Collaboration Between Researchers and State Policymakers: Models for Achieving Evidence-Informed Policy Andrew Coburn, Ph.D Muskie School of Public Service University of Southern Maine AHRQ Annual Meeting Bethesda, MD September 16, 2009

“….Researchers Are From Mars; Policy Makers Are From Venus” P. Feldman et al. (2001) Gerontologist 41: One perspective……. Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE How Can We Expand The Use Of Health Services Research In State Health Policy?

Evidence-Informed Decision Making The systematic application of the best available evidence to the evaluation of options and to decision-making in clinical, management, and policy settings.* * Canadian Health Services Research Foundation. (2001) Health Services Research and Evidence-Based Decision-Making. Ottawa Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE

Policy Design Policy Implementation Identify problems Review evidence and solution options Assess stakeholder interests and concerns Assess risks and costs to implementation Prospects for successful outcomes Track Implementation Evaluation against objectives Disseminate best practices Assess policy effectiveness Assess lessons learned Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE The Key Stages of EIDM

Defining questions and hypotheses Knowledge summary/synthesis Casual model based on theory Analysis and evaluation of findings Communication of results Dissemination/knowledge transfer Re-assessment of Question/problem Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE Key Stages in the Research Process

Models for Linking Research to Policy Decision Making “Researcher-Push”: Dissemination, translation, KT, research synthesis, “User-Pull”: Commissioned research, rapid response units, data and trends analysis, research synthesis “Researcher-User Exchange”: research-policy networks, informal policy-researcher exchange, “embedded” researcher “Organizational Excellence”: organizational strategy using multiple, integrated approaches to linking and using evidence. Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE

Source: J. Lomas Improving Research Dissemination and Uptake in the Health Sector: Beyond the Sound of One Hand Clapping, 1997 Factors Influencing the Policy Process

The Use of Evidence in Policy Decision Making The Use of Evidence in Policy Decision Making Emphasis has been on promoting greater access to research through dissemination and knowledge transfer. Follows tendency to view research and policy as products versus processes. Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE

The Use of Evidence in Policy Decision Making The Use of Evidence in Policy Decision Making Instrumental versus conceptual uses of evidence: tendency is to focus on how evidence influences specific decisions, underplaying the role of evidence in influencing general knowledge, thinking, and culture. Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE

What Facilitates Research Use In Policy Decision-making? Benefits of using evidence are understood; Users are partners in generating evidence; Evidence is relevant, timely, and methodologically uncontested; Results support political ideologies, are convenient and uncontentious; Results have high degree of certainty (error and risk), are robust in implementation, and involve low costs. Davies, Nutley, Smith, What Works? Evidence based policy and practice in public services (2000) Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE

Final Thoughts State capacity for EIDM is limited: how can we accelerate move to “rapid learning” in Medicaid and other state health policy? Importance of using multiple strategies Can we demonstrate results? Muskie School of Public Service UNIVERSITY OF SOUTHERN MAINE