Evidence-based medicine - an appropriate tool for evidence-based health policy? A case study from Norway.
Evidence-based medicine - an appropriate tool for evidence-based health policy? A case study from Norway.
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DOI：
10.1186/s12961-016-0088-1
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发表时间：
2016-03-05
影响因子：
4
通讯作者：
Elvbakken KT
中科院分区：
文献类型：
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作者：
Malterud K;Bjelland AK;Elvbakken KT
循证政策（EBP）是一个以循证医学（EBM）原则为模型的概念，广泛应用于不同领域的政策制定。系统评价（SR）与荟萃分析逐渐成为选择的方法来综合研究证据的干预措施和判断的证据质量和强度的建议。批评者认为，研究证据和服务政策之间的关系是薄弱的，EBP的概念依赖于对政策过程的误解。在探讨了循证医学的标准和卫生政策决策的知识要求后，我们提出了一个实证的出发点来讨论循证医学和EBP之间的关系。在一个案例研究中，探索挪威知识中心的卫生服务（NOKC），一个独立的政府单位，我们首先搜索有关的背景和发展的NOKC的信息，以建立一个研究背景。然后，我们确定，选择和组织的官方NOKC出版物作为一个典型的顶级的线知识交付的实证样本，坚持循证医学标准。最后，我们探讨了这类出版物中的结论，特别是它们作为政策决策工具的潜力。从NOKC在2004-2013年期间发表的151份SR的总样本中，2012年的一个有目的的子样本（14份出版物）建议对他们的结论持谨慎态度，因为基础文件的质量或相关性。虽然案例研究没有包括对采用和政策后果的系统调查，但发现员工代表不适合作为卫生政策决策的通用工具。案例研究表明，循证医学并不一定适合于为每一种政策决策提供知识。我们的分析提出了一个问题，即以证据为基础的运动，在这里由一个独立的政府组织代表，是否使用似乎过于局限的策略进行了过于广泛的委托。保健政策的制定应基于相关和透明的知识，并适当考虑到干预的背景。然而，我们并不认为政策过程的复杂性和混乱性与循证管理的标准是一致的。
Evidence-based policy (EBP), a concept modelled on the principles of evidence-based medicine (EBM), is widely used in different areas of policymaking. Systematic reviews (SRs) with meta-analyses gradually became the methods of choice for synthesizing research evidence about interventions and judgements about quality of evidence and strength of recommendations. Critics have argued that the relation between research evidence and service policies is weak, and that the notion of EBP rests on a misunderstanding of policy processes. Having explored EBM standards and knowledge requirements for health policy decision-making, we present an empirical point of departure for discussing the relationship between EBM and EBP. In a case study exploring the Norwegian Knowledge Centre for the Health Services (NOKC), an independent government unit, we first searched for information about the background and development of the NOKC to establish a research context. We then identified, selected and organized official NOKC publications as an empirical sample of typical top-of-the-line knowledge delivery adhering to EBM standards. Finally, we explored conclusions in this type of publication, specifically addressing their potential as policy decision tools. From a total sample of 151 SRs published by the NOKC in the period 2004–2013, a purposive subsample from 2012 (14 publications) advised major caution about their conclusions because of the quality or relevance of the underlying documentation. Although the case study did not include a systematic investigation of uptake and policy consequences, SRs were found to be inappropriate as universal tools for health policy decision-making. The case study demonstrates that EBM is not necessarily suited to knowledge provision for every kind of policy decision-making. Our analysis raises the question of whether the evidence-based movement, represented here by an independent government organization, undertakes too broad a range of commissions using strategies that seem too confined. Policymaking in healthcare should be based on relevant and transparent knowledge, taking due account of the context of the intervention. However, we do not share the belief that the complex and messy nature of policy processes in general is compatible with the standards of EBM.