NUR 550 Week 1 Discussion Question
NUR 550 Week 1 Discussion Question
NUR 550 Week 1 Discussion Question
DQ1 Define how translational research plays a role in influencing policy? Provide an example of a local health care policy that has been recently enacted and or is awaiting legislative passage that has been influenced by research.
DQ2 Using the GCU Library (notably the GCU Library: Nursing and Health Sciences Research Guide), find a database, journal, or other collection of resources that focuses on translational research. Select a population health problem or issue of interest from the available studies. What type of translational research is used for the study? Provide rationale as to why this is the best type of translational research is best for the study, and explain why translational research is the most appropriate approach for this problem or population.
NUR 550 Week 1 Discussion Translation Research and Population Health Management
Facilitating the translation of basic and clinical research into clinical practice and improved population health has become a major goal of the health‐related research enterprise. The original emphasis on supporting “bench to bedside” translation has been expanded to include facilitating applications of basic and clinical research into practice settings and into broader community environments. 1
In this essay, we emphasize the additional, critical role of public policy in achieving the overall goal of improving the health of individuals and populations by the more effective and efficient application of new knowledge. We suggest that the importance of this effort applies across the full spectrum of research from basic to clinical research, from controlled clinical trials to practice settings, and from clinical practice settings to efforts in the broader community. Although the role of policy has been sporadically included in the translation process, we suggest that its importance mandates greater attention and emphasis.
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Why Is Public Policy Relevant to Researchers?
Public policies can be impacted by basic and clinical research findings, and research can be impacted by public policy. Informing public policy is a critical and powerful way of improving the health of individuals and of populations. Lawrence Brown, 2 among others, has identified several ways in which research can impact health‐related policy making. These include accurately and objectively documenting the existence, quantifying the extent, and demonstrating the correlates of a problem; analyzing the problem to identify what interventions work and which do not, and identifying undesired and unintended consequences of policy decisions; suggesting or prescribing options to address the problem; and, perhaps most importantly, raising the quality of the debate about health issues to include scholarly evidence as well as anecdotes and biases. 3
The net effect is the promotion of “evidence‐based policy making” 4 as a direct analogy to evidence‐based clinical practice. In one survey, 5 almost 90% of policy makers and their staff valued researchers’ thoughts on the policy implications of their work. Numerous examples of the meaningful translation of basic, clinical, and health services research into public policy may be cited as indications of the potential of this approach. These include adding measures of the use of angiotensin converting enzyme inhibitors for treating heart failure in pay‐for‐performance physician payment reform models and implementing state mandates for human papilloma virus (HPV) vaccination.
The need for this input will continue to grow at the state and federal levels as new discoveries from translational efforts introduce new challenges to policy and regulation. Policy debates will follow advances in, for example, pharmacogenomics and individualized medicine, 6 as well as around efforts to expand access to new and established treatments for, for example, asthma and obesity to improve population health. 1
On the other hand, public policy can have substantial impacts on the research enterprise. The most direct impact is on financial support from public sources. The level of support is influenced by the general value that policy makers place on research as well as by political forces related to specific topics and proposals. 7 Other effects relate to specific areas of research. Recent examples include governmental limits on politically sensitive topics such as stem cell research, on applying results of clinical effectiveness research to health care financing, and on other issues opposed by powerful advocacy groups. 8 , 9
New policy initiatives can also spur major areas of research, as Medicare and Medicaid programs did for the growth of health systems research and health economics, 2 while political controversies can steer investigators away from some topics. 10 Finally, political forces can use or misuse research results to support policy decisions in unintended or inappropriate ways. 3 , 11 Thus, there is much at stake for all parties.
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The Role of Academia
Academic institutions can have a major role in influencing public policy. They have much to gain from public support of research and they have the expertise to promote evidence‐based policy making. They also have the advantage of being generally viewed as well‐informed, objective advisors or “honest brokers,” without a vested interest in the outcomes of a debate as do most other knowledge sources in a political environment. 12
Despite the potential values of the linkage between research and the policy making process, research is uncommonly used in making policy decisions. As summarized by Brown, 2 “… it must be a very good and rare day indeed when policymakers take their cues mainly from scientific knowledge about the state of the world they hope to change or protect.” The breadth and depth of the gap has been demonstrated by, for example, Soumerai and associates 13 in an analysis of the scant use of research data in state Medicaid policy making. Jonathan Lomas 14 likened the disconnect between research and policy making to the “sound of one hand clapping.”
This disconnect results from factors within universities as well as differences between the “two communities” of researchers and public policy makers. Within many academic health centers, the translation of basic and clinical research into policy has been constrained by the limited value placed on policy analysis and research. It often does not result in the same valued outputs as other forms of scholarship, that is, fewer manuscripts in traditionally accepted journals, fewer grants from established sources, etc., that impact promotion and tenure decisions. 15 Also, and substantially as a result of the first constraint, faculties commonly do not have the needed skills and knowledge of policy content, the political context in which policies are made, and approaches needed to effectively inform policy makers.
Differences between the goals, needs, and cultures of academia and public policy are also major obstacles to the meaningful use of research in policy making. 14 , 16 Policy makers function in a complex environment in which decisions are based on many factors including political and pragmatic pressures, competing priorities, prior commitments to stakeholders, ideologies, values, and economics in addition to the best objective evidence. Policy makers require straight‐forward, practical, and “actionable” results that focus on a specific issue within a short time frame and tthat consider contextual factors such as local relevance, cost, and political acceptability, and they may be forced to act even if the evidence is poor. Researchers, on the other hand, seek to study an intellectually challenging problem thoroughly and examine the complexity of issues without preset time frames to provide rigorous results and creative new approaches to solving problems that withstand the critique of peers. Research findings are commonly not easily accessed by policy makers and, when available, are suffused with technical jargon, statistical estimations, and cautions rather than the clear conclusions and specific recommendations needed by policy makers.
The net effect has been described by Lomas 17 as “finger pointing,” as policy makers argue that researchers produce an irrelevant and poorly communicated product that is “often the wrong size, needs some assembly, is on back order, and comes in last year’s fashion line.” Researchers, in turn, complain that policy makers act on political expediency to produce irrational decisions.
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