51	11	45	8.1	94	17.5	190	12.2
Mostly/ Very familiar	4	0.9	2	0.4	7	1.3	13	0.8
Somewhat familiar	47	10.1	43	7.7	87	16.2	177	11.4
Unaware	414	89	511	91.9	443	82.5	1,368	87.8
Have heard the name but not familiar	146	31.4	197	35.4	221	41.2	564	36.2
Not at all familiar / never heard of it	268	57.6	314	56.5	222	41.3	804	51.6
Total	465	100	556	100	537	100	1 ,558	100
Eisenberg Center
Aware	7	1.5	3	0.5	7	1.3	17	1.1
Mostly/ Very familiar	0	0	1	0.2	0	0	1	0.1
Somewhat familiar	7	1.5	2	0.4	7	1.3	16	1
Unaware	462	98.5	555	99.5	536	98.7	1,553	98.9
Have heard the name but not familiar	36	7.7	33	5.9	40	7.4	109	6.9
Not at all familiar / never heard of it	426	90.8	522	93.5	496	91.3	1,444	92
Total	469	100	558	100	543	100	1,570	100

Seventeen clinicians (one percent) reported that they were familiar with the Eisenberg Center. The complete results of awareness of AHRQ, the EHC Program, and the Eisenberg Center, by clinician respondent type, can be found in Appendix O, Table 1.

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4.3 Clinician Level of Knowledge and Understanding

4.3.1 Clinician CER Knowledge Score

To assess knowledge and understanding of CER, respondents who reported that they had heard of or read about CER were asked to indicate which of a series of 11 attributes reflected principles of CER (go to Appendix C: Clinician Survey Questionnaire, question 19). As indicated in Exhibit 24, respondent were asked whether they thought a set of attributes were true of CER.

Exhibit 24. Clinician Scores on CER Attributes

Attribute	Description	Is this an accurate statement?	Percent answering the question correctly
Attribute 1.	Compares effectiveness and risks of established and emerging treatments.	Yes	78%
Attribute 2.	Addresses treatments for common chronic medical conditions.	Yes	70%
Attribute 3.	Includes reviews of existing scientific literature.	Yes	77%
Attribute 4.	Includes new studies based on analyses of health care databases.	Yes	53%
Attribute 5.	Includes new scientific studies testing the efficacy of specific new medical treatments or technologies.	No	9%
Attribute 6.	Is conducted by pharmaceutical companies and medical device manufacturers.	No	24%
Attribute 7.	Intended to support informed decisionmaking.	Yes	79%
Attribute 8.	Addresses treatments for acute medical conditions.	No	8%
Attribute 9.	Identifies areas of clinical uncertainty and gaps in the scientific literature.	Yes	46%
Attribute 10.	Intended to assist in shared decisionmaking between clinicians and individual patients.	Yes	70%
Attribute 11.	Provides specific clinical practice recommendations for medical conditions.	No	14%

The IMPAQ team calculated a CER Knowledge Scale based on correct answers to each of the 11 items. A correct answer was scored as 1; an incorrect or "Not Sure" response was scored as 0. The team then summed the scores for each respondent to ascertain individual CER Knowledge Scale scores.

Among the 746 clinicians who responded to all 11 items, the CER Knowledge Scale ranged from 0 to 10 (that is, no respondent answered all of the questions correctly, as would have been indicated by a Knowledge Scale score of 11), with a mean score of 5.23 and a standard deviation of 2.57.

The majority of these respondents identified the correct attributes (six of the eleven attributes). Among respondents' incorrect answers were several notable findings. More than half (55 percent) ascribed Attribute 5 ("Includes new scientific studies testing the efficacy of specific new medical treatments or technologies") to CER, while approximately one-third (37 percent) indicated they were not sure whether this statement described CER. Similarly, 16 percent of respondents answered affirmatively to Attribute 6 ("Is conducted by pharmaceutical companies and medical device manufacturers") while 60 percent were unsure who conducts CER studies. Lastly, approximately half of the respondents who answered the knowledge scale items indicated that CER addresses treatments for acute medical conditions (53 percent) and provides specific clinical practice recommendations for medical conditions (44 percent). The complete results of CER knowledge scores, by clinician respondent type, can be found in Appendix O, Table 2.

4.3.2 Clinician EHC Program Knowledge Score

Similarly, the IMPAQ team developed an EHC Program Knowledge Scale consisting of 12 items to assess knowledge and understanding of the EHC Program (go to Appendix C: Clinician Survey Questionnaire, question 26). As indicated in Exhibit 25, respondent were asked whether they thought a set of characteristics were true of the EHC Program.

Exhibit 25. Clinician Scores on EHC Program Characteristics

Characteristics	Description	Is this an accurate statement?	Percent answering the question correctly
Characteristics 1.	Is co-sponsored by private health care and medical technology firms.	No	28%
Characteristics 2.	Funds and conducts comparative effectiveness research in the U.S.	Yes	83%
Characteristics 3.	Funds the development of new treatments.	No	35%
Characteristics 4.	Screens all sponsored researchers for conflicts of interest.	Yes	63%
Characteristics 5.	All reports are posted for public comment.	Yes	51%
Characteristics 6.	All reports are peer reviewed.	No	3%
Characteristics 7.	Is sponsored by AHRQ.	Yes	83%
Characteristics 8.	Open for public participation.	Yes	43%
Characteristics 9.	Uses transparent and clearly documented processes.	Yes	69%
Characteristics 10.	Includes clinicians as a target audience for research results.	Yes	74%
Characteristics 11.	Includes consumers/patients as a target audience for research results.	Yes	60%
Characteristics 12.	Includes policymakers as a target audience for research results.	Yes	48%

A correct answer was scored as 1, and an incorrect or "Not Sure" response was scored as 0. The team then summed the scores for each respondent to get the CER Knowledge Scale, with a potential range of zero to 12. Among the 183 clinicians who indicated they had heard of the EHC Program and provided answers to all 12 items, the EHC Program Knowledge Scale ranged from 0 to 12, with a mean of 6.32 and a standard deviation of 3.00.

The majority of these respondents correctly identified the characteristics that are indeed accurate (eight of the twelve). Fewer respondents correctly identified Characteristic 6 ("All reports are peer reviewed") and Characteristic 8 ("Open for public participation"): 3 percent and 43 percent, respectively. Approximately one-third of respondents agreed with Characteristic 1 ("Is co-sponsored by private health care and medical technology firms"), while over one half (54 percent) were unsure. Similarly, approximately one-third (29 percent) agreed with Characteristic 3 ("Funds the development of new treatments"), while 35 percent did not, and 37 percent were not sure. Over three-quarters correctly identified Characteristic 7 ("Is sponsored by AHRQ") and Characteristic 2 ("Funds and conducts comparative effectiveness research in the US"). The complete results of EHC Program knowledge scores, by clinician respondent type, can be found in Appendix O, Table 3.

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4.4 Clinician Attitudes and Perceived Benefits of CER

The IMPAQ team used 12 statements to assess attitudes and benefits of CER and one to assess attitudes and benefits of the EHC Program (go to Appendix C: Clinician Survey Questionnaire, questions 20, 21, 22, and 36). To assess attitudes and perceived benefits of CER, respondents were asked to indicate, on a 5-point scale, the extent to which they agreed or disagreed with a series of 12 statements about CER in clinical decision making. These statements asked if CER:

Statement 1.	Is neutral and unbiased.
Statement 2.	Is scientifically rigorous.
Statement 3.	Provides findings that are descriptive, not prescriptive.
Statement 4.	Provides objective information about drugs, medical equipment, and treatments.
Statement 5.	Provides findings that support informed decisionmaking.
Statement 6.	Highlights current evidence about effectiveness, risks, and side effects.
Statement 7.	Identifies areas of clinical uncertainty and gaps in the scientific literature.
Statement 8.	Includes confidence ratings on evidence in its reports, products, and materials.
Statement 9.	Helps me deliver better health care to my patients.
Statement 10.	In general, medical decisions based on comparative effectiveness research lead to better patient outcomes.
Statement 11.	Medical decisions based on comparative effectiveness research are more cost effective in the long run.
Statement 12.	Leads to shared decisionmaking between clinicians and individual patients.

This set of items was treated as a "Perceived Benefits" of CER scale and scored from -2 (Strongly Disagree) to +2 (Strongly Agree) so that positive scores would reflect more favorable attitudes toward CER and negative scores would reflect less favorable attitudes (with zero reflecting neutrality). A scale score was calculated per respondent based on the average agreement rating across all 12 items. Cronbach's alpha for the scale was 0.92.

Respondents' scores skewed toward the positive end of the scale across the 12 statements (mean of 0.56), with most respondents choosing "agree" or "neither agree nor disagree" to the statements. Fewer than seven percent of respondents indicated that they "disagreed" or "strongly disagreed" with the statements, and approximately ten percent of respondents "strongly agreed" with the statements. The statements that garnered the most agreement (either "strongly agree" or "agree") from respondents were Statement 5 (73 percent) and Statement 6 (72 percent). The complete results of perceived benefits of CER, by clinician respondent type, can be found in Appendix O, Table 4.

We also measured respondents' general attitudes towards CER use in clinical decisionmaking using a seven-item, five-point semantic differential scale using seven paired adjectives. Scale items included the following paired adjectives: beneficial/not beneficial; helpful/not helpful; easy to understand/hard to understand; objective/biased; credible/not credible; trustworthy/not trustworthy; and extremely valuable/not valuable. Responses were coded from "+1" to "+5" with the higher number reflecting the adjective associated with a positive attitude toward CER. An average scale score was calculated for each respondent. Cronbach's alpha for this scale was 0.83.

Responses skewed toward the positive adjective in each pair (mean of 3.73, standard deviation of 0.59), suggesting slightly positive attitudes among respondents who had heard of CER. The complete set of scores reflecting general attitudes towards using CER in clinical decisionmaking results, by clinician respondent type, can be found in Appendix O, Table 5.

As another measure of attitudes, the survey asked all respondents to indicate their interest in learning more about CER and the EHC Program. Slightly over half the respondents (54 percent) indicated that they were interested in learning more about CER. Similarly, just over half the respondents (57 percent) indicated that they were interested in learning more about the EHC Program. The complete results of interest in learning about CER and the EHC Program, by clinician respondent, type can be found in Appendix O, Table 6.

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4.5 Clinician Level of Behavior Change and Use of CER

4.5.1 General Information Sharing for Informed Decisionmaking among Clinicians

The team sought to understand how often and why clinicians share educational materials with their patients. The questionnaire asked all respondents to indicate how regularly they share educational materials with patients to help inform decisions about treatment options. The majority of clinicians indicated that they share such materials with some (38 percent), most (39 percent), or all (12 percent) of their patients. The complete results of respondents who share educational materials with their patients, by clinician respondent type, can be found in Appendix O, Table 7.

Two additional follow-up questions asked respondents to indicate the reasons they do not discuss treatment options with their patients (Exhibit 26). Approximately one-third (33 percent) reported that they do not have a discussion when there are no treatment options to discuss. Other reasons included lack of time (16 percent), patients' existing awareness of treatment options (18 percent), patients expecting the clinician to know the best treatment (14 percent), patient difficulty in understanding the treatment options (14 percent), patients being overwhelmed by the amount of information (14 percent), patients not appearing interested in hearing about options (11 percent), and not wanting to confuse patients (nine percent). Almost half of respondents (40 percent) indicated that the question did not apply to them since they discuss options with every patient. The complete results of reasons respondents do not discuss treatment options with their patients, by clinician respondent type, can be found in Appendix O, Table 8.

Exhibit 26. Top Reasons Clinician Respondents Do Not Discuss Treatment Options with Patients

Respondents were also asked to select the reasons why they do discuss treatment options with their patients and what they discuss when they describe those options. Slightly under half (47 percent) indicated that they do so because their patients ask them for options in general or because their patients ask about specific options (43 percent). The majority (87 percent) indicated that during these discussions they describe the risks and benefits of each option. More than half (54 percent) discuss the relative effectiveness of each option (70 percent) and their experience with each option. Less than half (41 percent) of the respondents reported discussing the potential cost of each option. The complete results of reasons respondents discuss treatment options with patients, by clinician respondent type, can be found in Appendix O, Table 9.

4.5.2 Use of EHC Program Products among Clinicians

The survey asked those respondents who were aware of the EHC Program (of the 190 respondents who indicated they were aware of the EHC Program, 160 responded)²⁰ a series of questions assessing which specific types of EHC Program products they had heard of, read or used, and shared with colleagues or other health professionals. For each product listed, at least two-fifths of the respondents indicated that they had heard of that product (Exhibit 27). Research reviews (81 percent), original research reports, (71 percent), research summaries (78 percent), clinician summaries (69 percent), continuing education activities (64 percent), and consumer summaries (59 percent) were most commonly listed.

Although awareness of EHC Program products was generally high, fewer clinicians reported having ever read or used them. Clinicians reported using research summaries (50 percent) most frequently, while only one-fifth (23 percent) used the consumer/patient summaries. Even fewer respondents indicated that they shared EHC Program products with a colleague or other health professional. The research summaries (23 percent) and clinician summaries (19 percent) were the most commonly cited products shared. The complete results of awareness, use, and sharing of EHC Program products among clinician respondent types can be found in Appendix O, Table 10.

Exhibit 27. Awareness and Use of EHC Program Products among Clinician Respondents who Reported Awareness of EHC Program

Among respondents who had used any of the EHC Program clinician products to become better informed about treatment options (e.g., the treatment summaries and research reviews), slightly under half reported using the products in the last six months (44 percent). Among respondents who had shared an EHC Program consumer summary with their patients to help them make better informed decisions about treatment options, approximately one-third did so within the past six months (32 percent), while slightly more clinicians reported that they have never shared an EHC Program consumer summary with their patients (36 percent).

4.5.3 Use of EHC Program Web Site among Clinicians

The majority of clinicians surveyed (83 percent) indicated that they had never heard of the EHC Program Web site. Only 104 respondents (6 percent) indicated that they had ever visited the EHC Program Web site. Those who were aware of the Web site most frequently cited an article in a medical/science journal (23 percent), conference (24 percent), another Web site (17 percent), continuing education (16 percent), professional organization (13 percent), or colleague (21 percent) as the catalyst to learning about the EHC Program Web site. The complete results of Web site use, by clinician respondent type, can be found in Appendix O, Table 11-13.

4.5.4 Intention to Use among Clinicians

Approximately half of those surveyed indicated that they are likely to use the consumer (47 percent) and clinician summaries (50 percent) in the next year, while approximately ten percent were unlikely to use either product. Approximately two-fifths were not sure if they would use either product. The complete results of future intentions to use the EHC Program products, by clinician respondent type, can be found in Appendix O, Table 14.

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4.6 Clinician Exposure to Dissemination Strategies

The questionnaire included several items to assess exposure to the specific dissemination strategies used by the four dissemination contractors. One-fifth of respondents (19 percent) reported that in the past 12 months they had taken any online CME/CE course that presented findings from a systematic evidence review that used CER to compare two or more treatment options.

Thirty-six respondents (2 percent) reported receiving an academic detail by a patient-centered outcomes specialist consultant who spoke with them about CER research findings and the EHC Program in the past 12 months. Six percent of respondents reported that any professional organization of which they were a member had sent them any information about CER or the EHC Program in the last 12 months. A small minority of respondents reported hearing about CER through their professional organization.

Lastly, slightly over half (56 percent) of the clinicians reported that they had seen, read, or heard anything that encourages patients to explore and compare their treatment options with their doctors. Among those who reported exposure to such information, 26 percent reported having seen these messages in the last week and 39 percent reported having seen such messages in the past month. The complete results of self-reported exposure to information about CER and the EHC Program, by clinician respondent type, can be found in Appendix O, Table 15.

²⁰ Awareness of the EHC Program was operationalized as a respondent indicating that he or she was either "somewhat" or "mostly/very familiar" with the EHC Program.

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Page last reviewed October 2013
Page originally created December 2014

Internet Citation: Evaluation of ARRA Comparative Effectiveness Research Dissemination Contract Efforts. Content last reviewed October 2013. Agency for Healthcare Research and Quality, Rockville, MD. https://archive.ahrq.gov/research/findings/final-reports/arracer/arracer-4.html

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