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December 2009 (Volume 87)
Adalsteinn D. Brown
Milbank Memorial Fund
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Context: As evidence-based medicine grows in influence and scope, its applicability to health policy prompts two questions: Can the principles and, more specifically, the tools used to bring research into the clinical world apply to civil servants offering advice to politicians? If not, what approach should the evidence-oriented health policy organization take to improve the use of research? Methods: This article reviews evidence-based medicine and models of research use in policy. Then it reports the results of interviews with civil servants in the Ontario Ministry of Health, which recently adopted a stewardship rather than an operational role, incorporating many evidence-oriented strategies. The interviews focused on functional roles for research-based evidence in policy advice. Findings: The clinical context and tools for evidence-based medicine can rarely be generalized to policy. Most current models of research use offer lessons to researchers wishing to apply their work to policy but little help for civil servants wishing to become more evidence oriented. The interviews revealed functional roles for research in setting agendas (noting upcoming issues and screening interest groups’ claims), developing new policies (reducing uncertainty, helping speak truth to power, and preventing repetition and duplication), and monitoring or modifying existing policies (continuously improving programs and creating a culture of inquiry). Each area requires different tools to help filter the push of evidence from researchers and set agendas, to facilitate the urgent pull on relevant research by civil servants developing new policy, and to support ongoing linkage and exchange between civil servants and researchers for monitoring and modifying existing policy. Conclusions: A functional framework for evidence-informed policy advice is useful for distinguishing the activity from evidence-based medicine and “auditing” the balance of efforts across the different functional roles of research in policy.
Author(s): Jonathan Lomas; Adalsteinn D. Brown
Keywords: evidence-based health care; health policy; organizational decision making
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Volume 87, Issue 4 (pages 903–926) DOI: 10.1111/j.1468-0009.2009.00583.x Published in 2009
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