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Science, technology, fiscal pressures and changing political sentiments are pushing and pulling the Canadian health care system in various directions. In some jurisdictions the scope and speed of change are startling. To deal with these changes, managers and practitioners are exhorted to think better and work smarter.
In the past decade several policy-oriented clinical and applied research organizations have sprung up across the country. Although they are to some degree distinct in mandate, funding, accountability and orientation, all share a commitment to evidence-based decision-making in health care. All generate a steady flow of reports and publications, and all call for a unified approach to evidence-based decision-making among researchers, providers, managers, policy-makers and the public. Moreover, these research organizations are simply the more mission-oriented practitioners of analytic disciplines variously known as clinical epidemiology, health services research, utilization analysis, clinical evaluation and outcomes research. Canada has a rich tradition of academic activity in all these areas, and there is a staggering annual output of new information about how the health care system works and how it might be made better.
In addition, intra- and inter-provincial differences in the organization and financing of health care are now more visible than at any time since the early 1970s. Providers, managers and policy-makers have a major opportunity to learn from this emerging pluralism.
Despite the wealth of information, it is striking how often local and larger policy decisions are made without clear reference to the best available research-based evidence. To some extent, this reflects the political nature of health care: not only scientific evidence but also values and circumstances influence decisions (thereby constituting evidence of a different type). We fully recognize that scientific evidence alone cannot determine individual and public values and macro-level health care policy: the "ought" cannot be derived from the "is." However, we remain concerned that the system still has limited capacity to absorb and translate high-quality scientific evidence into practice or policy-making, even where there is declared adherence to the principles of evidence-based decision-making.
Why is this so? A large part of the problem inheres in the structure of our provincial health care systems. Despite the regionalization of various stripes implemented in 9 of the provinces, there is as yet limited systems integration. A particular issue...