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a Center for Home Care Policy and Research, New York, NY
Correspondence: Penny Hollander Feldman, PhD, Visiting Nurse Service of New York, Center for Home Care Policy and Research, 107 East 70th Street, New York, NY 10021. E-mail: pfeldman{at}VNSY.org.
Laurence G. Branch, PhD
For five years, we have been the national program office for the Home Care Research Initiative, a Robert Wood Johnson Foundation-funded program that supports research and analysis intended to improve the knowledge base underlying policies affecting home- and community-based services (HCBS). The initiative has aimed at developing knowledge about more effective strategies for allocating dollars, targeting services, and promoting delivery system efficiency in order to expand access to high-quality HCBS. In our efforts to make the findings of our commissioned work readily accessible to the policy-making community, we have experimented with a number of dissemination strategies and have come to appreciate the complexity of tailoring information for use by different policy audiences.
Thus, we decided to explore the issue of dissemination more systematically, by talking with state long-term care (LTC) policy makers about their research information needs and looking at the activities of groups that actively communicate LTC information (see Appendix, Note 1). We supplemented this "environmental scan" by convening a group of LTC researchers and policy makers to discuss our findings. This forum article reports on the lessons and recommendations that emerged from this process and makes the case—based on the interviews and discussions reported herein—for support of information "brokers" to synthesize, translate, and disseminate important policy-relevant findings for LTC.
The difficulty of communicating complex evidence-based information to policy makers has generated a substantial literature, too voluminous to review in this short discussion piece. One of the classics in the field (Weiss 1977
), written nearly 25 years ago, remains applicable today. Even before the current "information revolution," government staff reported that they were "awash in information, particularly when ... undertaking a new initiative." Thus, their job is "to cut through the mass of information and make sense of it" (Weiss 1989, p. 429). Effective techniques for communicating research findings to decision makers also are described in the literature. These include presenting readily understandable, timely data in visually compelling formats, using illustrative anecdotes where appropriate, sending clear key messages about the meaning of data, suggesting ways to use research findings for answering important policy questions, and establishing relationships of trust and credibility with policy makers and media experts (Coburn 1998; Lomas 2000; Roos and Shapiro 1999; Tufte 1983).
Yet, our environmental scan provides evidence that in LTC—as in other applied research fields—the lessons taught by this literature have not been well absorbed. Undoubtedly, the problems of research dissemination in LTC are exacerbated by the fragmented state of the research community and the limited resources available for both research and dissemination activities—problems that affect all aspects of the field, not just dissemination activities. Despite this lack of resources, this article aims to encourage those in the field of LTC to take the task of information dissemination seriously, both to communicate more effectively within the resource constraints that currently exist and to encourage increased investment in research brokering activities for the future.
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The principal data sources for the scan consisted of (1) a set of semi-structured individual and group interviews, supplemented by limited follow-up interviews to clarify particular points; and (2) a literature review and web search to identify relevant articles and LTC policy information products. The purpose of the interviews was to capture the perceptions of information users, information producers, and information brokers—organizations or individuals devoted principally to translating and disseminating information. The purpose of the literature review and web search was to compare the products created by brokers with policy maker's perceptions of available research and to better understand the missions and activities of the broad range of organizations translating and disseminating research findings.
From September through November 2000, we conducted 34 individual interviews with a convenience sample consisting of: (1) senior state LTC policy makers (e.g., from Medicaid and Aging agencies); (2) individuals from constituent organizations representing policy makers (e.g., the National Governors Association, the National Conference of State Legislatures, the National Association of State Units on Aging); (3) LTC researchers from both universities and nonuniversity-based organizations that conduct policy analyses and serve as information resources for policy makers; and (4) representatives of organizations or programs whose primary mission is the dissemination of evidence-based policy-relevant information to the policy-making community (e.g., the Agency for Healthcare Research and Quality's User Liaison Program, the Academy for Health Services Research and Health Policy). We also conducted a group discussion with six researchers in LTC and a number of supplementary interviews to clarify particular points. The interviews lasted, on average, between 45 and 60 minutes. (A full list of individuals participating in the survey can be obtained from the first author.)
Conference
In December 2000, we shared a draft paper summarizing the results of the environmental scan with a group of 34 LTC researchers and policy makers who attended the annual meeting of the Home Care Research Initiative. In three plenary sessions and a set of smaller breakout groups, the conference participants reviewed, questioned, and amplified the findings of the scan. They also outlined a variety of practical strategies for addressing problems or issues identified, discussed barriers to achieving those strategies, and proposed ways to overcome them. This article incorporates the input of the conference members.
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; Greenberg, Mandell, and Onstott 1995; Lomas 2000; Roos and Shapiro 1999; Shulock 1999; Weiss 1977, Weiss 1989; see Appendix, Note 2). First, policy makers seek and prefer to use information obtained directly from trusted sources, preferably from sources with immediate knowledge of their state's circumstances, priorities, and needs. The substance of such information is generally perceived as more convincing and more readily applicable to current or anticipated policy problems than "undigested" information obtained from the academic literature. Second, effective dissemination is not simply about format and packaging; translation of research findings is also key. This means that findings must be presented in clear language that is free of research "jargon." Furthermore, effective translation requires that researchers think through and articulate unambiguously the policy implications of their work. Researchers who would influence policy makers must recognize that preliminary but timely results are more likely to have an impact than more definitive findings published long after a policy must be formulated or a program implemented. Finally, effective communication recognizes the glut of information facing policy makers and the lack of time they have to digest it.
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"Local" sources are most trusted by state policy makers, in part because their information is more readily applicable.
Over half of the policy makers interviewed responded to our question about information sources by referring first to information generated from within their state. One policy maker did not cite a single source of information that was not local, except for policy makers from other states. Another said, "often the research we do, and use, is our own. Nothing works better with legislators and others than local, current information." Two other respondents commented on the general distrust of data evinced by politicians in their respective states. One said, "our state is leadership-driven, not empirically driven," whereas another said, "we're not very data-driven"—yet both explicitly excepted their respective state's internal information and data sources from the general level of political skepticism. Others cited consumer input, provider groups, and planning committees as sources of information that were important to them. The fact that this information is local is what makes it so convincingly relevant; this type of information has little or no need to be translated to reflect the state's circumstances. Furthermore, because the source is well known by both policy makers and those they need to persuade, the accuracy of such information is more likely to be trusted.
Peers and experts are also preferred information sources.
When asked where they went for information on LTC, many state policy makers said they rely on informal contacts with peers—that is, policy makers in similar positions in other states—or a handful of nationally renowned experts in the field. This propensity to rely on informal information sources is a result of a combination of needs: the need to trust the source; the need to cut through the information glut; and the need to obtain information that is tailored to respondents' circumstances. For example, the peers considered most useful were those who struggle with problems similar to those faced by the respondent, rather than those from "model" states; similarity of circumstance ensures that the information provided is relevant. Peers also provide information shortcuts—why research a topic when a peer might have the information at hand? This need to use shortcuts also explains the reliance on selected leaders in the field who are researchers with national reputations or individuals who can readily link up respondents with other reliable information sources, as researchers from the National Academy for State Health Policy (NASHP) often do. In particular, policy makers appreciate the expertise of researchers who speak plainly and make themselves available to work directly with policy makers to meet the needs of their particular state.
Poorly translated information is not often used.
Researchers and policy makers do not generally speak the same professional language. As one of our conference participants observed, "researchers are from Mars; policy makers are from Venus." In both their written and verbal communications, LTC researchers are apt to speak the language of "independent" and "dependent variables," "error," "variance," "interaction terms," "endogeneity," "selection bias," "quality-adjusted life years," and the like. On the other hand, LTC policy makers in the executive branch of government are preoccupied with Medicaid waiver slots, "administrative match," "state only" programs, Olmstead provisions, and the like. Elected politicians, in turn, tend to focus on "doing what voters want," which, according to one respondent, consists principally of avoiding institutionalization—the "ultimate bad LTC outcome." Legislators' sensitivity to multidimensional LTC outcomes is minimal and their interest is even less. No wonder, then, that policy makers thinking about changes to their state's LTC system do not rely heavily on research reports produced by academic researchers or published in academic journals. Undigested LTC research is reportedly used most often if a state has dedicated staff who can devote time to culling the research literature and applying it to their own policy analyses.
Policy makers report frustration with researchers' unwillingness to articulate clearly the policy implications of their research—to "go out on a limb" and make policy recommendations based on their findings. These criticisms were not limited to publications in academic journals, but included many of the products generated by think tanks, government organizations, and policy centers (notable exceptions were the products of the General Accounting Office and AARP, which were universally praised). Policy makers do acknowledge the importance of well conducted research and even understand researchers' need to produce the "best" research possible. However, they also emphasize their need for timely information (one said, "we know we will always be acting on imperfect information") and encourage researchers to be more forthcoming with preliminary results.
Policy makers strongly prefer information that is concise, current, hits the main points, discusses the implications of research findings, and contains information that enables them to follow up if interested.
Research that meets academic standards was criticized on the grounds that it is not timely, its format is inappropriate, and its relevance to policy makers' needs is not clear. It was complained that information in most research publications tends to be dense, with the findings hidden in the text. Policy makers' views on printed information sources are very consistent. Format and timeliness are essential. "Optics are paramount," noted one policy maker. If the format is a research brief, it should be short and contain simple, clear graphics that can be used without alteration. Products that meet these requirements were highly rated and, according to our respondents, actually used. On the other hand, respondents reported that they rarely use the web because finding information is too time-consuming, and the information found is rarely exactly what is wanted. Web searches are delegated, if possible.
Conferences are a pr eferred means of obtaining information.
This finding is not surprising, given policy makers' preference for information from trusted, informal sources and their need to use shortcuts to navigate through information overload. The conferences that were praised, however, were the smaller, more focused conferences. In particular, respondents noted the importance of restricting attendance to "good people." They also liked conferences that helped them look ahead to anticipate upcoming problems and alert them to possible policy responses. Many of the larger, more well-known conferences were avoided because they focus too much on programmatic or operational issues, rather than on strategic planning or conceptual issues.
Policy Makers' Substantive Research Needs
When we asked policy makers about the areas where they felt research was lacking in LTC, they most frequently expressed the desire for data on "what other states are doing." Policy makers want to be able to compare their state with others; to do so, they need both data that allow comparisons to be made and a framework for making comparisons. They also value evaluations that show "what works and what doesn't work." Reliable and timely quantitative data that will allow valid and ongoing cross-state comparisons of LTC service use and expenditures are generally perceived as necessary but lacking. Policy makers also want to be updated on other kinds of comparative information, such as systems changes that are being implemented or are under discussion in other states, information that is not typically the result of academic research. Such information falls into several categories: descriptive program information, technical information, referrals to other information sources, and news about state practices, legislative changes, and other events that might affect the demand for or supply of LTC services.
Many of these policy makers' information needs reflect the importance they place on anticipating the future. For example, many policy makers listed workforce issues among the important areas where research needs to be done, along with needs for information about other demographic parameters likely to affect the supply and demand for LTC, such as the future availability of informal support. Other key issues were the development of housing opportunities for people needing HCBS, with particular interest in a host of issues related to promoting, regulating, and measuring quality of life and quality of care in assisted living facilities and related settings. Several policy makers said they needed research on how to respond lawfully to the Olmstead decision.
Other information needs are persistent and apparently enduring. For example, policy makers said they need research that addresses the cost-effectiveness of HCBS. They also want help in developing, structuring, and managing HCBS and often requested research on the efficacy of particular tools to help them do this—such as assessment tools and quality indicators. In particular, they expressed interest in research on different ways of integrating care, whether this be through capitation or other managed care mechanisms. Research on effective methods to keep people out of nursing homes was another favorite topic, as was the question of how to increase consumer choice in HCBS. Few policy makers expressed interest in research on LTC insurance, reflecting, perhaps, the failure of Congress to extend to states not participating in the original "Partnership for Long-Term Care" permission to relax Medicaid spend-down requirements for purchasers of private LTC insurance (see Appendix, Note 3).
The Brokering Environment in LTC
Strictly speaking, brokers are "middlemen"—mediators between the providers and end users of a product. Thus, if seeking information on applied policy research, we would expect an information broker to be an independent bridging organization that links the two distinct worlds of research production and policy making (Feldman, Gold, and Chu 1994, Feldman, Gold, and Chu 1997). Such bridging organizations do exist in the LTC field. However, a more striking observation that emerged from our environmental scan is the fact that a host of other organizations have developed or attempted to develop their own information brokering capacity. A number of membership organizations that represent state policy makers include brokering activities among their services to constituents, focusing on topics important to their membership. Furthermore, many individual researchers and research organizations both produce research and engage in a variety of dissemination activities, although generally limited to the information produced by in-house researchers. Finally, some foundations, advocacy organizations, and government agencies sponsor research from both in-house and outside researchers and disseminate the results of those studies. This diverse range of LTC brokering organizations reflects the fragmented state of LTC research.
Table 2 shows examples of the many groups that to some extent act as LTC information brokers. To a greater or lesser extent each has attempted to develop some capacity to bridge the communications gap between the individuals who produce analytic data and the politicians and policy makers who are potential end users of such data. (See Appendix, Note 4.) Table 3 shows some of the parameters along which broker groups vary.
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University-based and free-standing research centers focus primarily on conducting research (often in certain specialized areas). They also may work to translate and disseminate their research findings, but they typically devote proportionately few resources to these activities.
"Bridging organizations" truly act as middlemen. They tend to do little in the way of original research but focus primarily on identifying important policy issues and conveying policy-relevant information—some, but not all, research-based—to policy makers and politicians. Bridging organizations often work through standing or ad hoc committees of policy makers to identify key issues and needs. Some have their own in-house analytic or research staff to synthesize and translate existing research or conduct policy analyses, whereas others contract with outside researchers to do so. Some provide a good deal of news and technical assistance, and others focus on disseminating more formal analytic work. Although most have a health policy specialty, relatively few specialize in LTC issues per se.
"Constituent" or membership organizations, such as the National Governors Association or the National Conference of State Legislatures, tend to differ from bridging organizations in their closer proximity to and dependence on the states for organizational and financial support. Similar to bridging organizations, they work to identify important policy issues, provide useful information to their members, and they may employ their own analytic staff. However, constituent organizations usually must spread staff and resources across a host of issues and activities, both health and nonhealth related. For both types of groups, the function of research translation tends to wax and wane depending on the time constraints and skills of available staff, as well as on the success of efforts to secure outside funding for this purpose.
Academic researchers and research institutions warrant further discussion, because so many features of the academic environment make it likely that the information produced by academic researchers—both in and outside of academia—is unsuitable for or less easily available to policy makers. First, researchers' intended audience is usually other researchers; their preferred medium is peer-reviewed journals or presentations at academic conferences. There are strong career incentives to preserve this status quo and very few incentives, beyond the intrinsic rewards of influencing a particular program or policy, for researchers to translate their findings into policy-relevant terms or disseminate their findings more widely; also, few resources are available to help them do this. One of the researchers who participated in our conference commented: "Why would we think researchers are the people to influence policy? Applied researcher is an oxymoron."
The preceding quote notwithstanding, some individual researchers do reach out successfully to policy makers. Many more, however, lack the skills and tools needed to do this and would need significant support to make their work more readily accessible. However, there are few resources that would help them. For example, university communications departments are more likely to be geared to potential donors than to policy makers in a particular substantive policy area. Nonacademic research institutions tend to do a better job, especially to the extent that policy makers are seen as potential or ongoing customers or purchasers of applied research services. Even these institutions, however, often present their work in formats that conform to academic norms of focus and presentation.
Systems Issues in Brokering
As described above, the brokering environment in LTC is dense and diverse. These characteristics make generalization difficult: For each assertion, a valid qualification can be made. Nevertheless, several themes emerged from our interviews (Table 4 ).
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State policy makers in LTC are often not a key target for brokers.
Because LTC is located in different agencies in different states and because brokers tend to cover a range of topics, state policy makers in LTC may not be seen as key members of a broker's target audience. However, there is some evidence that LTC is becoming a higher priority outside its "natural" constituency (i.e., the agencies responsible for administering LTC services)—specifically, among legislators' and executives' offices. Several respondents reported that more and more of these policy makers are asking for information on LTC, and some constituent organizations are responding. Both the National Governors Association and the National Conference of State Legislatures, for example, have recruited staff with LTC experience and have developed some capacity to address aging- or disability-specific issues along with the other issues they routinely address. Other groups that specifically target LTC policy makers on an ongoing basis, such as the NASHP and the National Association of State Units on Aging, also must spread scarce resources across a range of activities of which research translation is not necessarily the highest priority.
Mechanisms for dissemination often miss the mark.
Common mechanisms for communication are often seen by policy makers to be missing the mark—a situation that should not be surprising, given that few of the brokers interviewed reported systematic evaluation of their brokering efforts. As noted previously, reports and other information produced by foundations, research institutions, and some government agencies were criticized for being too academic in nature. Information in general is often too dense and copious—policy makers find it difficult to pick out relevant and useful information. Websites were seen as difficult to locate and navigate, as well as often out of date. Finally, many conferences were criticized as being too focused on operational, rather than strategic issues. Why, then, do brokers persist in using these mechanisms? Brokers reported that they were often chosen on the basis of ease, cost, or at the behest of funders.
Brokering activities devoted to LTC are often sporadic and funding is erratic.
Groups that are able to devote resources to research translation and dissemination tend to be groups that cover a range of topics in health policy. Although some of these do attend to LTC issues consistently, more often attention is paid to LTC when, for some reason, the issue becomes "hot." Thus, attention to LTC issues depends not only on the range of non-LTC issues that must be covered or the interests and expertise of a broker's available staff but also on what the national media are covering at any given time. Moreover, few broker groups that specifically focus on LTC have resources that match those of larger groups, with the notable exception of AARP's Public Policy Institute. Furthermore, the predictability and availability of funding for LTC information makes dissemination problematic, because many brokers in LTC rely on soft money.
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, Weiss 1989 and others (Albaek 1995; Greenberg et al. 1995; Shulock 1999) have argued that such mismatches are attributable in large part to the tendency of social scientists to assume that policy makers follow a linear, "rational choice" decision-making process, whereby information is first collected and synthesized and decisions then made "on the merits." These scholars have observed, instead, that formal analysis feeds into a much larger, nonlinear political process of decision making, where the influence of evidence-based information is heavily dependent on its perceived relevance to political debate and public discourse. It follows that researchers and others who hope to maximize the use of research information must adapt themselves to this reality. The policy makers interviewed for this research would concur. As one conference participant noted, "research projects end, but politics endures." Policy makers made it clear that their use of research-based information is for the most part contingent on its translation into simple, understandable terms that make it germane to the problems they face and that enable them to persuade legislators and gubernatorial staff of its relevance to their political agendas.
Two related needs expressed by policy makers were to navigate the information environment and to anticipate issues that are likely to arise in the future. These needs point to the importance of synthesis and translation—that is, activities and products that pull together evidence-based information (thus helping policy makers to navigate the information glut) and interpret its meaning for policy formulation and planning for the future. Synthesis and translation, however, are but two—albeit key—components of any strategy intended to improve the overall information-brokering environment in LTC. Complementary efforts to bridge the terminological, cultural, and professional divide between researchers and policy makers should also be an important component of any strategy designed to improve the use of evidence-based information for LTC. These and other strategic objectives are outlined in Table 5 .
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Funders could address each of these factors. They could be more explicit about their expectations regarding translation and dissemination and be willing to provide the funding and/or technical assistance to facilitate it. Through consistent funding over time they could facilitate expertise-building by selected brokering entities; they could also facilitate "branding," a characteristic of successful brokering organizations that is discussed below. Dedicated, predictable support for synthesis, translation, and sophisticated dissemination of LTC research information would make it possible to improve vehicles for communication and help policy makers manage the information glut.
Improving Vehicles for Communication
Much more attention could be paid to mechanisms for communication when making LTC research findings available to policy makers. Good communicators recognize that writing for policy makers is a specialized skill that requires dedicated resources. A major contributor to AARP's success as a broker is the time and attention it expends in making its reports easy to read. The products from the National Academy on an Aging Society also reflect in-house expertise in report production. The General Accounting Office requires its staff to undergo writing courses to help ensure the production of clearly written products and employs editorial staff to help this process. Although in some instances it may make sense to teach researchers to do the synthesis, translation, and dissemination of research, in others it may be more expeditious and cost-effective to employ others to perform or provide support for these functions.
Meetings and conferences are another mechanism cited as being important to policy makers. However, few of the policy makers interviewed were able to identify meetings that were consistently useful, indicating that more work needs to be done to make meetings suitable for them. They recommended that conferences be small, focused, and attended by carefully selected individuals. As one said, in good meetings, "I stretch my mind and grow" and "learn more in two days than I would on the web" through the "back and forth dialogue" with others. To be successful, such events must be carefully designed and implemented to address topics of mutual interest, to rely on written materials that reflect the principles of good research translation, and to incorporate techniques for surmounting barriers resulting from the different "languages" that researchers and policy makers use to describe their work.
Another mechanism that could be strengthened is the relationship between local research centers and policy makers (Coburn 1998). Local research centers that have ongoing relationships with state agencies can work proactively to provide policy makers with advice that is informed by research findings and is sensitive to the culture, history, and ways of doing business particular to an individual state.
Helping Policy Makers Manage the Information Glut
Activities and products that synthesize and summarize a range of research findings are a helpful means of managing information overload, one of the most important realities for policy makers. Such activities and products should aim to survey the range of research findings on important questions, identify areas of convergence and disagreement, and spell out their policy implications. Policy makers can then act on the best evidence available, avoiding the need to assess individually research that is often conflicting, technical, and dense. Well-translated synthesis activities help policy makers see clear links between research findings and policy-making solutions. Syntheses also help researchers identify those areas and questions calling out for additional research.
"Branding" by information brokers is another practice that helps policy makers manage information overload. Organizations such as the AARP Public Policy Institute, that establish a clear identity, or "brand," by demonstrating a commitment to effective brokering over the long haul, help policy makers navigate the information glut because they are a recognizable and reliable source of information for certain identifiable subject areas. Given limited time and scarce staff resources, policy makers often turn first to a familiar source in the hope that their immediate question can be answered. It follows that successful branding is a virtue, if not a necessity, for brokers seeking to reach a large policy audience.
Recognizing the value of clearly identified information brands, some policy makers (and brokers in some bridging organizations) wistfully long for a one-stop shop or clearinghouse to help them manage information overload. Although it seems unrealistic that any one group could become a source of information on all LTC research—let alone other types of LTC information—a group could realistically provide a current awareness service focusing on recent research findings and, perhaps, ongoing projects of interest as well as referrals to a network of policy researchers. Such an enterprise would likely require substantial resources and would need to navigate carefully among existing brokers' established activities and areas of expertise. Moreover, it would only be seen as useful if the information were carefully edited to meet policy makers' needs and produced quickly by a source that had credibility in the policy-making community (and presumably the research community, as well).
Bridging the Gaps Between Researchers and Policy Makers
A major theme that emerged from both our interviews and our conference was the detrimental effect of the linguistic, cultural, and professional divide between researchers and policy makers. While they acknowledge these barriers, members of both groups see great potential for improved communication leading to greater use of research-based information. Bringing researchers and policy makers together helps make researchers' work more policy-relevant (Coburn 1998). "Such meetings make it possible to see what assumptions are operating regarding certain issues, to identify which options need to be explored, and determine what kinds of data are seen as most meaningful" (Roos and Shapiro 1999, p. JS300). Furthermore, involvement of policy makers early on maximizes the likelihood that they will use the research in their work—"bringing decision makers who can use the results of a particular piece of research into its formulation and conduct is the best predictor for seeing the findings applied" (Lomas 2000, p. 237; see also Schalm and Semradek 1994; Weiss 1977). An additional benefit of involving policy makers in the research process is that policy makers and researchers may thus develop relationships that extend far beyond any one research project.
One valuable bridging activity can be the involvement of outside researchers in developing and strengthening existing state infrastructure to turn already available data into useful information for policy. For example, in Michigan researchers were brought in to help design a new LTC targeting system (Fries, B., personal communication, University of Michigan, 1996); in Rhode Island a research group has been working to help the state develop an internal program monitoring and evaluation system (Allen, S., personal communication, Brown University, 2000). Such arrangements have the benefit of building state capacity while at the same time exposing LTC researchers to the real world problems to which their research skills and insights are applicable.
Because policy makers in LTC rely heavily on interpersonal contacts for information, those who build formal or informal relationships with both local and national researchers have easier access to information than those who do not. Where such relationships exist, finding information may be as simple as placing a call to a friend or colleague, or it may involve a more formal process of commissioning a study to be conducted through a competitive process. Linkages formed around particular state-specific research projects that are, in effect, commissioned by policy makers are generally perceived as the most policy-relevant; however, such research can be costly to fund, and not all states have budgeted funds for such activities.
As discussed earlier, conferences, workshops, and other meetings that are carefully tailored to facilitate communication across the professional divide can be an effective and relatively efficient way to build researcher–policy maker linkages. In addition, interview respondents and conference participants suggested several other mechanisms designed to build trust and facilitate collaborative agenda development. One conference recommendation was to develop targeted researcher–policy maker training programs to develop "common pathways" for skills and language. Another was to fund research–policy fellowships that would allow two-way movement, that is, for researchers to spend time in government and policy makers to spend time in an applied research setting. Distance education and "virtual" fellowships were two additional suggestions.
Improving the Production of LTC Policy-Relevant Research
Many important policy questions remain unanswered in LTC. The most common frustration expressed by the policy makers we interviewed was the lack of routinely collected, uniform, and robust state-level data to allow systematic, valid comparisons of how well the LTC system is working in states with different LTC policies. Researchers, in turn, observed the lack of ample, predictable LTC research funding—from government or foundations—for comparative or other policy-related purposes. Both groups agreed that in order to stimulate such funding it would be important to make a compelling case for the importance of LTC research findings both past and future. A number of examples of path-breaking, influential research were cited, including development of the ADL/IADL measurement system (Katz, Ford, Moskowitz, Jackson, and Jaffe 1961), the development of the nursing home Minimum Data Set (Morris, Hawes, Fries, Phillips, and Mor 1990), and the home health Outcomes Assessment and Information Set (OASIS) (Shaughnessy, Crisler, Schlenker, Arnold, and Kramer 1994). This research may consist of developing new techniques and tools, evaluating pioneering programs, and/or developing frameworks and identifying policy patterns and developments over time. Some of these efforts could be facilitated by helping states to improve their own ability to conduct research. Virtually all such efforts have the beneficial side-effect of forming useful researcher–policy maker contacts—as do overtures made by individual researchers who seek state data or other state-specific information for national research studies.
Strengthening System Capacity to Anticipate and Identify Emerging Policy Problems and Issues
In the end, policy makers seek to reduce uncertainty. They want to understand the many factors—some under their control and others not—that affect their ability to shape and deliver LTC services. These include demographic changes, legislation, regulation, and court decisions. They also include evidence of the efficacy of service delivery systems, models and targeted interventions, as well as methods and tools to manage services. To the extent that researchers wish to influence policy and facilitate good outcomes, they need to be aware of these factors in order to respond to policy makers' needs. A variety of mechanisms can be and, at any given time, are being marshaled to identify likely or emerging problems and issues. They range from the use of quantitative models and national surveys to the use of key informant interviews, site visits, and other qualitative methods to the use of expert panels, "summit" meetings, visioning, and other group techniques. To be truly useful, we believe, the findings of these various information-producing activities should be synthesized and translated for policy makers' use. In addition, they should be used to guide, at least partially, the development of future policy–research agendas and scanning efforts.
Our research findings deliver a useful reminder to those who think that producing good research is sufficient to improve the shape of LTC. The policy makers who contributed to our environmental scan told us, loud and clear, that academic-quality research is not reaching them. Therefore, more effort must be devoted to the task of synthesizing, translating, and disseminating research information to policy makers. Funders can contribute to this effort by considering ways to alter systematically the incentives and support provided to researchers and by committing dollars and/or technical assistance explicitly to brokering organizations and activities. Brokers can try to listen to policy makers' needs more carefully and focus on more effective mechanisms for communicating with them. And lastly, researchers can make efforts to include policy makers more directly in the process of formulating research questions and objectives, so that their research agendas more closely track the policy concerns of those who are responsible for the future of LTC.
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Acknowledgments |
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Received for publication February 1, 2001. Accepted for publication March 1, 2001.
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, Feldman, Gold, and Chu 1997 discussed the importance of developing such bridging functions within state government to promote the use of internally produced data for state health policy making. The Forum
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 P. H. Feldman, P. Nadash, and M. Gursen Researchers From Mars, Policymakers From Venus Health Aff., July 1, 2002; 21(4): 299 - 300. [Full Text] [PDF]
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