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首页> 外文期刊>Journal of Health Services Research & Policy >The need for an overall strategy
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The need for an overall strategy

机译：需要总体战略

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I am a firm believer that factors such as local culturenoften play a very important role in the outcome ofnhealth policy decisions and that useful research mustntake this into consideration in assessing the ultimatenutility of health policy decisions. I believe that realistnreviews (as described by Pawson and colleagues) wouldnrepresent the only valid methodology to synthesizeneffectively large, system level questions based on thenbelief that factors such as culture do contribute tonvariation at that level. The interactive and iterativenapproach of the realist perspective would also have anneducational value to all of those involved in theninitiative. This could be true to the level that thensynthesis itself could emulate a Hawthorne effect andnhave an impact on choices. This level of synthesis wouldnbe likely to have an effect upon the current state ofnprogramme delivery because of the high level ofnfeedback built into the methodology.nA system level question would certainly require anlarge team to undertake the synthesis. This could meannthat issues such as effective communication among thenteam would be a major factor in the quality of the finalnproduct. There is no doubt that an iterative process cannalso add significantly to a timeline if there are nonrigorous controls around reframing or making changesnin direction. I would assume that the realist methodologynstill leaves room for the inclusion of othernquantitative or qualitative synthesis techniques beingnutilized. The group has done an excellent review of thenstrengths of the realist approach, as well as thenimportant shortcomings that limit its application. Inapplaud the group for their excellent paper.nMy own perspective is that the iterative nature of thenrealist methodology would add significantly to thenoverall level of confidence in the product. It is quitenlikely that in the process of the review, the managersnand policy-makers would invest significant time andnenergy in familiarizing themselves with the content ofnthe original research that is being synthesized. I believenthe closer this relationship becomes, the higher thenlevel of confidence there will be in the product.
机译：我坚信，诸如本地文化之类的因素通常在健康政策决策的结果中起着非常重要的作用，在评估健康政策决策的最终效用时，必须进行有用的研究。我相信，现实主义的评论（如Pawson及其同事所述）将代表唯一有效的方法，该方法可以基于认为文化等因素确实会在该级别上引起同变的观点来综合有效地处理大型系统级问题。现实主义观点的互动式和迭代式的方法对于所有参与这种方法的人也具有教育意义。在合成本身可以模仿霍桑效应并对选择产生影响的水平上，这可能是正确的。由于该方法内置了高水平的n反馈，因此这种综合水平可能不会影响程序交付的当前状态。系统级的问题肯定需要庞大的团队来进行综合。这可能意味着诸如团队之间有效沟通之类的问题将是最终产品质量的主要因素。毫无疑问，如果围绕重新构图或改变方向没有严格的控制，则迭代过程也可以显着增加时间线。我认为现实主义的方法论仍然为将其他未被利用的定量或定性合成技术包括在内留有余地。该小组对现实主义方法的优势以及限制其应用的重要缺陷进行了出色的回顾。我对小组的出色论文表示赞赏。我个人的观点是，现实主义方法论的迭代性质将大大提高产品的整体信心。很有可能在审查过程中，管理人员和决策者将花费大量时间和精力来使自己熟悉正在合成的原始研究的内容。我相信这种关系越紧密，对产品的信任程度就越高。

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