Systematic reviews and health policy: the influence of a project on perinatal care since 1988

Abstract

Context: Interrelated publications between 1988 and 1992 have influenced health policy and clinical practice: The Oxford Database of Perinatal Trials (ODPT), Effective Care in Pregnancy and Childbirth (ECPC), A Guide to Effective Care in Pregnancy and Childbirth (GECPC), and Effective Care of the Newborn Infant (ECNI). These publications applied and advanced methods that had a substantial history in the medical, biological, physical, and social sciences. Their unique contribution was to demonstrate the feasibility of organizing and sustaining programs to conduct systematic reviews across an entire field of health care. The publications also influenced subsequent advances in the methodology of systematic reviews and contributed to their proliferation; in large measure, but not entirely, because their editors and many of the authors participated in organizing and developing the Cochrane Collaboration. This article describes how and why these publications attracted favorable attention and resources from policymakers in numerous countries.

Methods: This article applies historical methods to the analysis of primary sources that help explain the influence of systematic reviews, mainly on health policy. These methods guide an analysis of the rhetoric of the two volumes of ECPC and of primary sources generated as systematic reviews influenced health policy. The analysis of rhetoric employs the methods of intellectual history and social studies of science. The analysis of policymaking uses the methods of political and policy history, political science, and public administration. Because the focus of this article is how science influenced policy it alludes to but does not describe in detail the literature on the methods, production, and publication of systematic reviews.

Findings: The influence of the four publications on policy was mainly a result of (1) their powerful blending of the rhetoric of scientific and polemical discourse, especially but not exclusively in ECPC; (2) a growing constituency for systematic reviews as a source of "evidence-based" health care among clinicians, journalists, and consumers in many countries; and (3) recognition by significant policymakers who allocate resources to and within the health sector that systematic reviews could contribute to making health care more effective and to containing the growth of costs.

Conclusions: Analysis of this aspect of the history of producing and applying systematic reviews informs understanding of how knowledge derived from research informs policy.