In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy
Evidence Base in DesignWhen politics and medical science intersect, there can be much debate. Sometimes anecdotes or hearsay are misused as evidence to support a particular point. Despite these and other challenges, however, evidence-based approaches are increasingly used to inform health policy decision-making regarding causes of disease, intervention strategies, and issues impacting society. One example is the introduction of childhood vaccinations and the use of evidence-based arguments surrounding their safety.In this Discussion, you will identify a recently proposed health policy and share your analysis of the evidence in support of this policy.To Prepare:Review the Congress website provided in the Resources and identify one recent (within the past 5 years) proposed health policy.Review the health policy you identified and reflect on the background and development of this health policy.BELOW IS THE QUESTIONPost a description of the health policy you selected and a brief background for the problem or issue being addressed. Explain whether you believe there is an evidence base to support the proposed policy and explain why. Be specific and provide examples.BELOW IS THE REQUIRED READINGRequired ReadingsMilstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.Chapter 5, “Public Policy Design” (pp. 87-95 only)Chapter 8, “The Impact of EHRs, Big Data, and Evidence-Informed Practice” (pp. 137-146)Chapter 9, “Interprofessional Practice” (pp. 152-160 only)Chapter 10, “Overview: The Economics and Finance of Health Care” (pp. 183-191 only)American Nurses Association (ANA). (n.d.). Advocacy. Retrieved September 20, 2018, from https://www.nursingworld.org/practice-policy/advocacy/Centers for Disease Control and Prevention (CDC). (n.d.). Step by step: Evaluating violence and injury prevention policies: Brief 4: Evaluating policy implementation. Retrieved from https://www.cdc.gov/injury/pdfs/policy/Brief%204-a.pdfCongress.gov. (n.d.). Retrieved September 20, 2018, from https://www.congress.gov/Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055-1080. doi:10.5465/AMR.1996.9704071863Sacristán, J., & Dilla, T. D. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice, 21(6), 1014-1017.Tummers, L., & Bekkers, V. (2014). Policy implementation, street level bureaucracy, and the importance of discretion. Public Management Review, 16(4), 527-547. doi:10.1080/14719037.2013.841978PLEASE DONT FORGET TO ADD 4 REFERENCES NOT MORE THAN 5 YEARS old. please make sure to go through the readings before. CORE SKILL: reading a proposed policy and asking the question almost nobody asks — WHERE IS THE EVIDENCE BASE, and is it adequate to justify the intervention?
THE TASK: identify a recently proposed health policy or bill, analyze its evidence base, and evaluate whether it is sufficient.
HOW TO FIND A BILL: Congress.gov, your state legislature’s site, or the legislative tracker of a professional organization (ANA, AACN, AANP all maintain them). Choose something with real nursing relevance — safe staffing legislation, workplace violence prevention, scope-of-practice expansion, telehealth permanence, maternal health bills, Title VIII workforce funding.
WHAT TO EXAMINE — and this is the analytical spine of the assignment:
— WHAT PROBLEM does the bill claim to solve, and is the problem itself well-evidenced? (Sometimes the problem statement is the weakest part.)
— WHAT MECHANISM does the bill posit — how, specifically, is the intervention supposed to produce the outcome? A bill that mandates a thing without a theory of how the thing helps is faith-based policy.
— IS THERE EVIDENCE FOR THAT MECHANISM? Look for cited studies, agency reports, pilot programs, and — crucially — evidence from other states or countries that have tried it. A NATURAL EXPERIMENT already run somewhere else is the single most valuable evidence available and is frequently ignored.
— WHAT DOES THE COST ESTIMATE / FISCAL NOTE say, and on what assumptions does it rest?
— WHO SUPPORTS AND OPPOSES IT, and what evidence does each side cite? Note when both sides cite the SAME literature and read it differently — that is diagnostic of genuinely contested evidence, and identifying it is sophisticated analysis.
THE HONEST CONCLUSION MANY GOOD PAPERS REACH: policy is rarely made on evidence alone, and often the evidence base is thinner than the confidence of its advocates. STAFFING RATIO LEGISLATION is the ideal case study precisely because the evidence is genuinely mixed — Aiken and colleagues provide strong associational evidence linking staffing to mortality and failure-to-rescue, and the California experience provides real outcome data; but the causal inference from observational studies is contested, mandated ratios are a blunt instrument compared with ACUITY-based staffing, and there are credible cost and unit-closure concerns. A paper that engages that disagreement honestly will substantially outperform one that cherry-picks the supporting studies. SAYING “THE EVIDENCE IS INSUFFICIENT TO JUSTIFY THIS AS WRITTEN” IS A LEGITIMATE AND OFTEN CORRECT CONCLUSION — and it demonstrates more analytical integrity than manufacturing support.
THE DISTINCTION TO DRAW: EVIDENCE-BASED policy (the evidence drives the policy) vs. POLICY-BASED EVIDENCE (the policy is decided first, and evidence is recruited to justify it). The second is extremely common. Being able to spot it is the real skill here.
ALSO ADDRESS: whether the bill includes an EVALUATION requirement — a policy enacted with no mechanism to assess whether it worked cannot be corrected, and this omission is extraordinarily common and worth flagging as a design defect.
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