How Can We Synthesize Qualitative and Quantitative Evidence for Healthcare Policy-Makers and Managers

Health Services Research, School of Nursing and Midwifery at the University of Southampton.
Healthcare management forum / Canadian College of Health Service Executives = Forum gestion des soins de santé / Collège canadien des directeurs de services de santé 02/2006; 19(1):27-31. DOI: 10.1016/S0840-4704(10)60079-8
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Interest in synthesizing the findings of qualitative and quantitative evidence is increasing in response to the complex questions being asked by healthcare managers and policy-makers. There is a wealth of evidence available from many sources--both formal research and non-research based (e.g., expert opinion, stakeholder, and user views). Synthesis offers the opportunity to integrate diverse forms of evidence into a whole. We categorize the current approaches to the synthesis of qualitative and quantitative evidence into four broad groups: narrative, qualitative, quantitative, and Bayesian. Many of the methods for synthesis are emergent; some have been used to integrate primary data; few have a long history of application to healthcare. In the healthcare context, synthesis methods are less well developed than methods such as systematic review. Nonetheless, synthesis has the potential to provide knowledge and decision support to healthcare policy-makers and managers.

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Available from: Catherine Pope, Aug 11, 2014
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    • "Features Sources Discussing These Themes 8. Description of several viable options that can address the problem, along with what is known, based on research evidence about each option (including benefits/harms, costs/cost-effectiveness/technical feasibility/budget workability) Achenbaum 1988; Ayuk and Ali Marouani 2007; Baum et al. 2007; Bellew, Bauman, and Brown 2010; Bero and Jadad 1997; Burris et al. 2011; Campbell et al. 2009; Cherney and Head 2010; Colby et al. 2008; Contandriopoulos et al. 2010; Department for Business Innovation and Skills 2010; Elliot and Popay 2000; Gold 2009; Gruen 2005; Hanvoravongchai 2008; Haynes et al. 2011; Kouri 2009; Lavis 2009; Lavis et al. 2005a, 2009e; Lomas 2005; Mays, Pope, and Popay 2005; McCaughey 2010; Mercer et al. 2010; Milstien et al. 2010; Pawson et al. 2005; Pope, Mays, and Popay 2006a; Williams et al. 2009 9. Description of key implementation considerations related to the options Chambers 2011; Dobrow, Goel, and Upshur 2004; Dobrow et al. 2006; Lavis 2009; McCaughey 2010; Oxman et al. 2009a, 2009b; Pawson et al. 2005; Ssengooba et al. 2011; Williams et al. 2009; Williams and Bryan 2007 10. Description of equity considerations as well as the perceived positive or negative impact that options may have on various members of society Adeoye and Bozic 2007; Baum et al. 2007; Hanvoravongchai 2008; Hoffmann et al. 2002; Hyder et al. 2011; Lavis et al. 2009e; Milstien et al. 2010; Rijkom et al. 2000 11. "
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    ABSTRACT: Evidence briefs have emerged as a promising approach to synthesizing the best available research evidence for health system policymakers and stakeholders. An evidence brief may draw on systematic reviews and many other types of policy-relevant information, including local data and studies, to describe a problem, options for addressing it, and key implementation considerations. We conducted a systematic review to examine the ways in which context- and issue-related factors influence the perceived usefulness of evidence briefs among their intended users. We used a critical interpretive synthesis approach to review both empirical and nonempirical literature and to develop a model that explains how context and issues influence policymakers' and stakeholders' views of the utility of evidence briefs prepared for priority policy issues. We used a "compass" question to create a detailed search strategy and conducted electronic searches in CINAHL, EMBASE, HealthSTAR, IPSA, MEDLINE, OAIster (gray literature), ProQuest A&I Theses, ProQuest (Sociological Abstracts, Applied Social Sciences Index and Abstracts, Worldwide Political Science Abstracts, International Bibliography of Social Sciences, PAIS, Political Science), PsychInfo, Web of Science, and WilsonWeb (Social Science Abstracts). Finally, we used a grounded and interpretive analytic approach to synthesize the results. Of the 4,461 papers retrieved, 3,908 were excluded and 553 were assessed for "relevance," with 137 included in the initial sample of papers to be analyzed and an additional 23 purposively sampled to fill conceptual gaps. Several themes emerged: (1) many established types of "evidence" are viewed as useful content in an evidence brief, along with several promising formatting features; (2) contextual factors, particularly the institutions, interests, and values of a given context, can influence views of evidence briefs; (3) whether an issue is polarizing and whether it is salient (or not) and familiar (or not) to actors in the policy arena can influence views of evidence briefs prepared for that issue; (4) influential factors can emerge in several ways (as context driven, issue driven, or a result of issue-context resonance); (5) these factors work through two primary pathways, affecting either the users or the producers of briefs; and (6) these factors influence views of evidence briefs through a variety of mechanisms. Those persons funding and preparing evidence briefs need to consider a variety of context- and issue-related factors when deciding how to make them most useful in policymaking.
    Milbank Quarterly 09/2013; 91(3):604-48. DOI:10.1111/1468-0009.12026 · 3.38 Impact Factor
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    • "The analysis is a systematic narrative synthesis of the literature [12]. The intention is to generate new insights and bring transparency to the topic under investigation [13,14]. This type of review is appropriate for this topic for four reasons. "
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    ABSTRACT: Background Healthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study’s purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards. Methods A multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria. Results The 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or organisational impacts. No study directly examined standards development or other issues associated with their progression. Only one study noted implementation issues, identifying several enablers and barriers. Standards were reported to improve organisational efficiency and staff circumstances. However, the impact on clinical quality was mixed, with both improvements and a lack of measurable effects recorded. Conclusion Standards are ubiquitous within healthcare and are generally considered to be an important means by which to improve clinical practice and organisational performance. However, there is a lack of robust empirical evidence examining the development, writing, implementation and impacts of healthcare accreditation standards.
    BMC Health Services Research 09/2012; 12(1):329. DOI:10.1186/1472-6963-12-329 · 1.71 Impact Factor
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    • "Increasingly, systematic reviews are seen as helpful knowledge support for policymakers and managers [3-6]. Systematic reviews of effects are concise summaries that address sharply defined questions, employing rigorous methods to select credible and relevant information in order to generate summative reports [4,7]. "
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    ABSTRACT: Systematic reviews have the potential to inform decisions made by health policymakers and managers, yet little is known about the impact of interventions to increase the use of systematic reviews by these groups in decision making. We systematically reviewed the evidence on the impact of interventions for seeking, appraising, and applying evidence from systematic reviews in decision making by health policymakers or managers. Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register, Health Technology Assessment Database, and LISA were searched from the earliest date available until April 2010. Two independent reviewers selected studies for inclusion if the intervention intended to increase seeking, appraising, or applying evidence from systematic reviews by a health policymaker or manager. Minimum inclusion criteria were a description of the study population and availability of extractable data. 11,297 titles and abstracts were reviewed, leading to retrieval of 37 full-text articles for assessment; four of these articles met all inclusion criteria. Three articles described one study where five systematic reviews were mailed to public health officials and followed up with surveys at three months and two years. The articles reported from 23% to 63% of respondents declaring they had used systematic reviews in policymaking decisions. One randomised trial indicated that tailored messages combined with access to a registry of systematic reviews had a significant effect on policies made in the area of healthy body weight promotion in health departments. The limited empirical data renders the strength of evidence weak for the effectiveness and the types of interventions that encourage health policymakers and managers to use systematic reviews in decision making.
    Implementation Science 04/2011; 6(1):43. DOI:10.1186/1748-5908-6-43 · 4.12 Impact Factor
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