Alberta Innovates- Health Solutions

As part of a general effort to ensure that health research is valued by policy and decision-makers, and thereby support evidence based decision-making in health, the Alberta Heritage Foundation for Medical Research (AHFMR) is requesting proposals to review the "state of the science" in relevant topics in health services and health policy research.

The purpose of a "state of the science" review is to summarize the scientific research literature in a content area, to provide a summary of the areas of strength and weakness in the research base, and to identify gaps in knowledge. At the same time, the reviewers will be asked to meet and talk with decision-makers to determine what is currently known about the policies related to the questions, and specifically the policy context within Alberta. This policy context will be part of the final review.

The choice of topics for these reviews has been advised by priority themes for health services research guided by:

• A coordinated national consultation by major national funding agencies described in a summary report, June 2001 entitled "Listening for Direction".
• A provincial consultation process undertaken by AHFMR in 1999-2000 with Alberta's health authorities.
• The advice of the Health Research Advisory Committee of the Foundation, whose members are drawn from the academic and health care delivery constituencies in Alberta.
• The advice of the Health Advisory Committee of the Foundation, whose members are drawn from the international health research community.

Following the development of a list of priority themes and questions, the Foundation is calling for applications to conduct State of the Science reviews to determine the current state of knowledge about these questions, including their policy context.

The state-of-the-science reviews conducted under this request will be made available to all interested parties. They are intended particularly to inform future health planning and research activity in Alberta by:

• providing an overview of research-based evidence to policy and decision-makers in key topic areas,
• identifying gaps in the body of research evidence that should be addressed through projects or programs of research,
• strengthening the proposals of the research community seeking support from AHFMR and other funding agencies,
• informing the external and committee reviewers of the Foundation in their assessment of proposals for projects or programs of health services research.

The products of this process will set the stage for the development of a call for proposals for programs for research to address gaps in knowledge and answer priority questions. Following receipt and analysis of the completed reviews, the Alberta Heritage Foundation for Medical Research will, in consultation with its advisory groups, finalize the parameters of a new competition for funding of five-year programs of research. These programs will address priority areas identified as most likely to benefit from additional long-term research activity in Alberta, in part based on the results of the state of the science reviews (please see companion document "Developing Programs of Research -- Health Research Priority Themes and Questions).

Reviews of research information can take a number of different approaches and have various purposes. The generic term ‘literature review' has been replaced by a number of terms that refer to summarizations of knowledge, such as policy synthesis, systematic review, and synthesis research. The term state-of-the-science review as used here refers to an approach to research synthesis that has, as one of its two primary goals, provides an overview of the areas of strength and weakness in the body of knowledge. This includes identifying where research has generated firm information, and where there remain major gaps to be filled. For this purpose, the approach to a review includes cataloging or grouping of existing studies in a way that identifies strengths and weaknesses of the knowledge base, that may arise from study type and research method, quality and certainty of results, the questions asked, or measures used.

The second primary goal of the review is to place the research information available in the context of what is currently known about the policies bearing on these questions. Achieving the latter goal will require engaging relevant decision-makers to obtain their informed input to the review.

Syntheses are sought about knowledge areas that are quite broad. The definition of these areas has been informed by a wide-ranging consultation process, culminating in the recommendations of the Health Research Advisory Committee. Reviews are sought in four areas, described in the following questions.

1. What is known about the effects of various structures and processes on integrating services across different delivery components (public health, primary care, acute care, long term care and home care), and on improving individual and population health outcomes?

2. What is known about the impact of information management through information technology in the health system on individual and population health outcomes?
3. What is known about the impact of different ways in which public values are reconciled with technical information to inform resource allocation decisions, in particular on the introduction of new technologies and defining publicly funded health care services?
4. What is known about the models that have been used to develop indicators and benchmarks at different levels of accountability in the health system? How appropriately do these models and the resulting indicators reflect the responsibilities and challenges faced at different levels of the health system?

The deadline for receipt of applications is February 15, 2002.

The Foundation will notify the applicants of the decision by March 15, 2002.

The deadline for receipt of the completed review will be October 31, 2002.

Advised by the budget prepared by the review group, the Foundation will provide awards of up to $70,000 per State of the Science review to support the activity.

The application should be no more than five pages in length and should include:

• Statement of purpose
• Proposed methodology, including protocol for approaches to

• question refinement
• information sources and research selection
• cataloguing and grouping of the research literature
• analysis and presentation of results and implications
• placing the topic area in the context of determinants of health
• placing the review in a relevant policy context

• Summary of reviewers' experience in research synthesis
• Budget
• Names of the team members, summary of expertise and time commitment
• Curriculum Vitae of team members provided as attachments using the CIHR CV module

The principal investigator must be primarily affiliated with a not-for-profit Alberta institution, and that institution will be responsible for the administration of the funds awarded. Other members of the review team may be from outside the province.

The methods section of the proposal should demonstrate the application of principles for reviewing results of research in an unbiased fashion.

Particular attention should be paid to addressing the question of the assessment process and how it will take into account variations in research quality and, in particular, the approach to be used when the "best evidence" is not randomized controlled trials. Much of the most advanced understanding of literature review methods and meta- analysis applies best to randomized trials of interventions. However, many areas of health care do not lend themselves to this sort of study.

• Comprehensiveness of research identification strategy
• Transparency and quality of research selection process
• Adequacy and appropriateness of analysis
• Clarity of presentation methods
• Feasibility

1. Understanding of the content area
2. Understanding of the implications of the determinants of health in this content area
3. Understanding of the process to engage decision-makers in developing a policy context for the review.

The final "State of the Science" report should consist of five parts:

• a single page of bullet points documenting the main messages,
• a single page summary of the policy context of the review,
• a three-page executive summary,
• a full report plus appropriate appendices,
• a PowerPoint presentation including visual summary of key findings. in the health system.

The Foundation will make the review available to all interested parties; the authors of the review are encouraged to submit the document for publication to a peer-reviewed journal.