Evidence-based Reform Research Articles

Medicare Head Donald M. Berwick, MD, Takes on Mission of Health System Reform

CHICAGO—Donald M. Berwick, MD, MPP, has devoted much of his professional life advocating for improving quality and outcomes of health care through evidence-based reform of the nation’s health care delivery system. Now, in his new role as administrator of an agency spending more than $800 million to cover health care costs of about 100 million individuals, the Centers for Medicare & Medicaid Services (CMS), Berwick hopes to implement such reform. The effort will have implications for physicians, health care workers, and hospitals across the country. Before becoming CMS administrator on July 7, Berwick, a pediatrician, cofounded the independent and notfor-profit Institute for Healthcare Improvement (IHI). The institute uses evidence-based research to quantify measures aimed at improving quality of medical care and then disseminates the findings of such research to the health care community. As IHI’s president and CEO, Berwick, who was also a professor of health policy and management at the Harvard School of Public Health in Boston, helped develop IHI’s Triple Aim initiative (Berwick DM et al. Health Aff [Millwood]. 2008;27[3]:759-769). The initiative calls for redesigning the health care delivery system to simultaneously accomplish 3 primary objectives: improve the health of the population, enhance patient care (including quality of, access to, and reliability of care), and reduce or at least control the per capita cost of care. Triple Aim builds off the Institute of Medicine’s 6 aims for improvement in the delivery of health care in the United States as outlined in a 2001 report, “Crossing the Quality Chasm: A New Health System for the 21st Century” (http://bit.ly/b3BZ84). Although physician and consumer groups such as the American Medical Association, the Association of American Medical Colleges, and AARP applauded Berwick’s appointment by President Barack Obama and the passage of the Affordable Care Act by the US Congress, some critics charged that the reform advocated by Berwick and the passage of health reform legislation would lead to rationing, dissolution of the patient-physician relationship, and onerous involvement of the federal government into the care setting. Berwick, who was in Chicago on October 13 as part of a tour of every CMS regional office, stopped by the JAMA offices to visit with former colleagues (he was a JAMA editorial board member for 8 years) and to lay out his vision as to how he would like to see his agency’s role in health care delivery reform unfold. JAMA: What is your top priority? Dr Berwick: Improving care. I see CMS as a partner, a trustworthy partner, and also a force for the continuing improvement of health care for our beneficiaries. But it is not just for beneficiaries. We will be partners in the change of care for all Americans, changing it so it is safe care, better care, more patient-centered, timelier, and more effective. I am also convinced we can do that while controlling costs. Through innovation and change, we can discover ways to deliver care in which care gets better at the same time as it gets less expensive.

An integrated review of the literature on challenges confronting the acute care staff nurse in discharge planning

This integrative review presents and synthesises previous research investigating practices, perceptions and experiences of bedside staff nurses relative to hospital discharge planning. Preparation for hospital discharge should begin at or prior to admission. Forces in the acute care environment, however, often impede comprehensive discharge planning. Evidence-based redesign of discharge planning processes is a priority for nurses and health care leaders. An integrative review. The review was undertaken using eleven search terms to electronically scan CINAHL, Medline, PsycINFO and Dissertations and Theses databases for the period 1990-2009. Hand searching of reference lists and author searches was also conducted. Sixty English language articles were reviewed; 38 of these 60 publications met the study inclusion criteria. Seven themes were identified across the studies. These themes were intra- and interdisciplinary communication; systems and structures; time; role confusion; care continuity; knowledge; and the invisibility of the staff nurse role in discharge planning. Acute care bedside nurses frequently encounter significant barriers while providing discharge-related care. Although these barriers have been identified consistently in numerous studies spanning nearly two decades, few published reports address interventions designed to overcome identified obstacles and inefficiencies. Additional discharge planning redesign initiatives, which include rigorous evaluation of patient outcomes, are needed. As the direct caregivers with the most consistent presence and knowledge of patients' postdischarge needs, acute care bedside staff nurses play a critical role in preparing patients and families for the transition from hospital to home. Nurses are uniquely positioned to identify barriers and opportunities in discharge planning processes and contribute significantly to evidence-based reform initiatives. Effective and efficient patient-centred discharge planning processes can facilitate the transition from hospital to home and begin to address the adverse events experienced by some patients in the immediate postdischarge period.

Evidence-based reform in education

This article proposes an approach to education reform in which government encourages schools to use programs and practices proven to be effective in rigorous evaluations. In this system, teachers and school leaders would be able to select among a variety of proven methods, and could receive funds to help them adopt and implement these programs. Government would help build up a set of proven programs for all grade levels and many subjects, and would provide support to help schools choose and implement proven programs, but schools would have freedom to choose whatever works for their students. This policy, it is argued, would promote innovation and reform without top-down mandates, building knowledge as it increases effective teaching and improved outcomes for students.

Piloting PTWI--A Socio-Legal Window on Prosecutors' Assessments of Evidence and Witness Credibility

This article presents original empirical data generated from the Crown Prosecution Service (CPS) Pilot Evaluation of pre-trial witness interviewing (PTWI) in England and Wales. Section 1 introduces the PTWI Pilot and describes the methodological strengths and limitations of our qualitative socio-legal study. Forming the richly documented empirical core of the article, Sections 2-5 identify the principal considerations which seemed to influence case selection for Pilot interviews. An overlapping collection of evidentiary, strategic and circumstantial factors encouraged prosecutors to resort to PTWI, whilst other, countervailing considerations were apprehended as disincentives. Assessments of witness credibility were central to prosecutors’ attempts to balance these competing factors. Section 6 concludes by underlining the potential of qualitative socio-legal studies to promote more nuanced understandings of criminal process, and by extension to make practical contributions to evidence-based criminal procedure reform.

Evidence-Based Medicine and Hospital Reform: Tracing Origins Back to Florence Nightingale

The use of reliable evidence to evaluate health care interventions has gained strong support within the medical community and in the field of plastic surgery in particular. Evidence-based medicine aims to improve health care and reduce costs through the use of sound clinical evidence in evaluating treatments, procedures, and outcomes. The field is hardly new, however, and most trace its origins back to the work of Cochrane in the 1970s and Sackett in the 1990s. Though she wouldn't know it, Florence Nightingale was applying the concepts of evidence-based reform to the medical profession more than a century before. She used medical statistics to reveal the nature of infection in hospitals and on the battlefield. Moreover, Nightingale marshaled data and evidence to establish guidelines for health care reform. Tracing the origins of evidence-based medicine back to Nightingale underscores how critical this movement is to improving the quality and effectiveness of patient care today.

Turning failure into success: what does the case of Western Australia tell us about Canadian cannabis policy-making?

Cannabis policy in Canada is a puzzling affair. Since the 1960s and as recently as 2006, several policy windows have opened promising evidence-based cannabis law reform only to be slammed shut before achieving meaningful change. This ‘saga of promise, hesitation, and retreat’ has motivated Canadian cannabis researchers to investigate the reasons behind this policy inertia. These single-jurisdiction analyses have resulted in interesting yet necessarily tenuous findings. Fischer's (1999) Policy Studies article suggests the need for an analysis of Canadian cannabis policy in comparative context and offers Australia as a point of departure. This article addresses this analytic task by examining two recent case studies in cannabis policy. Specifically, borrowing Kingdon's (1995) concept of a policy window, it contrasts Canada's failure to decriminalise minor cannabis offences between 2001 and 2006 with Western Australia's successful decriminalisation of cannabis possession and production for personal use between 2001 and 2004. In particular, it appears that a lack of support from law enforcement and cannabis users, conflicting evidence and risk associated with a lack of an evaluation plan all combined with a weakened electoral mandate for the government to contribute to a perception that cannabis decriminalisation was not politically feasible. Additional variables worthy of further inquiry are also discussed.

Evidence-based practice: A challenge for European developmental psychology

In recent years the evidence-based practice movement has been seeing great gains in impact. Standards for research leading to evidence-based practice have been defined. So far, however, in the area of education standards of evidence are not extensively implemented and in most federal European policies an evidence-based reform has not been attained. The present paper advocates investing effort in evidence-based practice. In particular, the paper invites European developmental psychology and its representatives to transfer their knowledge and contribute to evidence-based practice which, in turn, will foster positive child and youth development. Incipiently, the paper discusses the new challenges facing universities and European scientific societies as contexts for scientific disciplines and their perspectives. Then, current directions in developmental psychology are described. The central section of the paper focuses on standards of evidence and the use of research for evidence-based practice and policy. It highlights the challenge facing European developmental psychology concerning active contribution to evidence-based practice. Two empirical examples are presented: (1) illustrating that kindergarten and school are the places where evidence-based practice preventions and interventions should take place; and (2) describing various steps of the transfer of basic research to evidence-based practice. Finally, the contribution that the European Society for Developmental Psychology can make to support the transfer of knowledge to evidence-based practice is outlined.

Cooperative Learning, Success for All, and Evidence-based Reform in education

This article argues that educational practice and policy should be based on evidence from rigorous experiments. Examples of cooperative learning and Success For All are given to illustrate how proven programs have been evaluated and broadly disseminated. Policy initiatives in the U.S. to promote use of proven programs are described. Evidence-based reform is possible in education, but it demands strong research and clear guidance for educators.

Towards Evidence-based Reform of European Universities

After the Bologna agreement and the Lisbon Agenda, reform of European university systems has been higher on the political agenda. This is necessary, since most European universities have been suffering from stifling blankets of government regulation, having to make do with much less funds than their North-American counterparts and do not appear high on the various rankings of top universities in the world. Furthermore, the booming economies of China and India will nurture and boost world-class universities in the coming decades. Also, universities are essential in their links to business and society to make the European economy more innovative and competitive, especially as European industries approach the world technology frontier. We argue on the basis of the stylized facts that foremost European universities need more autonomy to select students, reward staff, design new programmes, attract more funds and compete better in an increasingly tough environment. Although the general principles of the policy reform agenda are clear, the details are not. The link between governance, funding and performance is not obvious and needs still further data and research. We conclude that reform of European universities should much more be based on the best available empirical analysis. (JEL code: I23)

Evidence-Based Reform in Education: What Will it Take?

During the twentieth century, medicine, agriculture, technology, and other fields embraced a simple but powerful idea: Use what works. They began to require that innovative medicines, seeds, and machines be put to the test before being widely adopted. The result was revolutionary progress in each of these fields, which continues today. Evidence-based reform in any area does not just protect the public from ineffective innovations; it also creates a dynamic of progressive improvement, in which many researchers and developers are working to replace today’s best solutions with something even more effective, confident that the market will enthusiastically adopt proven innovations. Before evidence became important in medicine, agriculture, and technology, products and treatments in each area were disseminated by slick marketing, misleading demonstrations, word of mouth, and tradition. In the nineteenth century, for example, there was already plenty of knowledge in medicine, but neither physicians nor the general public paid consistent attention to it. In the early 1900s, William Halsted, a medical researcher at Johns Hopkins University, spent 30 years trying with limited success to convince physicians to wash their hands before operations and use sterile procedures that had been validated in research going back to the 1860s. The practice of education today is at much the same pre-scientific point as medicine was a hundred years ago. We have much knowledge in education, and educators do occasionally pay attention to it, as physicians did in 1908. However, there is limited research evaluating specific programs, practices, or materials, and that which does exist is rarely consequential in educators’ decisions. As a result important decisions about educational programs are likely to be made based on slick marketing, misleading demonstrations, word of mouth, tradition, and politics. This not only fails to provide the best educational programs to vulnerable children, but it also removes any incentive for developers to create programs and technology that actually work better than current practices. The result is the famous pendulum of educational reform, in which new ideas appear, become widely used, and only then are evaluated. By the time the evaluation evidence is in, the market has already given up on the new idea, and has rushed off to the latest new idea (see Slavin, 1989). A pendulum swing describes innovation in all fields, such as art and fashion, in which taste rather than evidence drives consumer choices. Unfortunately, education is one such field.

Response to Comments: Evidence-Based Reform in Education: Which Evidence Counts?

<i>Response to Comments</i>: Evidence-Based Reform in Education: Which Evidence Counts?

Evidence-Based Reform in Education: A Response to Robert Slavin

Evidence-Based Reform in Education: A Response to Robert Slavin

Introduction to ‘Early psychosis: abridge to the future’

Early intervention in psychiatry has taken a long time to emerge as a key strategy to reduce morbidity and mortality. In other fields of medicine it has received consistent support and great efforts are expended to educate the public about the value of early diagnosis and the benefits of timely intervention. There is finally substantial momentum behind similar endeavours in psychotic disorders, which, now they have reached "proof of concept" stage, could begin to be extended across the spectrum of serious mental disorders. There is also ambivalence and resistance to this evidence-based reform which warrants careful analysis. The Third International Early Psychosis Conference proved to be a watershed and was the largest and most vibrant meeting to that point. This preface aims to set the scene for a selection of contributions, derived from the array of new evidence reported in Copenhagen, and recently fully updated.

What Does the No Child Left Behind Act Mean to Early Childhood Teacher Educators?: A Call for a Collective Professional Rejoinder

This article is a call to become more critically aware of the new law commonly referred to as No Child Left Behind Act, which was put into effect in 2002 in the United States. The article is also an invitation to early childhood educators worldwide to engage in a dialogue that raises several questions: (a) How does such legislation affect early childhood educators and teacher preparation programs?; (b) How might teacher educators react and respond to the new law as they continuously practice informed decision-making about teacher preparation that is socially responsible? In view of these questions, it is a hope that we can see the initiation of nationwide dialogue regarding the issue of the No Child Left Behind Act. Primarily, how does the new law affect teacher educators and teachers? It is inevitable for us to be united and politically informed to prevent further scrutiny of questionable politically and economically driven educational practices in the United States, not to mention “test-heavy” evidence-based education reform.

Restorative Justice: Assessing Optimistic and Pessimistic Accounts

For informal justice to be restorative justice, it has to be about restoring victims, restoring offenders, and restoring communities as a result of participation of a plurality of stakeholders. This means that victim-offender mediation, healing circles, family group conferences, restorative probation, reparation boards on the Vermont model, whole school antibullying programs, Chinese Bang Jiao programs, and exit conferences following Western business regulatory inspections can at times all be restorative justice. Sets of both optimistic propositions and pessimistic claims can be made about restorative justice by contemplating the global diversity of its practice. Examination of both the optimistic and the pessimistic propositions sheds light on prospects for restorative justice. Regulatory theory (a responsive regulatory pyramid) may be more useful for preventing crime in a normatively acceptable way than existing criminal law jurisprudence and explanatory theory. Evidence-based reform must move toward a ...