CHRSP Methodology: Evidence in Context Reports
A Collaborative Approach
Engaging directly with people who work and lead the provincial healthcare system and with patients and caregivers from across Newfoundland and Labrador, CHRSP takes a collaborative approach to make sure our research syntheses address priority concerns for health system decision makers, and for patients and caregivers in Newfoundland and Labrador. The Canadian Institutes of Health Research call this methodology “integrated knowledge translation” because knowledge users and knowledge producers work together throughout the entire research project.
Step 1: Engage Partners/ Select Topics: Every year, CHRSP consults with the top leaders of the six health system organizations in Newfoundland and Labrador (i.e., the Department of Health and Community Services, the Department of Children, Seniors, and Social Development, and the province's four Regional Health Authorities) to find out what research evidence would be useful to them, seeking those topics for which evidence is needed to help inform a pending healthcare decision. In addition to including senior decision-makers within the six stakeholder organizations, CHRSP has a set of Champions who link us to fellow decision-makers and facilitate topic identification and selection for our annual roster of CHRSP Projects. The Program also has a Patient and Caregive Advisory Council who sugest topics nad themes for annual study.
Step 2: Set Priorities: Once potential research topics have been identified, the initial long list of topics is filtered down to the top five-to-seven topics, using criteria that include:
- the importance and urgency of the topic,
- the timeline for the impending policy decision,
- the availability of high-quality research evidence, and
- the availability of a specialized research team.
CHRSP then meets with its Champions, its Patient & Caregiver Advisory Council and all six provincial Health System Leaders (i.e., the Deputy Ministers and the Chief Executive Officers) to clarify and prioritize all proposed research topics. With these Health System/ Healthcar partners, we determine which topics should be studied as Evidence in Context Reports,which will be Rapid Evidence Reports, and which are better suited to be Jurisdictional Snapshots that outline practices, programs and policies implemented elsewhere that decision makers may wish to consider when developing new local policies.
Step 3: Build a CHRSP Project Team: For each topic selected, a CHRSP Project Team is assembled. The Project Team Leader is chosen on the basis of national and/or international expertise in the subject area. The CHRSP Project Team typically includes:
- A Team Leader (subject expert)
- A Health System Leader (i.e. The Deputy Minister, a Regional Health Authority CEO, or their delegate)
- A Health Economist (where required)
- A representative of the Patient & Caregiver Advisory Council
- The CHRSP Program Coordinator, Project Coordinator, and Research Assistants
- Local co-investigators from within the province's healthcare system
- Local academic co-investigators
- Local context advisors from across the health and healthcare system
- As necessary, experts in research synthesis methodology.
Step 4: Locate, Assess, and Synthesize Evidence: Once the CHRSP Project Team has been brought together, CHRSP researchers will locate, assess, and synthesize the available research evidence. The Team devises an appropriate search strategy and conducts rigorous electronic and hand searches of periodical indexes and databases to identify relevant evidence. Relevant evidence for a CHRSP project includes high-level research, such as systematic reviews, meta-analyses, and health technology assessments and high-quality primary studies published too recently to have been included in the high-level review literature. Evidence may also include relevant unpublished literature, government documents, etc. known as "grey literature."
Once relevant research materials have been collected, the team critically appraises and summarizes the evidence in terms of its quantity (i.e., we assess whether there is ample evidence on which to base a report) and its quality (i.e., we rate its methodological rigour using validated assessment tools).
Step 5: Set the Evidence in Context: While the research evidence is being located and assessed, contextual variables must also be considered. Contextual factors may increase or decrease the positive health impacts or cost-effectiveness of an intervention that was reported in the research literature. These variations in effectiveness result from differences between the research settings and local conditions in Newfoundland and Labrador. For instance, interventions that work well in large urban centres may not translate well into a rural Newfoundland setting. The CHRSP Project Team tailors its synthesis to the local context at every stage of the project. Contextual considerations may include: patient populations, sites of service and/or the service design, health human resources, organization and delivery of services, health economics, and politics.
Step 6: Interpret the Evidence: Once the literature has been located, assessed, and synthesized, the Team Leader will review the report and provide guidance in interpreting the evidence; the CHRSP Project Team will then develop a summary of implications for decision makers to consider. The full report will then be drafted.
Step 7: Review, Report, Disseminate: Finally, the CHRSP study will be reviewed by an external subject expert or experts; the results of the external review will be incorporated into the document, which will then be reviewed and edited by the CHRSP Project Team, finalized, and disseminated. Evidence in Context Reports include a full report (35-50 pages), an executive summary, a lay summary, other multi-media products, and online companion documents, as applicable. All CHRSP reports are disseminated through face-to-face meetings that are attended in-person or by video conference and that include the Project Team, together with health system stakeholders, decision-makers, relevant community groups, academics and clinicians who share an interest in the topic.
Evidence in Context reports are published on the NLCAHR website; placed in the Memorial University Libraries, Canada's National Library and Archives and Memorial University’s Yaffle Research Repository; disseminated by direct email to a distribution list of over 650 researchers and health system professionals; and posted in the Newfoundland and Labrador Medical Association Nexus Newsletter and the newsletter of the Association of Registered Nurses of Newfoundland and Labrador. Once the report has been disseminated, the NLCAHR team will solicit feedback from stakeholders and will host further meetings and events, as required, to help facilitate optimal uptake of the research results.