Conducting effectiveness studies in the context of evidence-based clinicalpractice

I propose that effectiveness studies might be conducted in an infrastructur e consisting of groups of evidence-based practitioners. Clinicians using ev idence-based approacher to clinical work have well-developed systems for co llecting outcome data that are fully integrated into routine clinical pract ice, a mode of work that ir ideally suited to effectiveness studies. A form al, National Institutes of Health-funded structure might be developed to su pport clinical practice infrastructures to host or conduct effectiveness st udies, These clinical practice infrastructures would speed the disseminatio n of evidence-based methods of clinical practice. Clinical practice infrast ructures would also enhance clinicians' ability to make contributions to re search. In particular, evidence-based practitioners use empirically-based m ethods of hypothesis testing and session-by-session outcome monitoring that are not well represented in many of the protocols that are evaluated in ra ndomized controlled trials.