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Improving use of research in state health policy development
States are essential players in disseminating evidence-based practices and policies that can lead to better health care for their citizens. Health system improvement could be accelerated if there were stronger communications channels between researchers and policy-makers at the state level. That's the conclusion of Health Management Associates' Jack Meyer and Tanya Alteras, who have developed a conceptual framework supporting effective use of health services research in state health policy-making.
In work supported by The Commonwealth Fund, Mr. Meyer and Ms. Alteras lay out a four-stage research and policy-making framework involving 1) understanding the scope and extent of the problem; 2) developing options; 3) implementing a program or policy; and 4) evaluating the program or policy.
The authors note that while health services research can be used to inform policy-makers about pressing issues; provide them with data and resources needed to develop new programs or reform existing ones; guide the implementation process; and evaluate programs or policies to determine whether they are meeting their goals, putting new and innovative research to work in the policy-making process requires tenacity and understanding on the part of both researchers and policy-makers.
"Effective partnerships between researchers and policy-makers are grounded in sustainable relationships and mutual trust," the authors say. "In a perfect world, research and policy-making would go hand-in-hand. Yet, in practice, communication between researchers and policy-makers frequently does not occur. Some policy-makers are busy with immediate problems and may not be well acquainted with researchers. And some researchers are focused more on academic studies and may be removed from the policy process. While there is no formula to guide communication and knowledge transfer between health services researchers and policy-makers, certain steps can help to ensure an effective, symbiotic relationship between the research and policy-making worlds."
Here's how Mr. Meyer and Ms. Alteras explain the steps in their conceptual framework.
1. Understanding the scope and extent of the problem. At the information-gathering stage, they say, state policy-makers frequently will use existing research to better understand an issue or problem. If a state agency has an existing relationship with a research institution or a research division within the agency, officials will most likely look there first for help.
Before a crisis hits, the authors say, policy-makers should be building and maintaining relationships with researchers to be better informed on relevant key policy issues. Each staff person should have a portfolio of key issues to track and monitor and should identify researchers who are experts in those fields.
Researchers, they say, should develop relationships with the administrative and legislative staff responsible for their issues. "This is the stage where influencing the policy process begins," they say. "Build your audience before you need it." They also recommend that researchers identify issues that are most important to policy-makers in their state and develop strategies for helping them address those issues.
2. Developing options. When developing policy options, according to Mr. Meyer and Ms. Alteras, the relationship between policy-makers and researchers and the exchange of information typically becomes more formal. State policy and program staff frequently commission research to determine the effects of various policy options on target populations, program costs, and costs or savings that the policy may have on other state agencies and programs.
As they develop policy options, policy-makers should remain open-minded, the authors say, allowing the research findings to guide decision making. Policy-makers should recognize there often are limitations to the data that researchers have available to them, and that this may diminish their ability to address certain policy options.
For their part, researchers need to recognize that databases may be limited, particularly when it comes to identifying gaps in services, programs, and unmet needs. They should become familiar with proxy data sets for studying salient state issues as so-called ideal state data may not always be available. Researchers need to be flexible about finding useful data and developing workable research models and should be ready and willing to modify policy options in response to stakeholder feedback.
3. Implementing a policy. While the second stage involved modeling potential outcomes, this stage involves the trial and error of testing policy options and determining their robustness under a wide variety of real world circumstances.
Policy-makers at this stage need to be aware that researchers need to have a different set of skills for the implementation stage than for the policy options development stage. Generally, according to Mr. Meyer and Ms. Alteras, researcher involvement at the implementation stage is limited. A government agency typically takes over, often with consultant assistance. Still, researchers can help analyze the potential effects of choices made during implementation.
Researchers need to recognize the unique set of skills needed for the implementation stage. Since trial and error are the norm, with midcourse corrections to programs and policies as needed, researchers can prove useful by explaining early results as they occur.
4. Evaluating the program/policy. For this stage of the framework, researchers must have open lines of communication with the state to access the qualitative and quantitative data necessary for a comprehensive and accurate evaluation. The authors say the role of program evaluator often is filled by an institution, such as a university department or think tank, with which the state has an ongoing relationship or perhaps even a standing contract for specific projects. One of the challenges at this stage, the authors say, is to get the evaluation findings on the radar of state officials, ensuring that program administrators and state legislators pay attention to the results, absorb them, and use them. A second challenge involves situations in which interim findings reflect positively on a program, but final data on outcomes or impact do not. Another challenge relates to the appropriateness of a research team or facility engaging in the evaluation process if they have been intimately involved in the program planning.
Policy-makers, the authors say, should avoid the perception of bias by seeking an outside, nonpartisan research team to evaluate a program. A comprehensive evaluation plan should be built into perspective legislation, including collection of baseline data before program implementation. Policy-makers should commit to an ongoing assessment of the program to promote a culture of continuous quality improvement. And they should communicate clearly how they want evaluation findings to be packaged and presented to ensure that findings are understandable and meaningful to the target audience.
Mr. Meyer tells State Health Watch that one of the barriers to better communication and working relationships between policy-makers and researchers is that a number of researchers fail to package their findings highlights in ways that policy-makers can easily understand and use them. "Researchers too often come up with 300 pages of solid and interesting material," he says. "No matter how interesting it is, it's hard for a very busy policy-maker to make use of it. I'm not suggesting that researchers cut corners. But they need to remember to summarize, highlight, extract key findings, and make policy recommendations."
Policy-makers, Mr. Meyer tells SHW, need to be better at cultivating relationships with researchers and not just call for help with an emergency that has a 24-hour deadline. "Take the time to get to know people and have some reciprocal obligations," he says.
According to Mr. Meyer, his four-step framework need not be followed in order, recognizing that some researchers won't want to do all four stages.
The report can be downloaded at www.cmwf.org/publications/publications_show.htm?doc_id=437168. Contact Mr. Meyer at email@example.com or telephone (202) 785-3669.