Bill Gardner totals up the length of time necessary to do a pilot study of a health systems intervention (like a new care delivery model or physician payment program), get funding, do a larger-scale study, then publish the results: up to 10 years. Then there's a lag between the publication and the implementation by other healthcare systems. That can take another 10-15 years. Sounds similar to the lag described in the Institute of Medicine's Crossing the Quality Chasm report:
It now takes an average of 17 years for new knowledge generated by randomized controlled trails to be incorporated into practice, and even then application is highly uneven.The lag between the introduction of a new technology or system and its widespread adoption is of great interest to me. Much of the research I've read is either coming at it from a diffusion of innovations perspective or an evidence-based medicine approach. This whole area is touchy for some doctors, and given that a third of US doctors are over 65 and older doctors tend to be slower to adopt new things, I think we need more levers to move clinicians to adopt better practices. And if that means putting them all on salary, I'd be okay with that.