Puzzling about problems: the ambiguous search for an evidence-based strategy for handling influx of health technology

Nedlund, Ann-Charlotte; Garpenby, Peter

doi:10.1007/s11077-014-9198-1

Cited by 17 publications

(21 citation statements)

References 25 publications

(25 reference statements)

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“…Electronic healthcare (ehealth) is a widely used example in this scenario (Nedlund and Garpenby 2014). This has to do with the fact that each new medical device has its own database, which can create a new silo system (Bygstad et al 2015).…”

Section: Institutional Context Of Data Usementioning

confidence: 99%

Big data for policymaking: fad or fasttrack?

2017

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The buzz surrounding big data has taken shape in various theoretical and practical forms when it comes to policymaking. The paper combines current research streams with long-standing discussions on government and technology in public policy and public administration, such as e-government and evidence-based policymaking. The goal is to answer the question whether big data is a fleeting trend or has long-lasting effects on policymaking. Three larger themes in the literature are identified: First, the role that institutional capacity has within government to utilize big data analytics; second, government use of big data analytics in the context of digital public services; and finally, the way that big data information enters the policy cycle, focusing on substantive and procedural policy instruments. Examples from the education, crisis management, environmental and healthcare domain highlight the opportunities and challenges for each of these themes. Exploring the various aspects of big data and policymaking shows that big data is here to stay, but that its utilization by government will take time due to institutional barriers and capacity bottlenecks.

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Section: Institutional Context Of Data Usementioning

confidence: 99%

Big data for policymaking: fad or fasttrack?

2017

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“…Boscarino ( 2009 ), for example, provided empirical evidence that interest groups search the problem stream for issues to attach to their pet policies. Nedlund and Garpenby ( 2014 ) illustrate how problem frame differences shape the puzzling of a policy problem. And interest group literature tells us that groups are capable of controlling the image of a problem through the use of rhetoric and policy analysis (Baumgartner andJones 1991 , p. 1045).…”

Section: Problem Streammentioning

confidence: 99%

Interest groups in multiple streams: specifying their involvement in the framework

Rozbicka

Spohr

2015

Policy Sci

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Although interests inhabit a central place in the multiple streams framework (MSF), interest groups have played only a minor role in theoretical and empirical studies until now. In Kingdon's original conception, organized interests are a key variable in the politics stream. Revisiting Kingdon's concept with a particular focus on interest groups and their activities-in different streams and at various levels-in the policy process, we take this argument further. In particular, we argue that specifying groups' roles in other streams adds value to the explanatory power of the framework. To do this, we look at how interest groups affect problems, policies, and politics. The influence of interest groups within the streams is explained by linking the MSF with literature on interest intermediation. We show that depending on the number of conditions and their activity level, interest groups can be involved in all three streams. We illustrate this in case studies reviewing labor market policies in Germany and chemicals regulation at the European level.

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“…Though, there is a need to recognize the contextual elements in decision-making, and highlight institutional factors and incentives to employ use of cost-effectiveness analyses in decision-making [8]. In practice, all steps -when evidence is produced, when evidence-informed guidelines in the form of policy documents are produced and when these guidelines are interpreted and used in practice -involve negotiations and collective sense-making [30].…”

Section: Methodological Considerations and Discussion Of The Main Resmentioning

confidence: 99%

“…The negotiations where policymakers exchange information, rework interpretations and give meaning to different policy matters, as in this case the "best" evidence for the treatment of heart diseases, can be understood as a way to find support in an ambiguous situation of formulating recommendations in the form of guidelines. The work in producing guidelines is not easily achieved, in practice the work involve negotiations and collective sense making [29,30].…”

Section: Health Policy Decision-makingmentioning

confidence: 99%

The matter of economic evaluations in health policy decision-making : The case of the Swedish national guidelines for heart diseases

Eckard¹

2015

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Economic evaluations are used to inform decision makers about the efficient allocation of scarce healthcare resources and are generated with the direct intent to support decisions in healthcare. Producing guidelines is a complex process and the inclusion of health-economic aspects in the formulation of the Swedish national guidelines as a basis for the written recommendations (priority gradings), distinguishes them from their European counterparts. Despite the increased use of cost-effectiveness data in decision-making, little is known about the actual use of such data. This thesis covers issues concerning how economic evaluations matter in health policy decision-making. The thesis includes four papers based on the Swedish national guidelines for heart diseases, one of the most prominent examples in Sweden of following the notion of evidence-based policy (EBP), in order to inform explicit priority setting. Both Papers I and II followed a qualitative case study design, based on the same data set. Paper I explored how a specific working group, the Priority Setting Group (PSG), handled the various forms of evidence and values when producing the national guidelines. Two themes were identified in reaching collective agreement in priority gradings; group facilitation activities and avoiding deadlock in the discussion. The work process involved disagreement and negotiation as part of that task. Paper I contributes to the theoretical and practical debate on EBP. Paper II focused on the use of cost-effectiveness data as decision support in the PSG work process. The paper addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. Three themes were identified. The paper contributes to knowledge on how cost-effectiveness evidence was used in actual decision-making. The use of cost-effectiveness evidence was one of many tools employed to avoid deadlock in discussion and to reach a priority grading, when the overall evidence base was weak, in times of uncertainty and on the introduction of new expensive medical technologies. Quantitative research methods were used for both Papers III and IV. Paper III explored how the PSG was presented with cost-effectiveness evidence as decision support and as a basis for their priority gradings. Cost-effectiveness ratios (ICERs) were provided, based on a systematic literature review, as well as how the results may be conveyed and communicated, for the treatment of heart diseases using a cost-effectiveness ranking or league and providing valid information within a limited space, aiding decision makers on the allocation of healthcare resources. The thesis also includes decision support in the form of cost-effectiveness analysis on catheter ablation treatment. Paper IV provides an example of presenting evidence in the form of a decision-analytic model. The modelling approach provides an analytic framework for decision-making, specifically under conditions of uncertainty as in the introduction of new medical technology. ...

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Puzzling about problems: the ambiguous search for an evidence-based strategy for handling influx of health technology

Abstract: This paper focuses on problem frame differences among actors (members of an advisory body, senior administrators and clinical unit managers) who are concerned with the introduction of new health technology at the regional level in Sweden. It explores issues

Cited by 17 publications

References 25 publications

Big data for policymaking: fad or fasttrack?

Big data for policymaking: fad or fasttrack?

Interest groups in multiple streams: specifying their involvement in the framework

The matter of economic evaluations in health policy decision-making : The case of the Swedish national guidelines for heart diseases

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