Policy Change Department of Veterans Affairs Health Services Research & Development Service Lynn McQueen, DrPH, MS, RN Evidence-Based Practice: Policy Change June, 2002

Overview Policy and evidence-based practice Implications and context What are we doing? Similarities in cross-national approaches & methods Differences in cross-national approaches & methods Is it working? Overall gaps and shared priorities Towards an international agenda Action steps & Challenge for this meeting

Evidence-Base Practice Within A Policy Context The implications of using a policy perspective Historical influences Current trends Key definitions and concepts Policy implementation across systems Evaluation and impact measurement Feedback, use, evolution Shared priorities, goals, and resources

What are we doing? Is it working? How do we collectively learn from each other so that we can: Advance individually? Evolve the collective state of science? Tackle the tough issues at increasingly complex levels? Know if it’s working? Build momentum?

Similarities Goals Local National International Approaches, Methods, & Measures Who is doing what? How do we find out? Where are the intersections? How do we fill gaps together? Roles Mechanisms

Differences Goals Historical Social & political Economics Professional Overall incentives Approaches, Methods, & Measures Resources Output Use Interpretation Feedback Overall incentives

A Powerful Intersection ! Shared Challenges Shared Priorities

Towards An International Agenda Agreement on Basics Action Steps Dealing With Complexity & Differences Starting Points Challenges For This Meeting

Agreeing On Basics? Output Feedback mechanisms Communication Definitions Concepts Models Approaches Methods Measures Output Feedback mechanisms Communication

Agreeing On Goals? Adding To Translation Science Findings of common interests E.g. the effectiveness of reminders Processes of common interest E.g. reminder effectiveness is influenced by how many are implemented

“Evidence-Based Quality Improvement” (EBQI) is systematized so that... Agreeing on ideas and concepts? “Evidence-Based Quality Improvement” (EBQI) is systematized so that... Providing the right care at the right time to the right patient becomes routine

Agreeing on Output? What Type? What Format? Diabetes: Efforts to increase provider awareness of diabetes treatment priorities were associated with changes in medical care that will substantially reduce both cardiovascular events and deaths. Over the next five years, this will result in about 4,000 fewer heart attacks and strokes and will prevent about 3,000 deaths.

Agreeing On Evolution Of Evidence-Based Tools? Development, use, improvement of decision aids Feed back to decision-makers in useful formats, when needed Use what we have now but pushing the boundaries Ever-increasing interpretation and ability to deal with complexity & uncertainty

Agreeing On An International Model That Supports Integration Expand overall policy advancement through integration of the shared needs at the intersection of: Evidence-based quality improvement (EBQI) Research

International Policy Change Research Shared Goals, Resources, Output IMPACT Findings, Impact Feedback/ Improved Care Clinical QI

Action Through Relationships & Communication Around An International Need Demonstrating What Is Possible Through… Actively engaging key target audiences Finding common incentives Building formal & informal networks Developing an international action plan

Summary: Policy Improvement In Evidence-Based Health Policy and evidence-based practice Within Context More similarities than differences Similarities in cross-national approaches & methods Differences in cross-national approaches & methods Much to learn from each other Overall gaps and shared priorities Agreement needed on key issues Develop a model and action plan together during this meeting