Health systems and policy research evidence in health policy making in Israel: what are researchers' practices in transferring knowledge to policy makers?

BACKGROUND: Ensuring the use of research evidence in health system management and policy decisions is an important challenge in this century. Knowledge transfer and exchange (KTE) has emerged as a paradigm to address the challenges and start closing the 'know-do' gap. This area of work is gaining momentum in most developed countries, yet, to date, no work has been performed in Israel within this area. The purpose of this study was to identify which KTE activities health systems and policy researchers in Israel have undertaken. METHODS: A cross-sectional web-based survey of researchers who have conducted health systems and policy research in Israel was developed. The survey consisted of a demographics section, quantitative scales, and open-ended questions. The survey was sent to all health systems and policy researchers in Israel (n = 125). RESULTS: The study response rate (28%) was relatively low as compared to other studies in the same field (range of 42% to 88%). Our survey found that more than a third of the health systems and policy researchers in Israel reported that they were frequently or always involved in the following KTE activities: interactions with target audience through the research process (i.e., during developing a research question or executing the research; 35% to 42%) or through formal or informal meetings during conferences, workshops, or conversations (40%). Less than half of the health systems and policy researchers in Israel are engaged in bridging activities aimed to facilitate target audiences to use research. CONCLUSIONS: This is a fairly new area in Israel and therefore the level of engagement of researchers in KTE activities is not very high. The low response rates could be because KTE is a new field in Israel and minimal KTE initiatives have been undertaken. It is preferable to have higher response rates, yet, after several initiatives, this was the outcome. While the findings are relevant, they may not reflect the total population of health system and policy researchers in Israel. Health system and policy researchers in Israel need to be introduced to the benefits and potential advantages of KTE in an organized and systematic way.

[OFEK virtual medical records: an evaluation of an integrated hospital-community system].

BACKGROUND: In 2005, an innovative system of hospital-community on-line medical records ("OFEK") was established at Clalit Health Services to reduce costs and improve medical care. GOALS: To examine the utilization of OFEK and its impact on quality indicators and medical-service utilization. METHOD: Examining frequency of use of OFEK with OFEK's own track-log data; "before" and "after" data were used to compare changes in quality indicators and service utilization for experimental versus control groups. RESULTS: Use of OFEK in primary-care clinics increased by hundreds of percent from 2005 to 2006 and continued rising in 2007 and 2008, albeit more slowly. At clinics in hospital catchment areas using OFEK extensively, the system reduced utilization of imaging services and, to a lesser extent laboratory use, and improved several quality measures. Analyses of the data from all catchment areas and from all study clinics revealed much weaker effects. In hospitals, the use of OFEK increased by tens of percent each year internal medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in surgical wards. CONCLUSIONS: The introduction of OFEK affected some of the outcome measures examined. OFEK affects community clinics and hospital wards differently, with more consistent effects in the community. DISCUSSION AND SUMMARY: The study helps assess the extent to which OFEK's targets were achieved. In addition, it contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of electronic-medical-information systems.

The impact of an integrated hospital-community medical information system on quality of care and medical service utilisation in primary-care clinics.

BACKGROUND: In 2005, an innovative system of hospital-community, on-line medical records (OFEK) was introduced in Clalit Health Services (CHS). GOALS: To examine OFEK's use and impact on quality indicators and medical-service utilisation in CHS primary-care clinics. METHODS: Examining the frequency of OFEK's use with its own track-log data; comparing 'before' and 'after' quality indicators and service utilisation of experimental versus control clinics. RESULTS: Use of OFEK increased by hundreds of percent between 2005 and 2006, continued rising at a slower rate in 2007 and decreased slightly in 2008. At clinics in catchment areas of hospitals using OFEK extensively, OFEK reduced the number of imaging tests and, to a lesser extent, laboratory testing and improved several quality measures. An examination of all clinics in the catchment areas and in the study revealed a much weaker impact. CONCLUSIONS: OFEK's introduction affected a number of outcome measures - some, significantly - in medical and financial terms. Its increased use at additional clinics may exert a stronger impact there, too. The study contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems.

The impact of an integrated hospital-community medical information system on quality and service utilization in hospital departments.

PURPOSE: In 2005, an innovative system of hospital-community on-line medical records (OFEK) was implemented at Clalit Health Services (CHS). The goals of the study were to examine the extent of OFEK's use and its impact on quality indicators and medical-service utilization in Internal Medicine and General Surgery wards of CHS hospitals. METHODS: Examining the frequency of OFEK's use with its own track-log data; comparing, "before" and "after", quality indicators and service utilization data in experimental (CHS patients) versus control groups (other patients). RESULTS: OFEK's use increased by tens of percentages each year, Internal Medicine wards showed a significant decrease in the number of laboratory tests and 3 CT tests performed compared with the control group. Wards using OFEK extensively showed a greater decrease in CT tests, in one imaging test, and in the average number of ambulatory hospitalizations. No similar changes were found in General Surgery wards. CONCLUSIONS: The study helps evaluate the extent to which OFEK's targets were achieved and contributes to the development of measures to examine the impact of such systems, which can be used to assess a broad range of Health Information Technology (HIT) systems.