Using Evidence to Improve Healthcare Delivery Systems

If pressed to identify the person or persons who has most directly affected their health and healthcare, most people would name their family members and friends, along with doctors, nurses, and others they’ve encountered at clinics or hospitals. Few would identify a politician or other policymaker because health policy is made far from the bedside. Yet the enactment of health policies can be transformative to the practice of medicine and the delivery of healthcare. For instance, in 1946, US President Harry S. Truman signed the Hospital Survey and Construction Act (also known as HillBurton), providing federal grants and guaranteed loans to improve hospital systems, vastly increasing the availability of hospital services throughout the nation. On July 30, 1965, US President Lyndon B. Johnson signed into law amendments to the Social Security Act authorizing the creation of Medicare and Medicaid insurance, providing accessible and affordable healthcare for untold numbers of poor, disabled, and older Americans. Most health policy initiatives are not as far-reaching as the Hill-Burton Act or the Social Security Act. Rather, they are enacted with specific objectives in mind. For instance, the New York City Department of Health and Mental Hygiene initiated 2 policies explicitly designed to improve public health by focusing on people’s behaviors: banning indoor tobacco smoking in any public space and prohibiting the use of trans fats in food preparation by all restaurants and retailers.1,2 Many more health policy initiatives focus on the healthcare delivery system, including the care provided by doctors, nurses, clinics, hospitals, and shortand long-term care centers. Health policy research generally attempts to determine the success or failure of policy initiatives, focusing on the complex, bidirectional interaction between policy and health. This inquiry is often conducted by interdisciplinary groups of investigators, taking advantage of the varying perspectives offered by physicians and nurses, economists and epidemiologists, psychologists and sociologists, political scientists and statisticians, and advocates and administrators. The field is quite heterogeneous; health policy research subjects include healthcare coverage, access and costs, markets and financing, public and private health insurance, management and organizations, disparities in care, knowledge implementation, and quality of care delivered by physicians, hospitals, and longterm care facilities among many others. Nevertheless, this research is distinguished by its attempt to characterize and examine health and healthcare delivery in the context of enacted health policies to inform future health policy. The purpose of the present commentary is to provide a general orientation to health policy research for a cardiovascular readership, as we discuss how to use evidence from this field of inquiry to improve healthcare delivery systems, emphasizing examples from the cardiovascular literature. We will begin by describing the objectives of policy research, offering 3 distinct purposes for which health policy research is often used. Afterward, we will describe methodologies best suited for policy research, followed by several main challenges currently facing the field. Finally, we will conclude by discussing the importance of conducting health policy research.