Invited Commentary
March 2015

Incentivizing “Structures” Over “Outcomes” to Bridge the Knowing-Doing Gap

Author Affiliations
  • 1Center for Evidence-based Practice, University of Pennsylvania, Philadelphia
  • 2Department of Medicine, University of Pennsylvania, Philadelphia
  • 3Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia
  • 4University of Pennsylvania Health System, Philadelphia
  • 5Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia

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JAMA Intern Med. 2015;175(3):354-355. doi:10.1001/jamainternmed.2014.5293

Knowing is not enough; we must apply. Willing is not enough;
we must do.


The quote that opens the Institute of Medicine’s 2007 report, The Learning Healthcare System,1 succinctly captures the crux of the knowing-doing gap: the gap that exists between what we know works based on the best available evidence and what we clinically practice. It is this gap that the evolving field of implementation science or knowledge translation seeks to mend. In this issue of JAMA Internal Medicine, Waters and colleagues2 evaluate the effectiveness of financial incentives directed toward clinical outcomes for closing the knowing-doing gap. Specifically, they examine the effect of the October 2008 Centers for Medicare and Medicaid Services (CMS) Nonpayment for Hospital-Acquired Conditions Initiative on the prevention of 4 clinical “never events”: catheter-associated urinary tract infections (CAUTIs), central line–associated bloodstream infections (CLABSIs), falls, and pressure ulcers.

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