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  • 标题:Improving Utility of Evidence Synthesis for Healthy Public Policy: the Three Rs (Relevance, Rigor, and Readability [and Resources])
  • 本地全文:下载
  • 作者:Hilary Thomson
  • 期刊名称:American journal of public health
  • 印刷版ISSN:0090-0036
  • 出版年度:2013
  • 卷号:103
  • 期号:8
  • 页码:e17-e23
  • DOI:10.2105/AJPH.2013.301400
  • 语种:English
  • 出版社:American Public Health Association
  • 摘要:Systematic reviews have the potential to promote knowledge exchange between researchers and decision-makers. Review planning requires engagement with evidence users to ensure preparation of relevant reviews, and well-conducted reviews should provide accessible and reliable synthesis to support decision-making. Yet, systematic reviews are not routinely referred to by decision-makers, and innovative approaches to improve the utility of reviews is needed. Evidence synthesis for healthy public policy is typically complex and methodologically challenging. Although not lessening the value of reviews, these challenges can be overwhelming and threaten their utility. Using the interrelated principles of relevance, rigor, and readability, and in light of available resources, this article considers how utility of evidence synthesis for healthy public policy might be improved. Systematic reviews can provide invaluable support to decision-making by providing readily prepared syntheses of quality-appraised evidence. Many research funders regard evidence synthesis as a mechanism for knowledge exchange. 1 However, there are conflicting reports from decision-makers about the use and value of evidence syntheses. 2,3 To improve the utility of systematic reviews, Lavis et al. 3 have called for more innovation in the preparation of systematic reviews. Specifically, they highlight the need for improved relevance and accessibility of reviews, while maintaining rigor that is the underpinning value of a systematic approach. Evidence synthesis for healthy public policy is typically complex and methodologically difficult, presenting challenges to the preparation of reviews that are relevant, rigorous, and readable (or accessible). Although policy relevant, the questions are often broad and imply inclusion of diverse data types and sources that can be difficult to synthesize. 4,5 Consequently, rigorous reviews of broad complex policy relevant questions are costly and can take a long time, sometimes years, to complete. 6–8 Complexity does not diminish the importance of the review questions, but decision-makers need evidence that is timely as well as relevant. 9,10 Regardless of how rigorous and comprehensive a review is, syntheses that are not timely may no longer be relevant once completed. 11 Moreover, long delays in dissemination of syntheses may perpetuate avoidable harm. 12 The nature of available evidence may also present challenges to the rigor and readability of complex reviews. Statistical synthesis is rarely appropriate, the resulting narrative syntheses are often lengthy, and the link between the synthesis and the conclusions can be opaque. In addition, the dearth of well-conducted studies assessing the health impacts of public policies, such as housing investment, welfare changes, etc., will often restrict the review findings to establishing uncertainty and may question the utility of such reviews. 13 This article describes the specific challenges of complex reviews, and what they can contribute to policymaking. The principles of relevance, rigor, and readability are presented, along with examples of how these principles can be incorporated into complex reviews for healthy public policy to help improve their utility. Finally, the value for money of long complex reviews is considered. Justification for, as well as ways and implications of, limiting a review are described.
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