Andrew Coburn, Ph.D Muskie School of Public Service University of Southern Maine

1. 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 MeetingBethesda, MDSeptember 16, 2009

2. How Can We Expand The Use Of Health Services Research In State Health Policy? One perspective……. “….Researchers Are From Mars; Policy Makers Are From Venus” P. Feldman et al. (2001) Gerontologist 41:312-321 UNIVERSITY OF SOUTHERN MAINE Muskie School of Public Service

3. 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 UNIVERSITY OF SOUTHERN MAINE Muskie School of Public Service

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

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

6. 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. UNIVERSITY OF SOUTHERN MAINE Muskie School of Public Service

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

8. 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. UNIVERSITY OF SOUTHERN MAINE Muskie School of Public Service

9. 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. UNIVERSITY OF SOUTHERN MAINE Muskie School of Public Service

10. 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 basedpolicy and practice in public services (2000) UNIVERSITY OF SOUTHERN MAINE Muskie School of Public Service

11. 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? UNIVERSITY OF SOUTHERN MAINE Muskie School of Public Service