This process resulted in a research program portfolio with more than goals that challenged previous prioritization methods. The third decade of NORA — responded to the need to find an efficient and effective method to identify and integrate research priorities. Intersecting the sectors are cross-sector programs that are organized by the major health and safety issues affecting the US working population. The BNI method was developed in NORA 3 to provide a strategic, structured, consistent, and transparent method to identify the highest research priorities and align funding decisions in a measurable, effective, and accountable manner.
The BNI method is an evidence-based approach to setting research priorities and aligning investment with research that has the greatest likelihood of significant impact to reduce the burden of worker injury and illness.
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Need provides evidence of the knowledge gap that needs to be addressed, consideration of the most appropriate methodological approach to address the need, the time fit for conducting that research at this point in time, the particular advantage NIOSH has to do the work, and the explicit stakeholder need. Impact identifies research with the greatest likelihood of reducing burden, potential for results to be used or disseminated by others, and the likelihood the research will generate knowledge that leads to follow-on research. While the constructs of burden, need, and impact have always been considered by researchers, the BNI method provides a clear and systematic approach that is useful at both program and project level.
At the project level, it formalizes thinking that investigators have long done. At the program level, it brings a new way of considering priorities and allocating resources. Burden may be defined as risks from exposure to work-related hazards; occurrence of injuries, illnesses, and deaths due to work-related factors; and broad economic and social impacts including well-being Schulte et al.
The assessment of burden is based on several main constructs: magnitude of the problem such as the number or rate of cases ; health impact severity; exposure to workers such as number exposed, severity of exposure or both ; societal costs; new or emerging issues; and relationship to work environment.
For emerging issues, the burden will be anticipatory. As with burden, need is a multifactorial concept. Need provides the rationale for NIOSH to conduct research to address high burden at a specific point in time. Need considers the evidence of the knowledge gap to be addressed and the appropriate methodological approach needed to address the burden such as etiologic, intervention, or translational research.
Factors such as intellectual and financial capital, statutory authority, and mission relevance are a few considerations. Need also considers whether there is evidence of an explicit stakeholder need and why NIOSH should address the need. Impact is an estimation of the potential for the research to positively affect worker health and safety on the basis of evident or anticipated results of the proposed research.
Potential impact is expressed as potential reduction in burden that is likely to occur if the information from the proposed research is utilized in interventions or further research. The assessment of impact is based on these factors: the likelihood of the research to reduce burden or lead to plausible future actions to reduce burden; the use or dissemination of research results by others to set standards, policy, or guidance, or use by stakeholders to adopt results or use technology or methods developed to reduce burden; and the likelihood the research will generate knowledge that leads to follow-on research that builds on findings.
The criteria used to define burden, need, and impact at the program level and the individual project level are shown in Table 1. Additional review criteria are provided to reviewers to help assess the relative strength of proposals. The BNI criteria have been used to select intramural research projects since and will be used in the review of extramural research beginning in FY Since , NIOSH has successfully implemented the BNI method at the program level to identify research priorities across programs and at the project level to select individual intramural research projects.
The strategic goals represent the major health and safety issues facing the US workforce and are the broad focus areas for research. They correspond to the cross-sector programs shown in Fig. Reduce occupational cancer, cardiovascular disease, adverse reproductive outcomes, and other chronic diseases. The intermediate goals further identify the health and safety outcome, the research focus area, the worker population, and the type of research needed to address these goals.
Also in , NIOSH introduced the BNI criteria into the extramural space with the publication of new investigator-initiated research funding opportunity announcements that direct extramural researchers to address the priority goals published in the NIOSH Strategic Plan and address the BNI criteria in the Significance section of their research applications. The extramural funding announcements explicitly state that BNI criteria are to be addressed by researchers at the proposal stage and considered by reviewers at the review stage National Institutes of Health NIH , These other inputs are considered as they arise and may be responded to with special funding opportunities.
In many agencies, multiple programs must compete for funding based on prioritized research goals.
NIOSH has organized its research program into 10 industry sectors representing the major economic sectors in the USA, and seven health, safety and well-being cross-sectors representing the major health and safety issues among workers in the USA. These programs work together in an integrated approach to identify shared goals based on BNI criteria. At this stage in the research prioritization, programs consider primarily the burden to be addressed and the need to reduce the burden. Impact or potential impact is considered at the time projects are reviewed for funding. This process is replicated in each cell of the matrix where all sector and cross-sector programs consider BNI and work collaboratively to identify top priority work.
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Each cell of the matrix reflects interaction between competing programs for priority funding. Programs work together with subject matter experts to identify top burden areas and need for research. In this approach, when sectors, cross-sectors, and subject matter experts reach concurrence in their assessment of burden and need, a priority is established.
Priorities are mapped into the cells of the matrix to reflect the integrated goals. Program subject matter experts review the rational for burden, need, and impact. Each program provides a merit score for burden, need, and impact using a 9-point scale for scientific merit NIH, NIOSH considered different weighting schemes for each factor and determined these three constructs are so equally fundamental that no weighting was used.
The magnitude of each individual factor affects the final score. The SRC considers the program review and, after discussion, each SRC member provides an overall score, which is averaged to determine the final overall score. Intramural projects that receive a strong overall score are recommended for funding.
All projects must go through additional scientific peer-review to ensure that the research methodology is of appropriate rigor. Proposals selected for funding that do not meet acceptable standards by peer-review can be turned down or revised to assure that the best quality work is funded. Beginning in , extramural researchers are now directed to address the same research priorities, and funding priority will be given to those projects that address priority goals. Extramural researchers who choose to address research goals outside of the matrix of priorities must provide compelling evidence of burden, need, and potential for impact that would support consideration of their application.
The BNI method was conceived of to develop a systematic and transparent method by which NIOSH could strategically drive OSH research for the nation with a clear set of attainable evidence-based prioritized research goals to ensure the best use of limited public funds. The second decade of NORA ended with 90 strategic goals, 31 health outcome goals, 80 additional goals for a total of over goals that challenged efforts to strategically align and prioritize OSH research and evaluation efforts.
NIOSH needed a new approach that would result in a more strategic system of setting priorities that could be clearly articulated and integrated in the intramural and extramural communities of researchers. The effect of the BNI method on research prioritization in the intramural research competition is show in Table 2.
- How NIOSH Identifies research priorities: Burden, Need, and Impact?
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Evaluation of the BNI method to date has been largely process oriented and focused on the intramural research competition. The results of the first three cycles of implementation are shown in Table 3. These data show that under the BNI method, applications have become fewer and more focused while success rates increased, emerging issues are being addressed, the number of priority goals has been streamlined, a consistent number of these goals are being addressed by the annual intramural competition, and all sectors and cross-sectors have priority goals that are being addressed.
Emerging issues include emerging technologies, emerging burden, emerging hazards, emerging products, emerging industry and issues, and emerging workforce. At the end of each funding cycle, NIOSH reviews the projects selected to consider whether the equal weighting of burden, need, and impact has affected the priority order to the extent that more important projects were overlooked. To date, the projects selected for funding have been deemed appropriate. Ongoing formal program evaluation efforts include a constellation of activities that assess project outputs and intermediate outcomes as well as the contribution NIOSH programs make to the achievement of end outcomes Downes et al.
A logic model of the BNI method as it relates to the overarching goals of research prioritization and funding alignment are shown in Fig. It is not a model for evaluating the impact of research projects.
As the BNI method is implemented across the extramural research programs, additional evaluation efforts will be developed. There remain a number of issues to consider as the BNI method is implemented to test whether this is an efficient and effective research prioritization tool. Overall, the burden of occupational disease and injury is severely underestimated and understudied Rosenman et al.
There is concern that the BNI method might limit investigator creativity. The matrixed approach to goal development based on assessment of burden, need, and impact channels creativity and innovation to address the most pressing OSH issues faced by workers in the USA. Consideration of this potential limitation must occur in the context of the absolute requirement that NIOSH serves as a good steward of limited public funds able to clearly justify the prioritization and allocation of research dollars, both intramurally and extramurally.
Work is needed to better compare burden across different subsectors of worker populations or health outcomes so that deliberate decisions can be made when there are high rates or prevalence of low-risk outcomes versus low rates of high-risk outcomes. For example, what weight should be placed on the relative importance of burden for high injury or illness rates in small worker populations or where there is evidence of significant disparities or high societal costs for these injuries and illness?
Many burden estimates are based on old data that may not be relevant to contemporary scenarios. The success of using a burden determinant for research prioritization will depend on increasing surveillance and informatics capabilities, especially challenging the changing nature of work.