Navigating the terrain between research and practice: a Collaborative Research Network (CRN) case study in diabetes research.
BACKGROUND
Clinical trials conducted in real world settings can improve the translation of research into practice. Although many experts have outlined strategies to conduct effectiveness research in primary care practices, there are few case studies describing how decisions and trade-offs influence the design and implementation of practical clinical trials.


METHODS
This paper outlines the IDEALL (Improving Diabetes Efforts Across Language and Literacy) Project, a study of self-management support strategies for diabetes. We present a case study about translational diabetes research. We explore patient, clinician, and practice recruitment; which interventions to study; and decisions about the level of integration of interventions into practices.


RESULTS
Recruitment strategies needed to take into account Institutional Review Board restrictions not allowing direct patient contact outside of the clinic. Patient diversity was increased by using a population-based database to identify eligible patients; clinic diversity was increased by including neighborhood and hospital-based clinics. An adjunctive model of care to provide interventions was used to avoid burdening clinics with integrating the interventions into clinical practice, but did not address the importance of sustainability in primary care settings.


CONCLUSIONS
Practical clinical trials involve complex strategies, decisions, and trade-offs. Researchers engaging in translational research should continue to describe how design decisions may influence the interpretation of results.
Department of Family and Community Medicine, San Francisco General Hospital, University of California-San Francisco, 995 Portrero Avenue, San Francisco, CA 94110, USA. handleym@fcm.ucsf.edu
Margaret A
MA
Handley
Hali
H
Hammer
Dean
D
Schillinger
D002140:California; D002986:Clinical Trials as Topic / Q000379:methods*; D003299:Cooperative Behavior; D019992:Databases as Topic; D003920:Diabetes Mellitus / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000458:organization & administration*; D006801:Humans; D019982:Organizational Case Studies; D018579:Patient Selection; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D012109:Research Support as Topic / Q000458:organization & administration*; D012648:Self Care; D012944:Social Support