Lomas Jonathan
Canadian Health Services Research Foundation, Ottawa, ON.
Healthc Policy. 2005 Sep;1(1):55-71.
This paper highlights the importance of research synthesis for healthcare managers' and policy makers' questions and the difficulty of generalizing from the methods used to answer clinicians' questions. Social science research has a central role in such syntheses because of the context-dependent nature of managers' and policy makers' questions, which generally encompass a far broader spectrum than the circumscribed "what works?" questions of clinically oriented reviews. A major challenge is in moving from purely researcher-driven processes, which summarize research, to co-production processes, which allow managers and policy makers to join with researchers in interpreting implications for the healthcare system. Additional challenges lie in clearly defining the function, role and objective of the synthesis; handling flexibility around finalizing the question; harnessing a manageable scope of literature to review; adopting rules to select the final sample of research; creating useful messages; and developing a format that is responsive to the needs and preferences of the audience. One inevitable conclusion is that research synthesis for managers and policy makers will, compared to that for clinicians, leave much discretion in the hands of the synthesiser(s). This raises the interesting issue of how to engender, in the absence of "methodological checklists," trust and credibility in both the people doing the synthesis and the processes they use.
本文强调了研究综合对于医疗保健管理人员和政策制定者所提问题的重要性，以及从用于回答临床医生问题的方法进行概括的难度。社会科学研究在这类综合研究中发挥着核心作用，因为管理人员和政策制定者的问题具有情境依赖性，其涵盖范围通常比临床导向性综述中限定的“什么有效？”这类问题要广泛得多。一个主要挑战在于从纯粹由研究者驱动的总结研究的过程，转向让管理人员和政策制定者与研究者共同参与解读对医疗保健系统影响的共同生产过程。其他挑战包括明确界定综合研究的功能、作用和目标；处理确定问题时的灵活性；利用可管理的文献范围进行综述；采用规则选择最终的研究样本；创建有用的信息；以及开发一种能满足受众需求和偏好的形式。一个不可避免的结论是，与针对临床医生的研究综合相比，针对管理人员和政策制定者的研究综合会让综合者有很大的自由裁量权。这就引出了一个有趣的问题：在没有“方法清单”的情况下，如何在进行综合研究的人员及其所用过程中建立信任和可信度。
