From evidence to policy on a national level – supporting the government’s role in a learning health care system

Article type
Authors
Hultcrantz M1, Hall U2, Lagerstedt K3, Richter Sundberg L4, Larsson L5, Hellberg L2
1Swedish Agency for Health Technology Assessment and Assessment of Social Services
2Ministry of Health and Social Affairs
3Health and Social Care Inspectorate
4Umeå University
5Lund University
Abstract
Background: In August 2018, the Swedish government appointed a special investigator to support a national ecosystem for evidence-based health care. In November 2019, the inquiry received an additional task now focusing on follow-up to enable a more strategic, evidence based and long-term sustainable management of health care on a national level. Since health care systems around the world face similar challenges, we believe the results of the investigation are highly relevant for a broader audience.

Objectives: To analyze how governmental agencies better can support a comprehensive follow-up of health care and thereby create a learning system on a national level. This includes following the effects of the government’s initiatives and reforms and analyzing where future governmental interventions are needed.

Methods: The investigator and her team have worked with an expert committee including representatives of governmental agencies, healthcare professions and healthcare providers, as well as a reference group of patient representatives. Additional information has been collected through questionnaires, workshops and meetings with stakeholders and other governmental inquiries working on related topics. Background information was collected from published research, governmental reports, existing regulations etc.

Results: Although roughly estimated more than 1,000 fulltime government employees work with follow-up in Sweden, the quality, effectiveness and equity in health care is not improving at anticipated rate. Our findings suggest that a coordination of the different initiatives is a prerequisite for creating a learning system on a national level. Key challenges arise in the interface between evidence and policy. At the Colloquium, we will present possible solutions to these challenges using the Swedish health care system as an example.

Conclusions: Although a lot of efforts are made in conducting and developing methods for evidence generation, implementation and follow-up, it is apparent that the full value for patients is not reached. Facilitators are needed for a learning system on a national level, where the government’s initiatives efficiently contribute to an increased quality, effectiveness and equity in health care. Sharing experiences from national efforts can be one way of increasing the understanding of what these facilitators are.

Patient or healthcare consumer involvement: We have received valuable input through regular meetings with a reference group of 6 representatives from different patient organizations throughout the work. The expert committee linked to the investigation also included a patient representative adding important perspectives to the discussions.