EXCELLENCE BASED ON EVIDENCE: What works and evidence informed practice
Knowledge transfer, and evidence informed health policy-minster's meeting
-
Upload
ghaiath-hussein -
Category
Health & Medicine
-
view
273 -
download
0
Transcript of Knowledge transfer, and evidence informed health policy-minster's meeting
Knowledge Transfer, and Evidence-Informed Health PolicyUndersecretary Meeting, Feb. 26, 2009
Ghaiath M.A. HusseinMBBS, MHSc. (Bioethics)
Research DirectorateFederal Ministry of Health
Acknowledgement
•Many the slides used in this presentation are used with permission from presentations by:
•Dr. Fadi El-Jardali (AUB)•Dr. Abdul Ghaffar (RPC Advisor,
WHO/EMRO)•Dr. Noha Dashash (PHC Directorate,
Jeddah, KSA)
Outline of the presentation
•Background•The ‘Knowledge Cycle’•The Knowledge Transfer•Evidence-Based Healthcare•Where are we?•What we need to do?•Conclusion and Discussion
خريطة توضح حجم دول العالم من حيث اإلنفاق على البحوث والتنمية وأكثر واقل عشر دول إنفاقا على البحوث في العالم )بالدوالر لكل مواطن www.worldmapper.orgلكل عام(. المصدر:
من مليون لكل المنشورة العلمية المقاالت عدد يوضح وجدول المنشورة، العلمية المقاالت عدد حيث من العالم دول حجم توضح خريطةلعام www.worldmapper.orgالمصدر: م. 2001السكان
The ‘Classical’ Knowledge Cycle
Researchers
Policy makers
What is KT?
•…a process by which relevant research information is made available and accessible for practice, planning, and policy-making through interactive engagement with audiences.
•Other terms include: research transfer, knowledge exchange, knowledge translation, knowledge mobilization, research uptake, research/knowledge utilization, and dissemination. Although these terms are similar and are sometimes used interchangeably
What’s Evidence-Based Healthcare?
8
Evidence-based healthcare (EBH) is the integration of best research evidence with clinical/policy expertise and patient/population values.
Why do we need to be evidence-based?•Lack of resources: we need to be sure
this is the best way to spend them -Cost-containment
•Quality improvement: Are we providing the best service?
•Accountability (for political leadership and served population)
Components of EBM/H
10
EBHC
EBHC
Individual Clinical /PolicyExpertise
Best External Evidence
Patient/Population’s Values & Expectations Modified from
Huneborg, 2000
Steps of evidence based medicine
•1)Ask a question•2)Acquire relevant articles•3)Appraise the evidence•4)Apply the findings•5)Assess our performance
What is worse than having no evidenceis to have bad evidence!
Hierarchy of Evidence
Systematic Reviews and Meta-analysis
Randomized controlled trials with definitive results
RCTs with non-definitive results
Cohort studies
Case Control studies
Cross-sectional surveys
Case reports / opinions
13
Evidence Pyramid
14
Potential contribution of evidence to policy• Exposure to a wider range of validated policy
options• Evaluation of the success and failure of previous
policies• Ability to identify relationships between
seemingly• independent factors (e.g.. Health care reform
and health outcomes)• Capacity to legitimize some policies while
casting doubt on others (Hanney et al, 2003)• Promote evidence based management practices
Science Decision-Making
Where am I?
You’re 30 metres
above the ground in a balloon
You must be a
researcher
Yes. How did you
know?
Because what you told me is absolutely correct but completely
useless
You must be a
policy maker
Yes, how did you
know?Because you don’t know
where you are, you don’t know where you’re
going, and now you’re blaming
me
The problem
17/30
A research institution is a "knowledge" factoryInput: information
Output: information
Processing
Knowledge
The policy and execution grinding mill
Information
Policy and communication
Processing
Knowledge
Analyses of threats and
benefits Impact
Testing Evaluation
Many “Leaks” from research & practice
Aware Accept Target Doable Recall Agree Done
ValidResearch
If 80% achieved at each stage then0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 x 0.8 = 0.21
Need a ‘new look’?
“In the world of research, completing the study is just the first step…making the research come alive and using it to build capacity for future science and scientists and to tell stories that capture policy-maker’s attention and ultimately lead to policy changes, are what it is all about”
(O’Brien-Pallas, 2003)
Research
• Generation of new knowledge• Synthesis of available information• Sharing good practices• Translation of knowledge (for
improved policy and management decisions)
Diagnosis, treatment• Trained health
workers• Clinical diagnostics• Treatment/medicines• Hospital services• Information
Health promotion, disease prevention
• Information• Products• Services
Access to
• Health products and services• Information• Conditions to gain/maintain good
health
environment
work social conditions
economic conditions
Biomedical researchHealth policy and systems
researchSocial sciences and
behavioural researchOperational
research
Basic research:physical and biological
sciences, includingchemistry, pharmacology,
toxicology, genetics, etc.
Research onpolicy formulation, relationship
to evidence,prioritization, etc.
Research and development for
medicines, vaccines, diagnostics, appliances,
etc.
Research onhealth systems management,
functions, efficiency, effectiveness, system factors
affecting access,scale-up, monitoring and
evaluation, etc.
Research onsocial and behavioral
factors influencing health and their relation
to equity, access, lifestyle and health-seeking behaviours,
etc.
Research onfactors affecting functioning of programmes,
effectiveness of targeting, impact
on behaviour, disease burdens
and public health,
etc.
Understanding the biological nature of diseasesCreating products to prevent or treat disease states
Understanding how to test, scale-up and follow through on the introduction of interventions to optimise their benefits
Impact24
The spectrum of research for development
25
Types of research
Potential stakeholders
Basic Clinical Health services
Population health
Patients +++ +++ Professionals +++ +++
Local administration + +++ +++ National policy-
makers +++ +++ +++
Regulatory bodies +++ +++ ++ ++ Industry +++ +++ ++ +
Research funders +++ +++ +++ +++ Researchers +++ +++ +++ +++
Source: Institute of Health Economics, Alberta, Canada, 2008.
Stakeholders for different types of research
Researchers and Policy-makers: From mutual understanding to mutual work
Matter of Fact!
•“There is nothing a government hates more than to be well informed; for it makes the process of arriving at decisions much more complicated and difficult”
John Maynard Keynes
Another Set of Facts!
•A substantial knowledge base exists, albeit under-utilized, to improve the health of populations
•Research is biased in favour of biomedical sciences and public health interventions with significant (disease-based) implications
•Researchers and policy-makers are two different groups with different backgrounds, different incentives and with different roles and responsibilities
Researchers and Policy makers are twoseparate communities?
“Researchers search for truth by using a rational model…policy makers search for a compromise, by using an intuitive model”
Choi et al (2005)
Feature distinguishing (academic) research and policy-makers
Researchers Policy-makers
Overall goal To advance science To improve the performance of health systems
Specific objectives
Tenure track positions Publications
To gain popular and political support
Output Detailed reports, based on science Press release s
Desired outcome Respect of peers
Perception more important than what happens in reality
Time factor Some studies can take years Demand results in the short term
Accountable to
Peers and editors of medical journals
Cabinet and constituents
How to Bridge the gaps?
Science Decision-MakingKnowledge
Brokers
Reza Majdzadeh
What we do now as Research Directorate?
Train, Review, curricula
SeminarsWebsiteDatabase
Steps Forward• Update the research priorities collectively• Develop a Knowledge Transfer & Evidence
Synthesis Unit• Establish a Decision Support Unit• Develop and activate the Policy Forum• Policy makers need to be able to:• Identify situations where research can help• Articulate research questions for topics of
policy relevant research; and• Access evidence and incorporate them in
decision making
Key Messages
•Policy makers need to be research-oriented
•Researchers should be action-oriented•Each partner need to understand and
cope with other partners•Always remember that our common and
ultimate goal as researchers & policy makers if the health of our people!