| BACKGROUND AND AIMSEvidence-based policy making becomes more important. The decision of health policy is mainly decided by evidence, resources and value. Decision makings in healthcare are associated with evidence of health practice, availability of scare resources, and political priority in recourse allocations. With the increasing contradiction between the scare health resources and health care demands, policy transparency and evidence-based decision-making become more essential.The key of the evidence-based policy making is to get the high quality evidences. The evidences of health policy come from various resources which include single research, expert opinions, policy briefs and so on. Validity of scientific inquiry is the key of evidence-based policy, in which systematic review plays an important role. As a traditional systematic review method, Cochrane systematic review has been utilized worldwide.But the method of systematic review has not widely adopted and used in the field of health policy. It is fairly difficult to directly evaluate the results of systematic review in health policy than in medical care because: 1) systematic review in medical care addresses specific clinical issues while health policy covers policy research at both micro and macro levels; 2) the unit of analysis of medical care focuses on patient as an individual, while health policy research studies population or community; and 3) the performance of medical intervention could be assessed by patient outcomes or effectiveness of drug uses, which could be measured by clinical indicators. On the other hand, health policy as an intervention could not be evaluated accurately as it is implemented in a well controlled environment. The confounding factors such as other policies could make the target policy complicated. In addition, the health statuses of study population are harder to measure as opposed to an individual. Therefore, the current systematic review method may be future developed to meet the needs of health policy research.The present study aims to develop methods of systematic review for health policy research, such as how to develop systematic review questions? Which kind of evidence can answer these questions? How to quantify the indicators of evaluations? How to evaluate the validity of evaluation? How to synchronize different evidences? How to interpret the results of systematic review?The purpose of this project is to develop a systematic review method for health policy research based on the philosophy of evidence-based medicine and the uniqueness of health policy studies. The method will be validated and case studies will be conducted based on the method.METHODOLOGYThe present study consists of two sections: method development and case study. The development of systematic review method for health policy research include:①Studied and summarised traditional systematic review methods such as Cochrane review method and Campbell review method; understood the characteristics of various types of studies in health policy.②Conducted group discussions. We organized a systematic review group and discussed the latest development and progress of systematic review weekly.③Attended training programs. We attended training programs sponsored and organized by WHO and MOH of China.④Conducted consulting. We received financial and technical supports from WHO, The University of Liverpool and EPOC group. Mail, teleconference, and group discussion were used to communicate with experts from the aforementioned experts;⑤Performed case studies. We conducted two systematic reviews to validate the method we developed.Methods of the case studies:①Team building. Systematic review team was composed of fixed population, searching experts and theme experts.②Consulting group. It included theme experts, method experts and decision policy-maker.③Working style. Regular discussions were conducted in every week by the group. They will coordinated by two special fixed populations for different phases of systematic review work.④Outcome forms. We will publish publications on Chinese and international journals except finishing the technical reports.RESULTSThe study results include a developed methodology and two case studies. As for the methodology, major development and breakthroughs are listed as following:·Two-phase systematic review method: The first step is to conduct a descriptive systematic review, which describes the present interventions or strategies of the review question, the object of the intervention, the distribution of the current studies, and the associated study designs and so on. Based on the results of descriptive systematic review, we classified complex policy interventions and defined specific interventions to be evaluated by systematic review.·Key technical methods:-Define the question of systematic review. At first, a theoretical framework of a theme is proposed by health policy and health economics experts. The question of systematic review is defined based on the results of literature review, priority of health policy, and most current knowledge.-Design inclusion and exclusion criteria. The first criteria should be considered is the relevance of the theme. Next the target population and the study methods should be considered. If the review question is registered at organizations such as EPOC and Campbell, the study should follow their designated criteria.-Confirm data sources and literature. Data resources include: Social, Economic, Health, psychology and other electronic databases; relevant websites of research institutions and international organizations; major journals relevant to the included studies; unpublished research retrieved through personal contact with the authors; the bibliography of the included studies. The searching strategies are formulated by theme experts, professional searching experts and other review team members. They could be modified after the pilot searching. -Literature Screening. It includes two phases. First, all the articles are screened by titles and abstracts. Then full texts will be screened. Screening and auditing should be done independently by two researchers; any disagreement could be discussed with a third researcher or a group.-Data extraction. Based on the predesigned data extraction form, two researchers will independently extract the key information of selected studies. Any disagreements will be discussed with a third researcher or a group. The contents of the data extraction form includes the basic information of the study, the target population, location, aim of the study, method, data sources, analytical method, major findings, and conclusions.Data analysis. Descriptive systematic reviews analyze qualitative information using analysis methods such as meta-anthropology, theme integration and framework analysis. Systematic reviews on intervention outcomes analyze quantitative information using methods such as meta-analysis and narrative analysis.Review results. Both systematic review method and key technical skills should be discussed.Results of case studies of the two systematic reviews are listed as follows:In the first case study, we conducted "Strategies for Expanding Health Insurance Coverage for Vulnerable Populations" as a descriptive systematic review by analyzing and integrating the results of all related studies based on our theoretical framework. Six categories include: strategy 1 (S1): Changing eligibility criteria of health insurance and making use of legislation or regulation to grant uninsured populations coverage; Strategy 2 (S2): Increasing awareness: making people aware of health insurance scheme, their eligibility and benefits through education and multimedia broadcasting; Strategy 3 (S3): Making premium affordable: Use of subsidy or setting proper premium level to make insurance scheme affordable for eligible populations; reduction of economic burden of vulnerable population; Strategy 4 (S4): Innovating enrollment processs: maximizing enrollment by facilitating enrollment procedure; 5 Strategy 5 (S5): Improving health care delivery: attracting people by covering a wide range of healthcare services, controlling prices of covered services, and/or improving quality of health care; Strategy 6 (S6): Strengthening capacity of management and organization.In the second case study, we conducted "Outreach strategies for expanding children's health insurance coverage" as an evaluation systematic review, only three studies were included, so we just integrated the narrative results. Two key strategies include: strategy 1: providing assistances to the population who is eligible to their health insurance in their application process; strategy 2: Selecting the appropriate location to meet the people who are eligible to their health insurance and informing them about their rights. We also disseminate the health insurance knowledge by sending telephone massages and giving presentations to target population.In the study, we found that few high-quality health policy studies center on health financing. Furthermore, there is not any research conducted in developing countries. Thus we should emphasize researches in developing countries and across different countries.CONCLUSION AND DISCUSSIONSTwo-phase systematic review method in health policy meets both the demands of the evidence-based policy making and development of health policy. Challenges of the method include: materials assessment, research quality and results explain. The scope of health policy research is wide, which result in the difficulty to get them in databases by index; how to explain the systematic review results is another difficulty because it has to cope with the micro background of countries or communities which is hard to get from the articles.; quality assessment is the obstacle to surpass for the evaluated systematic reviews in health policy for the varied research types.This study provides insightful recommendations for researchers of the systematic reviews:①Building up a systematic review group which includes researchers with different education backgrounds and technical expertise;②Following the basic principles and systematic review objectives, including transparency and replication;③Complying with the technical norms of the systematic review so that the screening and data extraction work would be conducted independently by two researchers;.④Documenting the process of systematic review work, and discussing regularly.INNOVATIONS AND LIMITATIONSThere are some innovations in this research :①As for the methodology, it is the first time to figure out the two-phase systematic review method in health policy research, which satisfy both the research characters in health policy and the different needs of the policy making process.②Developed key technology of the method which include the evidence resources, different analysis and integrate methods according to the data characters.③Verify the method by two case studies. To supply evidences for macro policy question by a descriptive systematic review and supply evidences for micro policy question by a evaluated systematic review. On the whole, this research explore systematic review method in health policy and verify it by case studies.There are some limitations in this research. It is important technology to assess the quality of the included researches for the evaluated systematic reviews, we haven't done the work appointing to various studies, because we registered EPOC method and obey their requirements.
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