Advertisement

Grading Evidence to Support Legislative and Budget Proposals—Veterans Health Administration’s Key to Implementing the Evidence Act

  • Author Footnotes
    ∗ Melissa M. Garrido and Elsa Pearson Sites are co-first authors.
    Melissa M. Garrido
    Correspondence
    Correspondence: Melissa Garrido, PhD, Partnered Evidence-Based Policy Resource Center, Boston VA Healthcare System, 150 S. Huntington St, Boston, MA 02130, USA.
    Footnotes
    ∗ Melissa M. Garrido and Elsa Pearson Sites are co-first authors.
    Affiliations
    Partnered Evidence-Based Policy Resource Center, Boston VA Healthcare System, Boston, MA, USA

    Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Melissa M. Garrido and Elsa Pearson Sites are co-first authors.
    Elsa Pearson Sites
    Footnotes
    ∗ Melissa M. Garrido and Elsa Pearson Sites are co-first authors.
    Affiliations
    Partnered Evidence-Based Policy Resource Center, Boston VA Healthcare System, Boston, MA, USA
    Search for articles by this author
  • Cecille Joan Avila
    Affiliations
    Partnered Evidence-Based Policy Resource Center, Boston VA Healthcare System, Boston, MA, USA

    Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
    Search for articles by this author
  • Steven D. Pizer
    Affiliations
    Partnered Evidence-Based Policy Resource Center, Boston VA Healthcare System, Boston, MA, USA

    Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
    Search for articles by this author
  • Author Footnotes
    ∗ Melissa M. Garrido and Elsa Pearson Sites are co-first authors.
Published:November 01, 2022DOI:https://doi.org/10.1016/j.jval.2022.10.007

      Highlights

      • The Veterans Health Administration’s experience with evidence-based medicine made it well positioned to strengthen the link between evidence and budget and policy decisions, in compliance with the Foundations for Evidence-Based Policymaking Act of 2018.
      • We describe the development, refinement, and use of a checklist to assess the strength of evidence included in Veterans Health Administration legislative and budget proposals.

      Abstract

      Objectives

      The Foundations for Evidence-Based Policymaking Act of 2018 requires cabinet-level agencies to use evidence to justify and support budget and policy making. As investigators from the Quality Enhancement Research Initiative (QUERI) program, we were tasked with assisting Veterans Health Administration (VHA) leadership with the implementation of the Evidence-Based Policymaking Act of 2018. Through meetings with stakeholders, we identified a gap in the review process for legislative and budget proposals; no systematic process existed to evaluate the supporting evidence base for proposals.

      Methods

      Here, we describe the development, refinement, and use of a checklist to assess the strength of evidence included in VHA legislative and budget proposals for changes to care delivery; clinical, research, and administrative operations; and staffing and workforce issues.

      Results

      The evidence assessment checklist is now part of the regular review process for VHA legislative and budget proposals. It is also being adapted for use elsewhere within the Department of Veterans Affairs. The checklist has provided a framework for briefings and training on best practices for using evidence to guide policy and budget decisions.

      Conclusion

      Including evidence reviews in the legislative and budget proposal prioritization process may be an effective institutional arrangement to promote the use of evidence to inform high-level health policy decisions and to build a “culture of evidence” within the government.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Value in Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. The promise of evidence-based policymaking: report of the Commission on Evidence-Based Policymaking. Commission on Evidence-Based Policymaking.
      2. Memorandum on restoring trust in government through scientific integrity and evidence-based policymaking. THE WHITE HOUSE.
      3. Foundations for Evidence-based Policymaking Act of 2018. Congress.Gov.
        • Kilbourne A.M.
        • Braganza M.
        • Bowersox N.W.
        • et al.
        Research lifecycle to increase the substantial real-world impact of research: accelerating innovations to application.
        Med Care. 2019; 57: S206-S212
        • Global Commission on Evidence to Address Societal Challenges
        The Evidence Commission Report: A Wake-Up Call and Path Forward for Decision-Makers, Evidence Intermediaries, and Impact-Oriented Evidence Producers.
        McMaster Health Forum, Hamilton2022
        • Lavis J.N.
        • Ross S.E.
        • Hurley J.E.
        • et al.
        Examining the role of health services research in public policymaking.
        Milbank Q. 2002; 80: 125-154
        • Hahn R.
        Building upon foundations for evidence-based policy.
        Science. 2019; 364: 534-535
        • Lavis J.N.
        • Oxman A.D.
        • Lewin S.
        • Fretheim A.
        SUPPORT Tools for evidence-informed health Policymaking (STP).
        Health Res Policy Syst. 2009; 7: I1
        • Heckels N.
        Engaging with UK government areas of research interest: learning and insights from the Universities Policy Engagement Network. Universities Policy Engagement Network.
        • Boaz A.
        • Oliver K.
        • Cuccato G.
        • Dashwood C.
        Rebuilding a resilient Britain: data and evaluation areas of research interest across government. Assets Publishing Service.
      4. Memorandum M-13-17 - Next steps in the evidence and innovation agenda. Office of Management and Budget.
      5. Evidence works: cases where evidence meaningfully informed policy. Bipartisan Policy Center.
        • Gluckman P.
        Briefing note: the New Zealand science advisory system. OFFICE OF THE PRIME MINISTER’S CHIEF SCIENCE ADVISOR.
        • Lavis J.
        How can we support the use of systematic reviews in policymaking?.
        PLoS Med. 2009; 6e1000141
        • Bragge P.
        Ten ways to optimize evidence-based policy.
        J Comp Eff Res. 2019; 8: 1253-1256
        • Frakt A.B.
        • Prentice J.C.
        • Pizer S.D.
        • et al.
        Overcoming challenges to evidence-based policy development in a large, integrated delivery system.
        Health Serv Res. 2018; 53: 4789-4807
        • Pizer S.D.
        • Frakt A.B.
        • Sheetz K.
        • Clancy C.
        Testing novel payment and delivery approaches through the Veterans Health Administration’s new center for innovation.
        Ann Intern Med. 2019; 170: 112-113
        • Venkataramani A.
        • Underill K.
        • Volpp K.
        Moving toward evidence-based policy: the value of randomization for program and policy implementation.
        JAMA. 2020; 323: 21-22
        • Lancaster K.
        • Rhodes T.
        What prevents health policy being ‘evidence-based’? New ways to think about evidence, policy and interventions in health.
        Br Med Bull. 2020; 135: 38-49
      6. Memorandum M-21-27 - Evidence-based policymaking: learning agendas and annual evaluation plans. Office of Management and Budget.
        • Sterne J.A.C.
        • Savović J.
        • Page M.J.
        • et al.
        RoB 2: a revised tool for assessing risk of bias in randomised trials.
        BMJ. 2019; 366: l4898
        • Sterne J.A.
        • Hernán M.A.
        • Reeves B.C.
        • et al.
        Robins-I: a tool for assessing risk of bias in non-randomised studies of interventions.
        BMJ. 2016; 12: i4919
      7. PCORI methodology standards. PCORI.
        • Atkins D.
        • Best D.
        • Briss P.A.
        • et al.
        Grading quality of evidence and strength of recommendations.
        BMJ. 2004; 328: 1490
        • Grimshaw J.
        • Eccles M.
        • Lavis J.
        • Hill S.
        • Squires J.
        Knowledge translation of research findings.
        Implement Sci. 2012; 7: 50
        • Cartwright N.
        Evidence-based policy: what’s to be done about relevance?.
        Philos Stud. 2009; 143: 127-136
        • Walker S.
        • Fox A.
        • Altunkaya J.
        • et al.
        Program evaluation of population- and system-level policies: evidence for decision making.
        Med Decis Making. 2022; 42: 17-27
      8. Scoring system and procedure. NIH.
      9. Non-regulatory guidance: using evidence to strengthen education investments. United States Department of Education.
      10. NIH Policy Manual - 1793 - Legislative proposals. NIH Office of Management Assessment.
        https://policymanual.nih.gov/1793
        Date accessed: September 3, 2021
        • Eversden A.
        Here are the signs agencies are giving on federal data initiatives.
        (Federal Times)
      11. Evidence plans. Office of Management and Budget.
      12. How states engage in evidence-based policymaking: a national assessment. Pew-MacArthur Results First Initiative.
        • Ho D.E.
        • Sherman S.
        • Wyman P.
        Do checklists make a difference? A natural experiment from food safety enforcement: do checklists make a difference?.
        J Empir Leg Stud. 2018; 15: 242-277
        • Crowley D.M.
        • Scott J.T.
        • Long E.C.
        • et al.
        Lawmakers’ use of scientific evidence can be improved.
        Proc Natl Acad Sci USA. 2021; 118e2012955118
        • Braganza M.Z.
        • Pearson E.
        • Avila C.J.
        • Zlowe D.
        • Øvretveit J.
        • Kilbourne A.M.
        Aligning quality improvement efforts and policy goals in a national integrated health system.
        Health Serv Res. 2022; 57: 9-19
        • Cookson R.
        Evidence-based policy making in health care: what it is and what it isn’t.
        J Health Serv Res Policy. 2005; 10: 118-121