 | | | | | | | | |
 |  |  |  |  | | |||
 |  |  |  |  | | |||
 | | |||||||
 | | | |
 | | ||
 | | ||
 | | ||
 |  | | |
 | | ||
 |  | | |
 | | ||
 | | ||
 | | ||
 | | ||
 | Setup Instructions |
| The
HRSA Border Health Program
United
States Department of Health and Human Services Improving Knowledge Transfer among Health Researchers and Decisionmakers at the Border: An Expert Meeting Meeting
Report On this page:
This meeting was supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Office of Rural Health Policy under contract number GS23F0087S and HHSH250200716118P. Please note that comments and recommendations from the Workgroup Meetings are not officially endorsed by HRSA. Executive SummaryThis expert meeting sought to identify ways to improve the translation and dissemination of border health research produced in the United States so as to maximize its use by decisionmakers in health policy and practice. As part of its work to improve access to health care along the border between the United States and Mexico, the Health Resources and Services Administration (HRSA) seeks to promote the use of evidence-based programs and the best available data and information in planning and providing population-based and personal health care services. In this context, the term “knowledge transfer” refers to range of activities designed to link research to policy and improve the likelihood that policymakers and practitioners will make evidence-informed decisions. While not unique to the border area, the challenges of linking research to policy in this regional are clearly evident. The report of the 2002 Border Health Research Agenda Council Meeting declared that “fragmentation of efforts and lack of communication mechanisms were identified as the two biggest problems affecting binational cooperation for health.”[1] Participants at the HRSA Border Health Summit conducted in August 2006 observed that while the number and variety of research studies continues to grow, it appears that the knowledge created through these investigations rarely gets translated into meaningful messages and disseminated effectively to policymakers, program administrators, and practitioners. “We know better than we do,” was a consistent theme. This invitational meeting brought together representatives from government agencies and foundations that fund research, leading researchers and university officials, health policymakers, program administrators, and health care providers to examine their experience and discuss ways to improve the flow of research-based knowledge among stakeholders at the border. The meeting agenda and participant list are included in Appendices I and II, respectively. 1. Introduction Steven Smith, Senior Advisor to the Administrator, HRSA Mr. Smith spoke about the importance of translating research into practice, as part of HRSA’s broader efforts to reduce health disparities and improve access to health care services. Feedback from the HRSA Border Health Summit in August 2006 revealed that participants were encouraged by the wealth of information presented, but were troubled that the research was rarely translated into better health outcomes. HRSA has had promising success in applying health services research findings to the field of organ donation, where targeted studies about “best practices” contributed to important policy changes that increased the number of successful organ donations. Similarly, Smith said that HRSA hopes to support local leaders along the U.S.-Mexico border in using research to improve the delivery and use of health services.
2. Framework for Assessing Efforts to Link Research to Action Daniel Campion, AcademyHealth The meeting agenda was structured around a framework for assessing knowledge transfer activities that is being used by the World Health Organization (WHO). Developed by John Lavis, Ph.D., of McMaster University and colleagues, the framework is described in a recent WHO Bulletin article that participants received in advance of the meeting, along with a worksheet they could use to reflect upon their own experiences with research transfers along the U.S.-Mexico border.[2] Mr. Campion presented the framework as outlined below.
Challenges in linking research to policy:
By addressing these challenges, researchers, policymakers, and foundations can help ensure that policy decisions are more informed by the evidence. The WHO framework outlines four steps to overcome knowledge transfer barriers:
1) Assessing the general climate for linking research to policy · To what extent do universities and research funders support researchers’ efforts to disseminate their findings and help policymakers understand and apply them?
2) The production of research · Do research funders take policymakers’ needs into account when setting priorities for future research? · Are systematic reviews being conducted, so as to synthesize key research findings in priority areas for policymakers?
3) Knowledge translation and dissemination · “Push” efforts include activities to summarize and deliver research findings to policymakers. Are research producers identifying actionable messages, fine-tuning messages for different user groups, delivering findings through credible channels, and teaching researchers how to communicate their findings? · “User Pull” efforts involve policymakers and health professionals “reaching in” to the research world in order to inform their decisions. How effective are policymakers at acquiring, assessing, and applying research? Do they hire analytic staff, use research findings when making decisions, and participate in skill-development programs to hone their use of data and research? · Efforts to facilitate “User Pull” are activities initiated by research producers to make it easier for policymakers to find and use research. For example, is there an electronic “one-stop shopping” source for optimally packaged high-quality reviews? Are findings actively distributed, such as through media coverage? · Exchange Efforts include meaningful partnerships between researchers and policymakers. Are there policy conferences that discuss recent research findings or learning networks to facilitate on-going exchanges?
4) Approaches to Evaluation · Rigorous evaluations of efforts to link research to action are needed. To what extent are these kinds of studies being funded and are all types of key stakeholders participating in these evaluations?
3. The Production and Use of Health Research along the Border - Jose Manuel De La Rosa, M.D., U.S.-Mexico Border Health Commission Member and Vice Dean, Texas Tech University El Paso School of Medicine. - Howard J. Eng, Dr.PH, Assistant Professor, University of Arizona - Martha Medrano, M.D., M.P.H., Director, Medical Hispanic Center of Excellence, University of Texas Health Science Center at San Antonio - Maria Teresa Cerqueira, M.D., Pan American Health Organization
Dr. Manuel de la Rosa spoke about the factors that determine which research studies impact health policy and practices. He noted that a study’s academic rigor and conclusions, both of which are critical foci for the research community, do not affect policy decisionmakers as much as political climate and packaging techniques. He also stressed that researchers should take an active role in health improvement by engaging in responsible research methodologies. For example, a 1997 Hepatitis A study conducted along the Texas border involved the vaccination of the populations studied. Dr. Manuel de la Rosa concluded that academics must be trained so that they can use their research to help drive policy agendas and improve the health of the communities that they study. The research community should also reach out to the communities studied, to inform them of the value of research and encourage their participation.
Dr. Eng presented the preliminary results of an ongoing survey study, which seeks to address the lack of border health research information. His survey assesses the dominant research areas, types, locations, sources of funding, collaborations, and publication types. From the survey results, Dr. Eng has found that the top 5 research areas reported are Access to Care, Diabetes, Cancer, Maternal and Child Health, and Infectious Diseases. These areas are all funded primarily by the Federal Government. Academic institutional collaboration, both domestic and international, has emerged as a widespread trend. It is also worth noting that, when asked about the border health research needs, 54 percent of respondents indicated increased funding; only 15.4 percent called for higher collaboration and communication efforts. Once the study is completed, Dr. Eng plans to publish the results in a peer review journal and on the Southwest Border Rural Health Research Center Web-site. Following Dr. Eng’s presentation, a few meeting participants offered comments. One suggestion was to explore whether the dominant research areas were determined by community needs or by funding sources. Another was to analyze the survey data by geographical subdivisions, given the widespread differences within the border area. The participants agreed that the term “border health researcher” should be defined – did the study select researchers according to their research focus or according to the location of their home institution? Finally, one participant noted that that the existing Institutional Review Board (IRB) regulations discourage cross-border research collaboration; researchers must obtain separate IRBs from each participating institution in order to conduct cross-border studies.
Dr. Medrano pointed to the importance of research dissemination, using her experience with the U.S. - Mexico Border Center of Excellence Consortium as an example. Having noted the need for increased communication and collaboration within the border health research community, Dr. Medrano oversaw the creation of a database which compiled approximately 453 current research programs and projects on the U.S.- Mexico border. This database has since been incorporated into the Pan American Health Organization Virtual Library. Dr. Medrano feels that online libraries and research databases can act as an intermediary between the researcher and the policy-maker, increasing the overall accessibility of Best Practices and model program designs. Such tools also facilitate knowledge management amongst researchers in the field, allowing for more collaboration and better targeted studies. The Consortium’s Sharing Model Curriculum Guidebook will be distributed during the Consortium’s annual forum in Tucson AZ (August 13 and 14, 2007).
Dr. Cerqueira described how the Pan American Health Organization has sought to facilitate collaboration and the practical application of research. She stated, “it is important that researchers go beyond simply describing a problem and start offering real solutions.” Dr. Cerqueira finds that the practical application of research to policy problems is hampered by research funding silos. She called for platforms to integrate information, so that social, environmental, and agricultural research could inform health studies. She also pointed out that data is collected differently on both sides of the border, which often hinders binational collaboration. Finally, to hasten the incorporation of research into policy, Dr. Cerqueira feels that the border research community should be more proactive and strengthen the sharing of information using online resources such as the border virtual health library that PAHO is supporting. This library is not merely a depository for information, but actively involves and reaches out to inform a variety of different border health stakeholders and to encourage the sharing of research findings. PAHO/WHO is also developing a global network of people and institutions to encourage the use of research to strengthen evidence based policy and practice, known as EVIPNet.
4. Knowledge Transfers from the Perspective of Policymakers Elizabeth Duke, Ph.D., HRSA Administrator
Dr. Duke began by reiterating her personal commitment, and that of the HRSA, to improving health along the U.S.-Mexico Border. She explained that Federal agencies like HRSA view research as a tool to help inform internal decisions, such as the allocation of funds to support research in special focus areas like oral health or diabetes. The information sought could either be an open-ended question, or substantive confirmation of a health trend that is already generally suspected. HRSA uses research for three different ends. First, best practices research informs how HRSA will implement programs and activities mandated by Congress, hopefully minimizing effort duplication. Second, research that documents health trends is critical to justifying the establishment of new programs. For example, HRSA’s anti-bullying campaign would not exist had substantial research not demonstrated the connection between bullying and criminal involvement. Finally, bold research lays the foundation for agenda shifts and changes in governmental policy. Public servants spend much time and energy focused on day-to-day implementation; HRSA’s strategic commitment to research serves as a built-in reevaluation of the Administration’s overall direction and goals. Dr. Duke’s advice to researchers seeking to interact with policy decisionmakers is to pay close attention to information packaging. “There is a bias in the Federal service towards the practical, and an unwillingness to talk about theory or methodology. It is extremely important that researchers learn to talk in an arena other than their own.” She recommended simplifying the vocabulary and reducing the content to its bare necessities. She also noted that Federal Government is a large apparatus that is slow to change; persistence and leadership are critical.
5. Workgroups: Ideas for Improving Knowledge Transfer along the Border
During the second half of the meeting, participants formed small groups to discuss possible approaches to improve research-policy linkages. Because this meeting sought to build on pre-existing work, the prompts for discussion was based on the WHO framework described in section two. These prompts are available in the meeting agenda in Appendix I. Participants were divided into four workgroups, based on the four border health research domains identified during the 2002 Border Health Research Agenda Council Meeting. The four workgroup themes were: (1) Environmental Health, (2) Disease Control and Prevention, (3) Health Services, and (4) Health, Society, and Development. Please refer to Appendix III for the workgroup minutes.
6. Cross-cutting Themes and Opportunities
A number of cross-cutting themes emerged from the workgroup deliberations, as listed below.
7. Possible Next Steps and Concluding Comments
1. Convene representatives from Federal agencies involved with border issues to assess their priorities for health-related research and approaches for research dissemination. Understanding the priorities of Federal agencies would help identify where further research agenda-setting activities (i.e., scoping reviews) and/or research syntheses may be needed. Bringing together lead staff from various Federal agencies may also reveal opportunities to collaborate across agencies, share data, avoid duplication, and use federal resources more efficiently. More clearly articulating Federal priorities in this area may help reduce some of the confusion expressed by several participants at the expert meeting about federal research projects and help other research funders (e.g., states, foundations) target their resources more effectively. Possible Approach: We could utilize the existing inter-agency workgroup as a mechanism for organizing such a conference. Possible participants might include: HRSA, CDC, AHRQ, CMS, EPA, Dept. of Homeland Security, Dept. of Agriculture, Dept. of Labor, and Dept. of Justice.
2. Develop research agendas targeting priority thematic areas, possibly in partnership with other Federal agencies and research funders. Each research agenda would map the literature so as to clarify boundaries and definitions, identify gaps in evidence, and identify areas where systematic reviews of the existing literature may be useful. These research agendas would help research funders identify the most relevant issues to study within priority thematic areas. Possible approach: HRSA would take the lead in identifying priority thematic areas where policymakers need the most help, possibly by asking leading policymakers and HRSA grantees about their most pressing needs over the next few years. This would include Federal agency officials, the U.S.-Mexico Border Health Commission, State border health offices, State offices of rural health, county officials, etc.
3. Provide skill-development programs/resources for users of border research. By participating in skill-development programs, HRSA grantees and other State and local officials would improve their ability to readily access, understand, and use research findings in decision making. Currently, there are no federally-sponsored skill development programs in place for this audience. Possible approach: Provide training sessions at relevant HRSA-sponsored all-grantee meetings, at U.S.-Mexico Border Health Association meetings, and/or as stand-alone workshops. Programs and materials developed for border health audiences could also be used for HRSA’s stakeholders in other parts of the country. Primary audiences would include border health offices, State offices of rural health, CHC/FQHC leaders, and other HRSA grantees. Secondary audiences could include State and local health departments, State legislators and county commissioners on health related committees, and planning agencies.
Meeting Agenda
7:00 – 8:00 Breakfast & Registration
8:00 – 8:30 1. Welcome & Introductions - Steve Smith, Senior Advisor to the Administrator, Health Resources and Services Administration - Marcia K. Brand, Ph.D., Associate Administrator, Office of Rural Health Policy
8:30 – 9:30 2. Knowledge Transfer Framework The core principles of knowledge transfer will be reviewed and discussed. - Daniel Campion, AcademyHealth
9:30 – 9:45 Break
9:45 – 11:15 3. Perspectives on Border Health Research Panelists will offer their perspectives on the production and use of research related to health care along the border from the perspectives of the U.S.-Mexico Border Health Commission, the Border Centers of Excellence Program, the Pan American Health Organization, and a recent survey of researchers. - Jose Manuel De La Rosa, M.D., Regional Dean, Texas Tech University - Martha Medrano, M.D., M.P.H., Director, Medical Hispanic Center of Excellence, University of Texas Health Science Center at San Antonio - Howard J. Eng, Dr.P.H., Assistant Professor, University of Arizona - Maria Teresa Cerqueira, M.D., Pan American Health Organization
11:15 - 11:45 4. Discussion of General Climate for Linking Research to Action - Elizabeth Duke, Ph.D., HRSA Administrator - Daniel Campion, AcademyHealth
11:45 – 12:30 Lunch Break
12:30 – 2:15 5. Towards a Solution: Breakout Sessions by Research Domain Participants will form small groups related to particular research domains to discuss possible approaches for overcoming the barriers identified earlier. The four domains include: 1. Disease control and prevention, 2. Environmental health, 3. Health services delivery and workforce, 4. Health, society and development. Possible discussion questions are: · Who should be the primary target audience for this domain of research? · What kinds of decisions are they confronting where research would be useful? · To what extent are research findings available to address these questions? · What approaches have you found most useful for disseminating research findings to this audience and getting them to use it? · What opportunities exist for improving the exchanges between researchers and decision-makers? · Is there a need for developing a research agenda in this area?
2:15 – 2:30 Break
2:30 – 3:15 6. Pooling the Findings Participants will reconvene and hear summary reports from each small group.
3:15 – 4:15 7. Discussion and Identification of Cross-cutting Themes and Opportunities - Facilitated discussion
4:15 – 4:30 8. Possible Next Steps and Concluding Comments - Marcia K. Brand, Ph.D., Associate Administrator, Office of Rural Health Policy
4:30 Adjourn
Participant List
|