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A Framework for Conceptualizing Evidence Needs of Health Systems
Research White Paper
Investigators: Karen Schoelles, MD, SM, Craig A Umscheid, MD, MSCE, Jennifer S Lin, MD, MCR, Thomas W Concannon, PhD, MA, Andrea C Skelly, PhD, MPH, Meera Viswanathan, PhD, Christine Chang, MD, MPH, Elizabeth Kato, MD, MRP, Eric Bass, MD, MPH, Julia Lavenberg, PhD, RN, Kim Peterson, MS, Amanda Newton, PhD, RN, Evan Meyers, MD, MPH, Stacey Springs, PhD, Vivian Christensen, PhD, Nicole Floyd, MPH, Celia Fiordalisi, MS, Jeanne-Marie Guise, MD, MPH, and M Hassan Murad, MD, MPH.
Author Information and AffiliationsStructured Abstract
Objectives:
To develop a framework for understanding the evidence needs of health systems to inform the AHRQ EPC Program future efforts.
Data sources:
Three data sources were used: (a) peer-reviewed literature from a systematic search of English-language publications in MEDLINE from January 2007–April 2017, (b) original data from four programs serving health system requests for evidence syntheses, and (c) input during a face-to-face meeting at AHRQ in June 2017 from health system stakeholders and EPC investigators.
Methods:
Data were synthesized narratively and thematically. We developed an initial framework to guide discussion and qualitative analysis. We built consensus around themes and refinement of the framework through weekly phone conferences, electronic communications, and a face-to-face meeting of workgroup members and health systems experts.
Results:
From the literature review, we found that health systems seek evidence to inform decisions about acquiring new or emerging medical technologies; implementation or expansion of service offerings; and selection of governance, finance or delivery system models. Studies emphasize a preference for rapidly completed, succinct and easily understood evidence syntheses with layered information presentations. Studies of tools for promoting health system use of evidence describe methods for clarifying how the evidence applies to the local and operational context and how evidence intersects with other considerations in decisionmaking. Data from the four evidence synthesis programs illustrate a breadth of questions addressed and report types used by health systems. Discussions with health system experts highlighted the importance of trustworthiness of the process for synthesizing published literature; trustworthiness of the evidence itself; mechanisms for integrating internally generated data with evidence from published literature; and evaluation, feedback and updating mechanisms facilitated by transforming the published literature into machine executable knowledge for use by decisionmakers.
Conclusions:
We identified several domains to facilitate interaction between health systems and evidence synthesis producers. Successful engagement will require specifying the type of decision or question of the health system; type of evidence synthesis to best address the question(s) of interest; tools to promote the use of evidence; and a feedback or auditing mechanism to determine the impact of evidence integration into health system decisions. Both the trustworthiness of the evidence synthesis process and communication of the trustworthiness of the evidence are additional key domains. Partnerships with health systems are critical for understanding their evidence needs and establishing trust.
Contents
Suggested citation:
Schoelles K, Umscheid CA, Lin JS, Concannon TW, Skelly AC, Viswanathan M, Chang C, Kato E, Bass E, Lavenberg J, Peterson K, Newton A, Meyers E, Springs S, Christensen V, Floyd N, Fiordalisi C, Guise JM, Murad MH. A Framework for Conceptualizing Evidence Needs of Health Systems. Research White Paper. (Prepared by Scientific Resource Center, under Contract No. 290-2012-0004-C). AHRQ Publication No. 18-EHC004-EF. Rockville, MD: Agency for Healthcare Research and Quality; December 2017. Posted final reports are located on the Effective Health Care Program search page. https://doi.org/10.23970/AHRQEPCWHITEPAPER3.
This report is based on research conducted by the Agency for Healthcare Research and Quality (AHRQ) Evidence-based Practice Centers’ Methods Workgroup. The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.
This research was funded through contracts from the Agency for Healthcare Research and Quality to the following Evidence-based Practice Centers: ECRI Institute-Penn Medicine (290-2015-00005-I); Kaiser Permanente Center for Health Research (290-2015-00007-I); RAND (290- 2015-00010-I); RTI (290-2015-00011-I ); Pacific Northwest (290-2015-00009-I); The Johns Hopkins University (290-2015-00006-I); University of Alberta (290-2015-00001-I); Duke University (290-2015-00004-I); Brown University (290-2015-00002-I) and Mayo Clinic (290-2015-00013-I).
The information in this report is intended to help EPCs and AHRQ understand health-systems need and use of evidence to inform their decisionmaking. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.
AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.
Persons using assistive technology may not be able to fully access information in this report. For assistance contact vog.shh.qrha@cpe.
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