The role of data and research is highly valuable in understanding a health policy issue and in developing a solution to the problem. It assumes that health policy driven by an evidence base will link the evidence, policy solution, and the significance of the situation. However, evidence may support opposing views of a policy solution. For example, will expanding access to care for the poor increase or decrease costs? There is evidence that supports both sides of this policy debate and the cost shifting currently in place for most delivery systems makes it difficult to ascertain which view is correct.
Another barrier to crafting policy is that there can be a lack of clarity about the evidence that is needed. Nurses generally understand that evidence-based practice is based on science. However, there is a hierarchy of what constitutes evidence from scientific inquiry that ranges from systematic review, randomized controlled trials, cohort studies, case control studies, cross-sectional surveys, case reports, expert opinion, and anecdotal information (Glasby & Beresford, 2006). This hierarchy can make it difficult to reach an agreement among stakeholders, policymakers, and the public about what evidence is appropriate for health policy. As noted by Hewison (2008), practitioners and consumers may be at odds over which type of evidence is the more valuable. New evidence may need to be 70developed before one can move ahead with a policy recommendation that may include evidence informed by input from community stakeholders.
Despite the debate over what constitutes evidence and which evidence is relevant for health policy, health services research (HSR) can be very effective in developing policy options. HSR is a far broader form of research than clinical research in that it is a multidisciplinary field of scientific inquiry that looks at how people gain access to health care, how much care costs, and what happens to patients as a result of this care. The main goals of HSR are to identify the most effective ways to deliver high quality cost effective safe care across systems (Agency for Healthcare Research and Quality [AHRQ], 2013a). These include issues such as the restructuring of health services, human resource use in health care settings, primary care design, patient safety and quality, and patient outcomes. For example, Linda Aiken’s work on safe staffing (Aiken, 2007; Aiken et al., 2002), Mary Naylor’s work on transitions in care for older adults (Naylor et al., 2004), and Mary Mundinger’s work on the use of nurse practitioners (Mundinger et al., 2000) are widely cited in policy literature. There has been an increase in comparative effectiveness research, which uses a design to inform decisions about Medicare. It uses a range of data sources to compare the costs and harms of various treatment decisions and is commonly used to study the cost effectiveness of drugs, medical devices, and surgical procedures (AHRQ, 2013b).