Table 1. Contrast of Innovations Informed by National Institutes of Health (NIH)–Funded Studies and Practice Innovators
Characteristics of NIH-Funded StudiesCharacteristics of Studies Based on Everyday Practice
Begin with identified gap in the literatureBegin with identified local need
Structured by idealized conceptual frameworkStructured by awareness of known local assets
Design based on infusion of unsustainable resourcesDesign is responsive to local constraints
Grant often adds responsibilities to existing jobsDesign often redistributes responsibilities based on new services offered
Develop grant-dependent roles outside the practicesDevelop relationships between practices and community resources
Designed to minimize impact on physiciansDesigned to redefine physician role
Grant avoids perturbing the system or adding new outside systemDesign intends to create a learning system
Intervention is responsive to pathologyIntervention is responsive to patient experiences of health and illness
Funded interventions engage idealized patients as represented in the literatureInterventions engage real patients as represented in the practice
Based on incremental changeBased on punctuated change or whole-practice transformation
Funded interventions almost exclusively motivated by disease-specific aimsInnovations almost exclusively motivated by the health of patients and community