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Commentary |

Practice-Based Research—“Blue Highways” on the NIH Roadmap

John M. Westfall, MD, MPH; James Mold, MD, MPH; Lyle Fagnan, MD
JAMA. 2007;297(4):403-406. doi:10.1001/jama.297.4.403.
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US Route 34 drops out of the Rockies like so many spring-fed creeks. Passing through the front-range sprawl of bedroom communities and suburbs, it narrows to 2 lanes and begins its trek across the Great Plains. In its heyday it was a bustling highway with countless travelers on their way to vacation in the cool Colorado Mountains. Now it lies still, a “blue highway,” heat rising in waves off the pavement, dotted with small, dusty farming communities. A brochure for a nearby town boasts, “Just an hour from I-70.”

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Figure. “Blue Highways” on the NIH Roadmap
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The current National Institutes of Health (NIH) Roadmap for Medical Research includes 2 major research laboratories (bench and bedside) and 2 translational steps (T1 and T2). Historically, moving new medical discoveries into clinical practice (T2) has been haphazard, occurring largely through continuing medical education programs, pharmaceutical detailing, and guideline development. Proposed expansion of the NIH Roadmap (blue) includes an additional research laboratory (Practice-based Research) and translational step (T3) to improve incorporation of research discoveries into day-to-day clinical care. The research roadmap is a continuum, with overlap between sites of research and translational steps. The figure includes examples of the types of research common in each research laboratory and translational step. This map is not exhaustive; other important types of research that might be included are community-based participatory research, public health research, and health policy analysis.

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