Matrix Evidence

With the strap line ‘Distinguishing Effective Evidence-Based Programs from Everything Else’, the US Coalition for Evidence-Based Policy has launched its monthly newsletter. Circulated as an e-newsletter, it summarizes key findings from high quality (the focus is on well-conducted RCTs) evaluations across all areas of social policy. The Coalition follows guidelines issued by the US National Academies on evaluation designs.

The newsletter provides results from the Coalition systematically monitoring the literature to identify all new RCTs – and other rigorous nonrandomized evaluations – published or posted on-line across all areas of social policy. It includes (i) summaries of the few findings identified by an expert panel as meeting the highest (Congressional “Top Tier” or near Top Tier) evidence standards; as well as (ii) summaries of promising findings that are not yet ready for Top Tier consideration (e.g., due to only short-term follow-up). The Coalition views these latter findings – promising but not conclusive – as valuable for identifying programmes that merit testing in more definitive RCTs.

Looks like another valuable resource for the evidence-based policy community?

Tags: evidence-based policy, randomised controlled trials, USA
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A symposium of the Fifth Annual Scientific Session of the Surgical Outcomes Club in Chicago, Illinois, in October of last year, was dedicated to the topic of comparative effectiveness research in surgery. The symposium served to clarify current thinking about what comparative effectiveness research is, particularly its objectives and methods.

The definition of comparative effectiveness research has evolved with the input of a variety of parties, including the Congressional Budget Office, Office of Management and Budget, and the White House. A working definition has been produced by the Federal Coordinating Council for Comparative Effectiveness Research that you can find here. Briefly, the definition talks about improving health outcomes by ‘developing and disseminating evidence-based information to patients, clinicians, and other decision-makers, responding to their expressed needs, about which interventions are most effective for which patients under specific circumstances’.

Comparative effectiveness research is currently being used in some jurisdictions to make policy and coverage decisions. While policy making and coverage decisions are increasingly made on the basis of research evidence, the evidence on which decisions are made is typically very weak.

Tags: evidence-based policy, medicine, USA
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The emphasis of UK health policy has changed in recent years to focus much more sharply on prevention relative to cure. An article in this month’s New England Journal of Medicine suggests that public health interventions to reduce salt intake could deliver reductions in death and disease akin to smoking cessation campaigns.

In the article, Bibbins-Domingo and colleagues present evidence from the US to suggest that a public health intervention programme to reduce daily salt intake by 3 g (1200 mg of sodium) could reduce the annual number of new cases of coronary heart disease (CHD) by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and reduce the annual number of deaths from any cause by 44,000 to 92,000.

A campaign to reduce salt intake could save 194,000 to 392,000 quality-adjusted life-years and $10 billion to $24 billion in health care costs annually. Even if the intervention reduced salt intake by just 1 g per day, the benefits would still be substantial and would warrant implementation.

Tags: evidence-based policy, public health, USA
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I know it’s not much to do with evidence and policy, but what the heck – it’s Christmas and I had to share this. Check out this You Tube clip of a retired US construction worker building his very own version of Stonehenge without any help! Just goes to show that the science behind what appears to be mysterious stuff doesn’t always have to be that complex. Occam’s razor rules!

Tags: USA
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A new study published in the Wisconsin Medical Journal shows road traffic accidents involving teenagers could be reduced by introducing graduated driving licenses restrictions for young people.
Researchers from the Medical College of Wisconsin’s Injury Research Center in Milwaukee and the Children’s Hospital of Wisconsin looked at crash data from six US states and found that more than 300 deaths and over 21,000 injuries could have been prevented by introducing additional restrictions on teen driving licenses. The research concluded that seven elements could make a difference:

1. Minimum age of 16 years for obtaining a learner’s permit
2. A holding period of at least six months after obtaining a learner permit before applying for intermediate phase
3. At least 30 hours of supervised driving
4. Minimum age of 16.5 years for entering the intermediate phase
5. No unsupervised driving at night after 10 p.m. during the intermediate phase
6. No unsupervised driving during the intermediate phase with more than one passenger younger than 20 years
7. Minimum age of 17 years for full licensure.

Tags: evidence-based policy, USA
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U.S. Preventive Services Task Force have published a report suggesting the policy of recommending routine screening for women aged between 40 and 50 may not be entirely consistent with the available evidence. Their report cited evidence that the potential harm to women having annual screenings beginning at age 40 outweighs the benefits.

“We’re not saying women shouldn’t get screened. Screening does saves lives,” said Diana Petitti, vice chairman of the, which released the recommendations in a paper being published in the Annals of Internal Medicine. “But we are recommending against routine screening. There are important and serious negatives or harms that need to be considered carefully.”

A review of several major studies and a new statistical analysis showed that mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy. Women who have a family history of breast cancer or other risk factors should continue to seek annual screening, doctors said.

However, the findings were not well received by politicians in Washington. The White House responded by saying that despite the evidence cited in the report, the findings were not binding on either physicians or insurers; government insurance programs would continue to cover mammograms for women starting at age 40.
Republicans argued that the recommendations illustrated the dangers of an expanded government role in medical decision making.

The report has brought into sharp focus the sometimes uneasy relationship between evidence and politics, especially when it comes to healthcare in the US. The secretary of health and human services, acknowledged in a statement that the recommendations, had “caused a great deal of confusion and worry.” stressing that the task force “is an outside independent panel of doctors and scientists who make recommendations” and who neither “set federal policy” nor “determine what services are covered by the federal government.”

Tags: evidence-based policy, medicine, USA
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The US Office of Management and Budget (OMB) has announced a new initiative, backed with funding designed to encourage Executive Departments and Agencies to use rigorous, independent evaluations to establish whether government policy initiatives are delivering their intended outcomes at a cost that represents value for money.

A memorandum from OMB Director Peter Orszag sets out the details of the initiative that includes introducing an on-line resource setting out the details of all Federal evaluations, planned or already underway; establishing an inter-agency working group to promote good practice in evaluation design and implementation; and a new voluntary initiative that will provide funding for agencies that demonstrate their commitment to using rigorous evaluation to inform policy.

In a covering story on the Government Executive website, George Grob, an adviser to the Massachusetts-based American Evaluation Association, called the policy a step toward making program reviews an essential function of government.

Tags: evidence-based policy, USA
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First up is reference to a speech made by US President Barack Obama to the National Academy of Sciences in April 2009. Here is a snippet:

….. we are restoring science to its rightful place. On March 9th, I signed an executive memorandum with a clear message: Under my administration, the days of science taking a back seat to ideology are over. Our progress as a nation — and our values as a nation — are rooted in free and open inquiry. To undermine scientific integrity is to undermine our democracy. It is contrary to our way of life.

The full transcript can be found at www.realclearpolitics.com/articles/2009/04/27/obama_speech_academy_of_sciences_transcript_96221.html

Tags: Obama speeches, USA
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