The application of evidence-based priority setting in a District Health Authority

Despite the current drive towards evidence-based medicine, it is not clear how commissioners actually use research findings in making decisions on priority setting. This study describes an attempt to directly introduce evidence on the effectiveness of interventions into the annual priority setting process of a District Health Authority (DHA).

Literature searches were undertaken on proposals for Health Authority funding. The identified literature was then critically appraised, and relevant information was used by members of the Department of Public Health to score the individual bids in terms of health gain. These scores were then fed into the priority setting process.

A total of 144 proposals for funding were submitted. For 6.2 per cent of proposals there was strong evidence to support the intervention, for 21.2 per cent there was fair evidence in support, and for 38.1 per cent there was poor evidence. A search was not possible for 16.8 per cent of the proposals. There was a moderate correlation between the strength of evidence for the effectiveness of the proposal and initial scoring of the proposal for health gain (r = 0.41, p < 0.001). At the end of the priority setting process there was no correlation between strength of evidence and priority ranking (r = 0.01, p = 0.97).

It is feasible, but difficult, to use information resources and critical assessment of research evidence as part of the priority setting process of a DHA. The research evidence did appear to influence the initial assessment of proposals. However, the strength of the research evidence was not associated with the priority choices made by the DHA in its purchasing plan.