Systematic Reviews and Health Policy: The Influence of a Project on Perinatal Care since 1988

Abstract

Context: Interrelated publications between 1988 and 1992 have influenced health policy and clinical practice: The Oxford Database of Perinatal Trials (ODPT), Effective Care in Pregnancy and Childbirth (ECPC), A Guide to Effective Care in Pregnancy and Childbirth (GECPC), and Effective Care of the Newborn Infant (ECNI). These publications applied and advanced methods that had a substantial history in the medical, biological, physical, and social sciences. Their unique contribution was to demonstrate the feasibility of organizing and sustaining programs to conduct systematic reviews across an entire field of health care. The publications also influenced subsequent advances in the methodology of systematic reviews and contributed to their proliferation; in large measure, but not entirely, because their editors and many of the authors participated in organizing and developing the Cochrane Collaboration. This article describes how and why these publications attracted favorable attention and resources from policymakers in numerous countries. Methods: This article applies historical methods to the analysis of primary sources that help explain the influence of systematic reviews, mainly on health policy. These methods guide an analysis of the rhetoric of the two volumes of ECPC and of primary sources generated as systematic reviews influenced health policy. The analysis of rhetoric employs the methods of intellectual history and social studies of science. The analysis of policymaking uses the methods of political and policy history, political science, and public administration. Because the focus of this article is how science influenced policy it alludes to but does not describe in detail the literature on the methods, production, and publication of systematic reviews. Findings: The influence of the four publications on policy was mainly a result of (1) their powerful blending of the rhetoric of scientific and polemical discourse, especially but not exclusively in ECPC; (2) a growing constituency for systematic reviews as a source of “evidence‐based” health care among clinicians, journalists, and consumers in many countries; and (3) recognition by significant policymakers who allocate resources to and within the health sector that systematic reviews could contribute to making health care more effective and to containing the growth of costs. Conclusions: Analysis of this aspect of the history of producing and applying systematic reviews informs understanding of how knowledge derived from research informs policy.

An evaluation of the effectiveness of information literacy training for undergraduate midwives to improve their ability to access evidence for practice

“…With the publication of 'A Guide to effective care in pregnancy and childbirth' in the 1990s (Enkin et al, 1995), the importance of evidence-based practice in midwifery, and the ability to deliver this, took important steps forward (Hancock et al, 2000 p.7). Although Archie Cochrane had been advancing the notion of effective healthcare for many years, this work, taken up subsequently by the Cochrane Pregnancy and Childbirth Group brought the concept into focus for midwives and obstetricians (Bastian, 1994;Fox, 2011;Mosteller, 1993). However, it must be acknowledged that although we may talk the talk in midwifery, the application of evidence in practice may indeed be random at best (Renfrew, 1997).…”

Macro‐level diffusion of a methodological knowledge innovation: Research synthesis methods, 1972–2011

“…Archibald (“Archie”) Cochrane is recognized for providing a vision for EBP inseparable from the methods used in medical research, first with his emphasis on RCTs, and second, on systematic review of RCT findings (Alvarez‐Dardet & Ruiz, ; Chalmers, ). Just prior to the establishment of the Cochrane Collaboration, and the declaration of the evidence‐based practice (and later, policy) movement (Evidence‐Based Medicine Working Group, ), publications from two important high‐profile lines of research were released, the Effective Care in Pregnancy and Childbirth (ECPC) project (Fox, ; Mosteller, ) and a study on treatments for myocardial infarction (Antman, Lau, Kupelnick, Mosteller, & Chalmers, ). ECPC effectively advocated for and demonstrated the benefit of a systematic approach to review.…”

“… Such boundary organizations include the Cochrane and Campbell Collaborations, the EPPI‐Centre (UK), and health science programs in Australia, Canada, and more recently, the United States (Fox, ).…”

Use and Applications of Systematic Reviews in Public Health Nutrition

“…But a central principle for such decision-making is that it be objectively informed by the totality as well as the quality of the available scientific evidence relevant to the question at hand. The best starting point is an understanding of what the scientific evidence tells us (24), even though final decisions may incorporate non-evidence-driven judgments as well as considerations that may be outside the available science and relate to other values including ethics, cost-effectiveness, and political feasibility (23). A framework for decision-making must acknowledge that there is a distinction between evaluating and arraying the evidence and the decisions that are made on the basis of that evidence and other considerations.…”