How hard can it be to include research evidence and evaluation in local health policy implementation? Results from a mixed methods study

Implementation Science

Myfanwy Davies²  Helen Howson³  Helen Snooks¹  Bridie Angela Evans¹ 

[1]CHIRAL, ILS2, College of Medicine, Swansea University, Swansea, SA2 8PP, UK

[2]School of Social Science, Bangor University, Bangor, UK

[3]Medical Directorate, Welsh Government, Cardiff, Swansea, UK

关键词: Health service delivery;    Chronic conditions management;    Research and evaluation;    Evidence-based policy;    Health policy implementation;   

Others  :  813806
DOI  :  10.1186/1748-5908-8-17

 received in 2012-05-21, accepted in 2013-01-31,  发布年份 2013

【 摘 要 】

Background

Although an evidence-based approach is the ideal model for planning and delivering healthcare, barriers exist to using research evidence to implement and evaluate service change. This paper aims to inform policy implementation and evaluation by understanding the role of research evidence at the local level through implementation of a national chronic conditions management policy.

Methods

We conducted a national email survey of health service commissioners at the most devolved level of decision-making in Wales (Local Health Boards – LHBs) followed by in-depth interviews with representatives of LHBs, purposively selecting five to reflect geographic and economic characteristics. Survey data were analysed descriptively; we used thematic analysis for interview data.

Results

All LHBs (n = 22) completed questionnaires. All reported they routinely assessed the research literature before implementing interventions, but free-text answers revealed wide variation in approach. Most commonly reported information sources included personal contacts, needs assessments, information or research databases. No consistent approach to evaluation was reported. Frequently reported challenges were: insufficient staff capacity (17/22); limited skills, cost, limited time, competing priorities (16/22); availability and quality of routine data (15/22). Respondents reported they would value central guidance on evaluation.

Five interviews were held with managers from the five LHBs contacted. Service delivery decisions were informed by Welsh Government initiatives and priorities, budgets, perceived good practice, personal knowledge, and local needs, but did not include formal research evidence, they reported. Decision making was a collaborative process including clinical staff, patient representatives, and partner organization managers with varying levels of research experience. Robust evaluation data were required, but they were constrained by a lack of skills, time, and resources. They viewed evaluation as a means of demonstrating that targets had been met.

Conclusions

There is a gap between evidence-based aims of national health policy and how health services are commissioned, implemented, and evaluated at local level. Commissioners and managers are unable to routinely incorporate research evidence. If health services research is to identify most effective ways to implement high quality care, it should be incorporated into commissioning and service delivery. Local commissioners and managers need to build the critical use of research evidence and evaluation into health policy implementation at local level in order to provide consistent and effective healthcare services.

【 授权许可】

   
2013 Evans et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Ham C, Hunter DJ, Robinson R: Evidence based policymaking. Br Med J 1995, 310:71-72.
• [2]Bjorndal A: Improving social policy and practice: knowledge matters. Lancet 2009, 373:1829-1831.
• [3]Sibbald B, Walshe K: Research that is both rigorous and useful. J Health Serv Res Policy 2010, 15(Suppl 2):1-2.
• [4]Muir Gray JA: Evidence based policy making. Br Med J 2004, 329:988-989.
• [5]Black N: Evidence-based policy: proceed with care. Br Med J 2001, 323:275-278.
• [6]Donald A: Commentary: research must be taken seriously. Br Med J 2001, 323:278-279.
• [7]Cooksey DA: A review of UK heath research funding. HMSO: London; 2006.
• [8]Innvaer S, et al.: Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy 2002, 7(4):239-244.
• [9]Eccles MP, et al.: An implementation research agenda. Implement Sci 2009., 4(18)
• [10]Majeed FA, et al.: Equity in the NHS. Monitoring and promoting equity in primary and secondary care. Br Med J 1994, 308(6941):1426-9.
• [11]Merino GA, Lema LV, et al.: Health technology assessment and health policy-making in Europe. Edited by Garrido VM. World Health Organisation on behalf of the European Observatory on Health Systems and Policies; 2008.
• [12]Hamilton S, et al.: Mind the gap between policy imperatives and service provision: a qualitative study of the process of respiratory service development in England and Wales. BMC Heal Serv Res 2008., 8(248)
• [13]Glasby J, Beresford P: Who knows best? Evidence-based practice and the service user contribution. Critical Social Policy 2006, 26:268-284.
• [14]Petticrew M, Roberts H: Evidence, hierarchies and typologies: horses for courses. JECH 2003, 57(7):527-529.
• [15]Sheldon TA: Making evidence synthesis more useful for management and policy-making. J Health Serv Res Policy 2005, 10(Suppl):S1:1-S1:4.
• [16]MacFarlane A, et al.: The e-health implementation toolkit: qualitative evaluation across four European countries. Implement Sci 2011., 6(122)
• [17]El-Jardali F, et al.: Use of health systems and policy research in the health policymaking in eastern Mediterranean countries: views and practices of researchers. Implement Sci 2012., 7(2)
• [18]Pearce C, Hall S, Phillips C: When policy meets the personal: general practice nurses in australia. J Health Serv Res Policy 2010, 15(Suppl 2):26-34.
• [19]Forsetlund L, Bjorndal A: The potential for research-based information in public health: identifying unrecognised information needs. BMC Publ Health 2001., 1
• [20]Ross S, et al.: Partnership experiences: involving decision-makers in the research process. J Health Serv Res Policy 2003, 8(Suppl 2):p. S2:26-34.
• [21]Lourenco T, et al.: Local decision-makers views' of national guidance on interventional procedures in the UK. J Health Serv Res Policy 2010, 15:3-10.
• [22]Muir Gray JA, Porter T: Opportunity value. J Health Serv Res Policy 2009, 14(3):p 129-130.
• [23]Klein R: Evidence and policy: interpreting the delphin oracle. J Royal Soc Med 2003, 96:429-431.
• [24]World Health Organisation: Global health risks: mortality and burden of disease attributable to selected major risks. Geneva: World Health Organisation; 2009.
• [25]Welsh Assembly Government: A profile of long-term and chronic conditions in Wales. Cardiff: Welsh Assembly Government; 2006.
• [26]Welsh Assembly Government: Improving health and the management of chronic conditions in Wales: an integrated model and framework for action. Cardiff: Welsh Assembly Government; 2007.
• [27]Welsh Assembly Government: Designed to improve health and the management of chronic conditions in Wales: service improvement plan 2008–2011. Cardiff: Welsh Assembly Government; 2008.
• [28]HSR-Europe: Health service research: helping tackle Europe's health care challenges. Utrecht: HSR-Europe; 2011.
• [29]Robson C: Real world research. Oxford: Blackwell; 1993.
• [30]Bryman A: Social research methods. Oxford, UK: OUP; 2001.
• [31]Silverman D: Doing qualitative research. 3rd edition. London, UK: Sage Publications Ltd; 2010.
• [32]Ritchie J, Spencer L: Qualitative data analysis for applied policy research. In The qualitative researcher's companion. Edited by Huberman AM. Thousand Oaks, California: Sage Publications; 2002.
• [33]Srivastava A, Thomson SB: Framework analysis: a qualitative methodology for applied policy research. JOAAG 2009, 4(2):72-79.
• [34]Arney FM, et al.: Integrating strategies for delivering evidence-informed practice. Evidence & Policy 2009, 5(2):179-191.
• [35]Bayliss HR, et al.: Does research information meet the needs of stakeholders? exploring evidence selection in the global management of invasive species. Evidence & Policy 2012, 8(1):37-56.
• [36]Meyer M: The rise of the knowledge broker. Sci Commun 2010, 32:118-127.
• [37]Macintyre S, et al.: Using evidence to inform health policy: case study. Br Med J 2001, 322:222-5.
• [38]Ward V, et al.: Planning for knowledge translation: a researcher's guide. Evidence & Policy 2010, 6(4):527-541.
• [39]Gough D, Boaz A: Complexities of making use of research. Evidence & Policy 2011, 7(3):247-249.
• [40]Lomas J: Using ‘linkage and Exchange’ to move research into policy at a Canadian foundation. Health Aff 2000, 19(3):p 236-240.
• [41]Lavis JN, et al.: How Can research organizations more effectively transfer research knowledge to decision makers? The Millbank Quarterly 2003, 81(2):221-248.
• [42]Moore G, et al.: What works to increase the use of research in population health policy and programmes: a review. Evidence & Policy 2011, 7(3):277-305.
• [43]Gold M: Pathways to the use of health services research in policy. Health Serv Res Policy 2009, 44(4):1111-1136.
• [44]Greenhalgh T: Chronic illness: beyond the expert patient. Br Med J 2009, 338:629-631.
• [45]McDonnell A, Wilson R, Goodacre S: Evaluating and implementing new services British medical journal 332, 109–112. Br Med J 2006, 332:109-112.
• [46]Appleby J, et al.: Variations in healthcare: the good, the bad and the inexplicable. Kings Fund: London; 2011.
• [47]Porter A, et al.: Equity and service innovation: the implementation of a bibliotherapy scheme in Wales. J Health Serv Res Policy 2008, 13(Suppl 2):26-31.
• [48]Richards DA, et al.: Delivering stepped care: an analysis of implementation in routine practice. Implement Sci 2012., 7(3)
• [49]Agency for healthcare research and quality. http://archive.ahrq.gov/about/whatis.htm webcite