ideasIdea
A fixed share of trial-group funding for getting proven care to patients
Many people never receive treatments already proven to work. Cooperative trial groups would have to spend a tenth of their budget testing how to close that gap.
Public trial networks (the NCTN groups, EORTC, UK NIHR portfolio) would be required to allocate at least 10% of funding to implementation trials: cluster-randomised or stepped-wedge studies of how to raise guideline-concordant care, genomic testing rates, timely referral, geriatric assessment and survivorship follow-up. These trials are cheap per patient, use routine data and address a gap that observational studies put at tens of thousands of avoidable deaths a year in high-income countries alone.
Hypothesis
Trial networks that spend 10% on implementation trials increase guideline-concordant care for at least two measurable indicators (for example biomarker testing before first-line therapy, adjuvant therapy completion) by 10 percentage points in participating regions within four years.
Rationale
Implementation science has a track record in cardiovascular medicine (statin and blood-pressure programmes) and in HIV; in oncology, the gap between proven and delivered care is well documented but seldom the object of a funded trial because no drug sponsor benefits.
What would test it
One network runs the quota for a full funding cycle and compares indicator improvement and cost per additional patient correctly treated with a matched network that does not.
Maturity
speculative
Who has to act
policy
Cost to try
Medium ($1M to $50M)
Years to first evidence
4
Bottlenecks it attacks
- Funding follows fashion, not burden · Money goes to the cancers and questions that are easy or popular, not the ones that kill most or where a dollar would do most.
- Fragmented care and guideline gaps · Patients fall between specialists, wait for referrals and often do not get the treatment guidelines say they should.