management and palliative care, policymakers and researchers alike can work together to generate policy solutions by using and expanding the existing evidence base. Finally, policy recommendations on subjects like malpractice reform and long-term care reform may require more rigorous analysis prior to implementation. Building on the results of this study, future research at the Stern Center of Evidence-Based Policy will focus on: • Policy-focused systematic reviews to identify timely interventions that effectively improve the cost and quality of healthcare. • Pilot Studies of cutting-edge interventions that are likely to reduce healthcare utilization costs and improve health outcomes; • Modeling of policy options to demonstrate the effects of evidence-based policy choices on long-term socioeconomic trends affecting providers and patients; and • Dissemination of policy recommendations based on rigorous evidence to a broad range of policy stakeholders at multiple levels of government. Addressing the Health Needs of an Aging America | 32 Addressing the Health Needs of an Aging America | 33 Appendix A: Research Methodology This study resulted from a two-year combined effort of a multidisciplinary research team to identify, without bias, the universe of scientific evidence and policy recommendations that may reduce healthcare costs and maintain or improve health outcomes in the target older adult population. Scoping Study The objective of the scoping study was to use existing systematic review techniques to scan research articles from across the entire domain of published biomedical and health services literature in order to capture all possible healthcare interventions that are relevant to older adults and aim to reduce costs while maintaining or improving quality of care. Our study was comprised of three phases. 1. Researchers used PubMed to identify systematic reviews and individual studies that were published following passage of the Affordable Care Act (2010-2014). From an initial database of studies that met age and economic criteria (n=404,472), researchers identified all systematic reviews (n=3,109) and individual studies (n=60,082). All individual studies in the top 5% of highly cited articles as well as a random sample of 5% of articles added to PubMed in their publication year were then identified (n=1,876). 2. All studies that were relevant to older adults, included cost and clinical outcomes, and contained interventions were included for review (n=1169). Policy Scan Building on major studies by the Patient-Centered Outcomes Research Institute (PCORI) and the Institute of Medicine (IOM) and parallel work by McCabe et al. (2007), the Policy Scan identified actionable policy recommendations relevant to the healthcare of older adults in the United States from a diverse set of relevant organizations.39 We defined relevant organizations as those whose central purpose is to advocate and/or conduct research, or lobby commercially, in the area of healthcare, health outcomes, or physical wellness of older adults. This included advocacy organizations (e.g. American Association of Retired Persons), industry groups (e.g. America’s Health Insurance Plans), professional associations (e.g. American Medical Association) and think tanks or non-government policy organizations (e.g. Bipartisan Policy Center). Actionable recommendations were those in which organizations explicitly called for government action to achieve goals of efficiency, effectiveness, equity, and responsiveness. Our study was comprised of four phases. 1. Researchers queried organizations indexed by the Encyclopedia of Associations, DIRLINE, and OpenSecrets.Org, as well as organizations identified by internal experts, to identify a unique set of relevant organizations making actionable policy recommendations. An initial analysis of 493 organizations identified by searching databases of the Encyclopedia of Addressing the Health Needs of an Aging America | 33 39O.L. McCabe, A.K. Page, A.S. Daniels, Improving health care for mental and substance use conditions: A framework for bridging the quality chasm, International Journal of Mental Health 2007; 36(2): 65-79. Addressing the Health Needs of an Aging America | 34