Using Evidence to Influence Health Policy

Abstract

At a recent evidence-based practice nursing research conference, Dr. Mary Wakefield (2011), the highest-ranking nurse in the U.S. government, stated that evidence-based health policy is as important as evidenced-based practice. As administrator of the Health Services and Resources Administration (HRSA), Dr. Wakefield oversees a $9.7 billion budget intended to improve access to health care services for people who are uninsured, medically vulnerable, and geographically distant. How can she and other government officials make the best decisions about which of potentially infinite health care policies to fund and implement?In her remarks at the conference, Dr. Wakefield (2011) described several important health initiatives that were based on evidence generated by the work of nurse researchers. For a moment, let us ponder two important questions: (a) What role does the level of evidence of health care recommendations play in a decision to institute a particular health policy initiative and (b) How can we teach our students, particularly DNP students, to incorporate health policy recommendations in their work?Regarding the first question, nursing evidence impacts health policy only when it is publicized and multiple disciplines outside of nursing become interested in how the evidence offers possible cost-effective solutions to the complex problems of public health (Hinshaw, 2011). In other words, a potential solution with a demonstrated high level of evidence to support its effectiveness in resolving a complex public health problem must also be publicized to influence health policy makers' decision to adopt the evidence-based solution.Although the level of evidence of information is important, the supporting evidence also needs to be of high quality, contain an economic analysis, and be politically viable. As a historical but important example, in 1997, nurse researcher Harriet Kitzman in collaboration with researchers from other disciplines pro- duced important evidence demonstrating the dramatic improvements in health outcomes achieved by teaching low-income pregnant women about prenatal health and childhood development (Kitzman et ah, 1997). Intervention outcomes included healthier pregnancies, less child abuse and neglect, and fewer trips to emergency rooms for accidents and poisonings (Kitzman et ah, 1997). As part of her remarks, Dr. Wakefield (2011) announced that $1.5 billion was authorized under the Affordable Care Act to create and implement a new Maternal, Infant, and Early Childhood Home Visiting Program. This $1.5 billion program was developed on the basis of well-publicized evidence generated by Kitzman and colleagues (1997).The Maternal, Infant, and Early Childhood Home Visiting Program proposes a solution to a complex public health issue. The visitation program improves the health outcomes of pregnant women and their children while at the same time sav- ing health care dollars. This program offers us an example of how a combination of high-level evidence and political savvy can influence national policy.According to the Robert Wood Johnson Foundation (2010), the program costs $4,500 per year per family. Thirty years of evidence including three randomized controlled trials and 9 years of intervention follow-up studies in multiple state sites caught the eye of politicians interested in cost-effective maternal-child health programs. In addition, longitudinal studies show that the cost savings to society is long-term (Robert Wood Johnson Foundation, 2010).Quantified, improved, and long-term clinical outcomes and cost savings led President Obama to support the program as a 2008 presidential candidate. As president, he asked the Congress to authorize support for the Maternal, Infant, and Early Childhood Home Visiting Program (Robert Wood Johnson Foundation, 2010).Dr. Kitzman's research demonstrates that a high-level quality of evidence is essential but not sufficient to impact health policy. …