影响卫生技术评估研究成果决策转化因素的作用机制研究

目的 :系统分析影响我国卫生技术评估研究成果向决策转化因素的作用机制。方法 :从研究者与决策者相结合的角度,运用扎根理论构建影响卫生技术评估研究成果决策转化因素的作用机制理论模型,并运用结构方程模型对上述理论模型进行验证。结果 :通过扎根理论与结构方程模型的验证与进一步修正,发现研究与决策方的机构因素以及个人因素通过双方的沟通交流因素对成果转化情况产生影响,其效应值分别为0.30和0.23;双方沟通交流因素作为中介变量对研究成果转化产生影响,其效应值高达0.78;研究与决策需求因素对成果转化情况产生直接影响,其效应值为0.12。结论 :研究方与决策方的交流对于决策转化的成效起到重要的作用,因此,在加强相关培训、促进卫生技术评估研究人员与决策人员对于循证决策认知的同时,促进双方的沟通交流显得尤为重要。     

我国卫生技术评估与决策转化研究概述

卫生技术评估在国际上已经得到广泛应用,并成为各国卫生决策的重要组成部分,发挥着越来越重要的作用。本文通过描述卫生技术的相关利益方,回顾卫生技术评估及转化的国际经验及潜在的影响因素,在结合我国卫生技术评估政策转化实际情况的基础上,提出了卫生技术评估知识转化程度测量、政策决策方和卫生技术评估研究方影响知识转化的因素挖掘以及转化程度测量等研究设想。     

研究者视角的中国卫生技术评估决策转化现状分析

目的 从研究人员视角描述中国卫生技术评估相关研究向决策转化的现状,并分析其中可能存在的影响因素,为促进我国卫生技术评估向决策转化提供建议.方法 采用问卷调查法和文献检索法,在全国范围内调查研究人员,收集研究人员对我国卫生技术评估现状、研究结果的政策转化和利用情况等观点.结果 研究共调查了382名研究人员.调查结果显示.尽管研究人员充分认可研究成果向政策转化的必要性,并且在进行选题时已经对决策转化有所考量,但多数卫生技术评估研究仍停滞在学术阶段,多数研究人员仅提交报告并在学术期刊上发表文章,仍缺乏决策转化的实际行动.此外,部分研究者未能获得充足的研究经费和时间,研究机构对卫生技术评估研究所给予的支持仍显不足,这些也是影响卫生技术评估向决策转化的重要原因.结论 有必要建立卫生技术评估研究必要的规范,以统一并提高研究质量,为决策转化打下坚实的基础：并完善卫生技术评估的研究系统,以保障研究经费、高素质的研究人员、多样化的研究成果传播渠道.     

卫生技术评估决策转化的影响因素

目的:从研究者视角,描述我国卫生技术评估决策转化现状,挖掘卫生技术评估决策转化过程中的影响因素,为加强卫生技术评估决策转化利用提出建议。方法:采用问卷调查的方法收集数据,并运用logistic回归模型对卫生技术评估决策转化过程中的影响因素进行分析,探寻各变量和决策转化之间的关系。结果:共回收问卷382份,其中,有效回收353份,有效回收率92.4%。统计结果发现研究的政策相关性、研究人员对于转化的信心、研究人员与卫生技术使用部门的沟通情况、研究人员与决策部门对课题目标设定的沟通情况以及课题成果的传播和沟通对卫生技术评估决策转化有重要影响。结论:建议鼓励研究人员在今后研究成果的转化利用中发挥积极能动性,重视研究人员和技术使用部门的沟通,加强研究与政策需求之间的相关度,加强研究和决策双方的沟通以及合作重视知识中介的作用。     

我国开展医院卫生技术评估的路径与策略

随着我国卫生医疗领域改革的不断深入和新版《医疗技术临床应用管理办法》的实施,医院在卫生技术准入和管理中的作用逐渐加强,对以医院卫生技术评估为代表的循证支持决策的需求也在增加。本文基于对我国开展医院卫生技术评估试点医院评估项目问题和经验的总结,并结合国际上典型国家的理论基础和实践经验,探索提出我国医院卫生技术评估的发展路径:一是技术路径,包括评估的技术类型、评估流程和评估结果等,并从五个维度提出了我国开展医院卫生技术评估需要重点关注的十个因素;二是治理路径,即如何引入和引导利益相关方以独立的方式参与评估。我国开展医院卫生技术评估试点项目和理论研究的发展目标是尽快探索出符合我国国情的医院卫生技术评估方法、流程及相关制度,发展策略是加强国家指导和与全国医院绩效考核工作相结合以强化认知共识;与医疗联合体建设相结合推进决策转化应用;注重在医院内部通过成果实施、传播和升华培养评估文化;加强卫生技术评估决策转化监管与评估。     

英国NICE卫生技术评估研究决策转化机制及对我国的启示

英国国家卫生与服务优化研究院(NICE)被认为是利用卫生技术评估研究结果促进卫生循证决策的典范,在应对新医疗技术带来的过快卫生费用增长方面发挥了重要作用,其证据开发过程和研究成果向政策的转化过程同样也成为世界各国纷纷效仿的重要方面。本文介绍了NICE在英国卫生服务体系中的法定定位、开展卫生技术评估的类别、过程和政策转化机制,以期为促进国内卫生技术评估研究成果在循证卫生政策制定中的应用提供借鉴。     

中国卫生技术评估决策转化现状及影响因素的定性研究

目的本研究旨在通过对中国卫生技术评估决策转化现状的定性研究,探索中国卫生技术评估决策转化的影响因素,为卫生技术评估在中国卫生政策制定中发挥更大的作用提供建议。方法通过关键知情人访谈收集信息,对收集到的定性资料进行主体框架法分析。结果定性分析帮助梳理了卫生技术相关决策部门的决策证据来源、决策者参与研究的主要方式、决策者需要的证据产出形式、决策者对卫生技术评估的认知、卫生技术评估与政策的融合程度和转化程度,共梳理了9个卫生技术评估决策转化的影响因素。结论中国卫生技术评估决策转化目前尚处于初级阶段,应注意对决策     

我国卫生技术评估决策转化现状及影响因素的定性研究

目的探讨我国卫生技术评估研究人员对卫生技术评估决策转化现状和影响因素的看法,为加强我国卫生技术评估决策转化提供参考。方法运用关键知情人访谈法,对从事卫生技术评估研究的相关人员进行访谈。共访谈22名从事卫生技术评估研究的相关人员。结果访谈对象普遍认可决策转化,并在选取课题时考虑决策需要,采用多种方式与决策者进行沟通,从而促进研究结果转化。但多数被访者对决策程序缺乏了解,所在的研究机构也缺乏决策转化相关培训和激励措施。选题缺乏主动性,仍沿用传统传播方式,缺乏转化的主动性和创新性,总体研究质量不高。决策转化的影响因素包括研究人员选题的重要性、紧迫性和可行性,其所处的研究机构类型,对政策制定的了解程度,与决策者沟通的畅通程度,研究结果的产出方式,在语言转换方面所做的努力以及研究质量、决策环境等。结论目前,我国卫生技术评估决策转化尚处于起步阶段,研究人员需加强与决策人员的沟通,建立传播推广机制,加强对决策程序的了解,增强语言转换等。     

基本医疗保险循证决策体系构建：卫生技术评估的作用

卫生技术评估是一种基于当前最优证据支持卫生技术决策的评估方法,国际上已广泛应用于医疗保险政策制定过程,如医保支付范围和目录确定、支付价格形成等,并在优化卫生资源配置、控制医疗费用合理增长等方面发挥了重要作用。本文从价值追求、决策转化、证据提供等方面探讨卫生技术评估在促进我国基本医疗保险高质量发展中的作用,认为医保决策中建立卫生技术评估决策转化机制面临着医保改革深化的现实需求和医疗大数据快速发展等机遇,同时也面临着缺乏有效的HTA组织管理路径和决策转化机制,以及价值取舍等挑战。最后,从认知准备、决策转化和实施传播等方面提出卫生技术评估应用于我国基本医疗保险决策转化体系的构建策略。     

卫生技术评估研究结果产出方式的偏好分析

目的 比较研究人员和决策人员对卫生技术评估研究结果产出方式的偏好程度的差异,为扩大卫生技术评估研究的决策使用提供依据.方法 采用问卷调查的方法,收集研究人员和决策人员对不同卫生技术评估研究结果产出方式的评价,运用统计描述的方法,对偏好差异进行描述分析.结果 研究人员和决策人员对卫生技术评估研究结果的产出方式偏好有所差异;在不同行政单位、不同行政级别以及不同教育程度的决策者之间,对产出方式的偏好也存在不同;而不同职称、不同教育程度的研究者,所偏好的成果产出方式则较为一致.结论 进一步强化研究方与决策方之间的沟通交流,根据不同决策人员的需求采取合适的产出方式,加强机构对卫生技术评估结果决策转化的支持,逐步完善激励机制,并强化卫生技术评估结果向广大社会公众的传播.     

Maximizing the impact of systematic reviews in health care decision making: a systematic scoping review of knowledge-translation resources

Context: Barriers to the use of systematic reviews by policymakers may be overcome by resources that adapt and present the findings in formats more directly tailored to their needs. We performed a systematic scoping review to identify such knowledge‐translation resources and evaluations of them. Methods: Resources were eligible for inclusion in this study if they were based exclusively or primarily on systematic reviews and were aimed at health care policymakers at the national or local level. Resources were identified by screening the websites of health technology assessment agencies and systematic review producers, supplemented by an email survey. Electronic databases and proceedings of the Cochrane Colloquium and HTA International were searched as well for published and unpublished evaluations of knowledge‐translation resources. Resources were classified as summaries, overviews, or policy briefs using a previously published classification. Findings: Twenty knowledge‐translation resources were identified, of which eleven were classified as summaries, six as overviews, and three as policy briefs. Resources added value to systematic reviews by, for example, evaluating their methodological quality or assessing the reliability of their conclusions or their generalizability to particular settings. The literature search found four published evaluation studies of knowledge‐translation resources, and the screening of abstracts and contact with authors found three more unpublished studies. The majority of studies reported on the perceived usefulness of the service, although there were some examples of review‐based resources being used to assist actual decision making. Conclusions: Systematic review producers provide a variety of resources to help policymakers, of which focused summaries are the most common. More evaluations of these resources are required to ensure users’ needs are being met, to demonstrate their impact, and to justify their funding.     

Promotion of evidence-informed health policymaking in Nigeria: bridging the gap between researchers and policymakers

In Nigeria, the lack of adequate understanding of the complex nature of translating research into policy and the incompatibility existing between researchers and policymakers constitute a great challenge to evidence-informed policymaking. To address these challenges a one-day evidence-to-policy training workshop was organised for policymakers, researchers and other major stakeholders in the health sector in southeastern Nigeria. Of the 104 individuals invited to the workshop 87 (83.6%) attended. The workshop training sessions focused on capacity development for evidence-informed health policy-making and building effective linkages/partnerships. The post-workshop assessment indicated significant improvements in participants' knowledge, their understanding of the health policymaking process and the use of evidence compared to their pre-workshop status. Using a focus group discussion, major strategies identified by participants that can bridge the gap between health policymakers and researchers included: involving both parties in planning and execution of health research and health programmes; promoting dialogue between researchers and policymakers; institutionalising research grants and commissioning research in health ministries; and ensuring that researchers are made to focus on the core needs of policymakers. There is need for further discussion and debate on the researchers and policymakers partnership concept in low income settings.     

决策者视角的中国卫生技术评估决策转化情况分析

目的 从决策者的角度来研究中国卫生技术评估在决策中的转化和利用情况,探索其中可能存在的影响决策转化的因素,为促进卫生技术评估决策转化提供参考.方法 采用问卷调查法对国家和地方层面的卫生政策决策人员利用卫生技术评估研究结果情况进行调查,并进行描述性分析.结果 调查共回收有效问卷112份.结果显示,决策人员对卫生技术评估能够一定程度上参考借鉴,或进行决策采纳,但在促进行动方面有所欠缺.决策部门内部相关培训、资助方面尚十分有限.但决策者对未来卫生技术评估在决策中能够起到的作用给予了很高的信心.决策者重视研究的时效性和语言的通俗易懂程度,因此与研究方也会较多地交流报告提交的方式,他们更倾向于收到报告的概述.结论 卫生技术评估决策转化程度和水平有待提升,决策部门对卫生技术评估的资助力度有待加大,将卫生技术评估引入决策过程的相关机制有待构建.     

A societal outcomes map for health research and policy

The linkages between decisions about health research and policy and actual health outcomes may be extraordinarily difficult to specify. We performed a pilot application of a "road mapping" and technology assessment technique to perinatal health to illustrate how this technique can clarify the relations between available options and improved health outcomes. We used a combination of data-mining techniques and qualitative analyses to set up the underlying structure of a societal health outcomes road map. Societal health outcomes road mapping may be a useful tool for enhancing the ability of the public health community, policymakers, and other stakeholders, such as research administrators, to understand health research and policy options.     

Galvanizers, guides, champions, and shields: the many ways that policymakers use public health researchers

Context: Public health researchers make a limited but important contribution to policy development. Some engage with policy directly through committees, advisory boards, advocacy coalitions, ministerial briefings, intervention design consultation, and research partnerships with government, as well as by championing research‐informed policy in the media. Nevertheless, the research utilization literature has paid little attention to these diverse roles and the ways that policymakers use them. This article describes how policymakers use researchers in policymaking and examines how these activities relate to models of research utilization. It also explores the extent to which policymakers’ accounts of using researchers concur with the experiences of “policy‐engaged” public health researchers. Methods: We conducted semi‐structured interviews with thirty‐two Australian civil servants, parliamentary ministers, and ministerial advisers identified as “research‐engaged” by public health researchers. We used structured and inductive coding to generate categories that we then compared with some of the major research utilization models. Findings: Policymakers were sophisticated and multifaceted users of researchers for purposes that we describe as Galvanizing Ideas, Clarification and Advice, Persuasion, and Defense. These categories overlapped but did not wholly fit with research utilization models. Despite the negative connotation, “being used” was reported as reciprocal and uncompromising, although researchers and policymakers were likely to categorize these uses differently. Policymakers countered views expressed by some researchers. That is, they sought robust dialogue and creative thinking rather than compliance, and they valued expert opinion when research was insufficient for decision making. The technical/political character of policy development shaped the ways in which researchers were used. Conclusions: Elucidating the diverse roles that public health researchers play in policymaking, and the multiple ways that policymakers use these roles, provides researchers and policymakers with a framework for negotiating and reflecting on activities that may advance the public health goals shared by both.