How to package the evidence for health reform

by Brian Quinn

Over the last few months, every day seems to bring a new journal article or report with the intent of informing the health care debate.  The releases usually are featured in an e-mail alert that breathlessly touts the importance of the new study's findings for discussions on issues like coverage expansion or payment reform.  Most of the research is top-notch and contains key insights that could help policy-makers.

But the volume of journal articles is staggering--RWJF certainly does our part in adding to the noise--and it leads to the all-important question of, does the research have impact?  And is it getting through to the intended audiences?  Much as I'd like to believe that DC policy-makers start every day with a cup of joe with plenty of time to peruse the latest journal offerings (research is part of my job description, and I still find it challenging to keep up), I somehow think that they might welcome any attempt to translate, synthesize, and bundle the latest research findings into more easily digestible bits.  Despite hearing occasional cynicism about how well our government and public policies work, I actually think that most policy-makers would prefer to not have to make health care reform decisions in an evidence-free environment.

This is an important issue for the health services research community to consider.  If we really want to use our research to advance health care policy and practice, we need to spend more time thinking about how to make the findings from our work more relevant and useful to decision-makers.  Concerns about issues of research translation aren't best left to others--they get at the heart of what applied research really is.

These arguments aren't new and the field has started to think harder in recent years about how to make their work more accessible.  The advent of the policy brief--a product sometimes also called an "issue brief" that looks somewhat less frightening than a white paper and is (theoretically) written in more accessible language--has been an important step in this direction.  The best of the policy brief breed are written for a policy audience, rather than a research audience, and put key findings in a concise, easy-to-read format in a way that makes them more helpful to non-technical audiences.

The various attempts to summarize research findings for non-research audiences is an important step in the right direction, but I don't think we should spend too much time patting ourselves on the back.  For one thing, many of the briefs are only shorter versions of longer research papers.  They're no more designed for the policy audience than the original journal articles they come from.  And for another thing, the policy briefs still haven't increased our ability to break through the noise.  If we really want to have an impact on the policy process, we need to move beyond the policy brief and find new modes of research translation.

One of the things the research community could do more of is synthesize, synthesize, synthesize.  This is one of the main pieces of bread and butter of the Institute of Medicine--they issue doorstop-heavy reports that review the weight of the evidence on big, important health policy topics, and those reports tend to be the first and last word on these subjects.  But there are other, equally valid ways to translate and synthesize findings for policy-makers, like RWJF's Synthesis Project, which is designed to give policy-makers reliable insights into complex issues by pulling together all of the research on a hot health care topic into a user-friendly format.  By weighing the merits of studies on a pressing issue, and drawing conclusions about what the research has found, these efforts can help policy-makers who are being inundated with conflicting studies that can resemble a "he said, she said" squabble.  The Synthesis model is by no means the only possibility, but it does provide one example of what the health services research community might consider if we really want our research to have an impact.

Comments

[Mary Jo]

I worked in the field of health care managing a staff of 12 case managers who in turn managed over 2000 medically fragile children for over 8 years. I think we need to look at all the costs associated with healthcare (billing, payment and insurance) and establish standardized coverage, treatment and fee schedules to eliminate some of these costs. This will work for most people (there will always be complex cases that do not fit). Too much of our money is being spent on bad medicine, billing, coding, collecting and negotiating insurance and payment terms with numerous employers. We could have a 2-3 tier system perhaps with just higher decuctibles at each tier (for lower premium costs). Collectively we should be able to bargain for great rates. We need to do the same thing on the malpractice side - establish up front what the compensation would be for an error (similar to workers comp claim settlements). We need to make sure health care dollars are being used to improve health, not to pay attorneys, insurance personnel, billing agencies etc.