Health services research

Last updated

Health services research (HSR) became a burgeoning field in North America in the 1960s, when scientific information and policy deliberation began to coalesce. [1] Sometimes also referred to as health systems research or health policy and systems research (HPSR), HSR is a multidisciplinary scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to patients as a result of this care. [2] HSR utilizes all qualitative and quantitative methods across the board to ask questions of the healthcare system. It focuses on performance, quality, effectiveness and efficiency of health care services as they relate to health problems of individuals and populations, as well as health care systems and addresses wide-ranging topics of structure, processes, and organization of health care services; their use and people's access to services; efficiency and effectiveness of health care services; the quality of healthcare services and its relationship to health status, and; the uses of medical knowledge.[ citation needed ]

Contents

Studies in HSR investigate how social factors, health policy, financing systems, organizational structures and processes, medical technology, and personal behaviors affect access to health care, the quality and cost of health care, and quantity and quality of life. Compared with medical research, HSR is a relatively young science that developed through the bringing together of social science perspectives with the contributions of individuals and institutions engaged in delivering health services. [3]

Goals

The primary goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety. [4] HSR is more concerned with delivery and high quality access to care, in contrast to medical research, which focuses on the development and evaluation of clinical treatments.[ citation needed ]

Health services researchers come from a variety of specializations, including geography, nursing, economics, political science, epidemiology, public health, medicine, biostatistics, operations, management, engineering, pharmacy, psychology, usability and user experience design. [5] While health services research is grounded in theory, its underlying aim is to perform research that can be applied by physicians, nurses, health managers and administrators, and other people who make decisions or deliver care in the health care system. For example, the application of epidemiological methods to the study of health services by managers is a type of health services research that can be described as Managerial epidemiology.[ citation needed ]

Approaches

A common distinction of approaches to HSR is between levels of analysis: [6]

Another distinction can be made between the intent of the research question as either normative/evaluative or exploratory/explanatory. [3]

Collective leadership

Leadership that includes all members of staff and patients in a healthcare setting is referred to as "collective leadership". The idea is that all people involved in healthcare, including those at the receiving end such as patients and caregivers/families, share responsibility for decision making, performance of the healthcare system, and successes. Collective leadership is based on the concept that all stakeholders share viewpoints and knowledge in order to keep up with rapid technological changes, patient-centered outcomes, and the increasing need for specialization in healthcare. The effectiveness of this approach is still being understood and there is no strong evidence to suggest that this approach improves clinical performance, mortality of inpatients, or other outcomes such as staff absences. [7]

Education

Medical conferences and educational meetings are a common approach to help healthcare professionals at an institution learn new skills, keep up with ever-changing clinical practice guidelines, have opportunities for advancing their skills, and create opportunities to connect with peers. [8] Various formats are used including workshops, audits, educational outreach, feedback sessions, lunch-and-learn seminars, and courses. There is a large variety in the inclusion criteria, number of people participating in these sessions, type of interactions (for example, passive seminar or hands-on learning experience), frequency of these opportunities, costs, and learning goals. Research into the effectiveness of these approaches is not strong. [8] Educational meetings may slightly improve professional practice and may have a very small improvement on patient outcomes. [8] In addition, there is weak evidence to suggest that educational meetings may help healthcare staff change their practices to comply with changes or desired practices more than other approaches to encourage change including emails, text messages, or fees. [8]

Low and middle income countries

Research looking into the quality of healthcare in low and middle income countries and different approaches to improving performance of healthcare delivery in countries with resource constraints is growing. The main goal is to improve performance of healthcare. Performance-based payment (P4P) is one approach that has been studied. Performance-based payment is a broad approach that includes the concept of offering financial incentives if specific targets are met. [9]

Data sources

Many data and information sources are used to conduct health services research, such as population and health surveys, clinical administrative records, health care program and financial administrative records, vital statistics records (births and deaths), and other special studies.[ citation needed ]

Research in different countries

Canada

Several government, academic and non-government agencies conduct or sponsor health services research, notably the Canadian Institute for Health Information and the Canadian Institutes of Health Research (i.e. the third pillar: "research respecting health systems and services"). Others include the Institute for Clinical Evaluative Sciences (ICES) for the province of Ontario, and the Canadian Collaborative Study of Hip Fractures.[ citation needed ]

Denmark

Data availability

Several registries are available for research use, such as Danish Twin Register or Danish Cancer Register. [10]

France

Public Health Research Laboratory.

Sweden

Data Availability

Sweden has a substantial number of national-level registries available to researchers. Many of these are administered by the National Board of Health and Welfare, including comprehensive administrative datasets regarding specialist in-patient and out-patient care, municipal social services, as well as cause of death and drug prescription registries. [11] Over 100 clinically oriented quality registries exist oriented towards an array of specific patient populations and sub-domains. [12]

Centers

A number of Swedish universities host research groups focusing on the Health Services Research, including the Karolinska institute, [13] Lund University, and Uppsala University. [14]

United Kingdom of Great Britain and Northern Ireland (UK)

Several governmental agencies exist that sponsor or support HSR, with their remits set by central and devolved governments. These include the National Institute for Health and Care Research (NIHR) and its constituent infrastructure (including the CLAHRC programme); [15] Healthcare Improvement Scotland; [16] Health and Care Research Wales; [17] and Health and Social Care Research and Development. [18] Many universities have HSR units, a web search can find these with relative ease.

United States

Data availability

Claims data on US Medicare and Medicaid beneficiaries are available for analysis. Data is divided into public data available to any entity and research data available only to qualified researchers. The US's Centers for Medicare and Medicaid Services (CMS) delegates some data export functions to a Research Data Assistance Center. [19]

23 Claims data from various states that are not limited to any particular insurer are also available for analysis via AHRQ's HCUP project. [20]

Centers

Colloquially, health services research departments are often referred to as "shops"; in contrast to basic science research "labs". Broadly, these shops are hosted by three general types of institutions—government, academic, or non-governmental think tanks or professional societies.

Government Sponsored

University Sponsored

  • Center for Surgery and Public Health, U.S. -based research institute at the Brigham and Women's Hospital (Harvard University Affiliate)
  • Regenstrief Institute
  • Institute for Healthcare Policy and Innovation, U.S. -based research institute at the University of Michigan (Founded in 2011, IHPI includes smaller centers focused on specific healthcare topics)
  • Leonard Davis Institute of Health Economics, U.S.-based center for HSR at the University of Pennsylvania

Think Tank or Professional Society Sponsored

See also

Related Research Articles

Evidence-based medicine (EBM) is "the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients. ... [It] means integrating individual clinical expertise with the best available external clinical evidence from systematic research." The aim of EBM is to integrate the experience of the clinician, the values of the patient, and the best available scientific information to guide decision-making about clinical management. The term was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians about individual patients.

Medical physics deals with the application of the concepts and methods of physics to the prevention, diagnosis and treatment of human diseases with a specific goal of improving human health and well-being. Since 2008, medical physics has been included as a health profession according to International Standard Classification of Occupation of the International Labour Organization.

<span class="mw-page-title-main">Medical guideline</span> Document with the aim of guiding decisions and criteria in healthcare

A medical guideline is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine. However, in contrast to previous approaches, which were often based on tradition or authority, modern medical guidelines are based on an examination of current evidence within the paradigm of evidence-based medicine. They usually include summarized consensus statements on best practice in healthcare. A healthcare provider is obliged to know the medical guidelines of their profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment.

Clinical governance is a systematic approach to maintaining and improving the quality of patient care within the National Health Service (NHS) and private sector health care. Clinical governance became important in health care after the Bristol heart scandal in 1995, during which an anaesthetist, Dr Stephen Bolsin, exposed the high mortality rate for paediatric cardiac surgery at the Bristol Royal Infirmary. It was originally elaborated within the United Kingdom National Health Service (NHS), and its most widely cited formal definition describes it as:

A framework through which NHS organisations are accountable for continually improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

<span class="mw-page-title-main">Agency for Healthcare Research and Quality</span> United States government agency

The Agency for Healthcare Research and Quality is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered in North Bethesda, Maryland, a suburb of Washington, D.C.. It was established as the Agency for Health Care Policy and Research (AHCPR) in 1989 as a constituent unit of the Public Health Service (PHS) to enhance the quality, appropriateness, and effectiveness of health care services and access to care by conducting and supporting research, demonstration projects, and evaluations; developing guidelines; and disseminating information on health care services and delivery systems.

A clinical decision support system (CDSS) is a health information technology that provides clinicians, staff, patients, and other individuals with knowledge and person-specific information to help health and health care. CDSS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include computerized alerts and reminders to care providers and patients, clinical guidelines, condition-specific order sets, focused patient data reports and summaries, documentation templates, diagnostic support, and contextually relevant reference information, among other tools. CDSSs constitute a major topic in artificial intelligence in medicine.

Evidence-based practice is the idea that occupational practices ought to be based on scientific evidence. The movement towards evidence-based practices attempts to encourage and, in some instances, require professionals and other decision-makers to pay more attention to evidence to inform their decision-making. The goal of evidence-based practice is to eliminate unsound or outdated practices in favor of more-effective ones by shifting the basis for decision making from tradition, intuition, and unsystematic experience to firmly grounded scientific research. The proposal has been controversial, with some arguing that results may not specialize to individuals as well as traditional practices.

A patient safety organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection, analysis, reporting, education, funding, and advocacy. A PSO differs from a Federally designed Patient Safety Organization (PSO), which provides health care providers in the U.S. privilege and confidentiality protections for efforts to improve patient safety and the quality of patient care delivery

The Clinical Practice Research Datalink (CPRD) is an observational and interventional research service that operates as part of the Department of Health and Social Care. It is jointly funded by the National Institute for Health and Care Research (NIHR) and the Medicines and Healthcare products Regulatory Agency (MHRA). CPRD is working closely with the extensive primary care, topic specific and comprehensive NIHR research networks and with NHS Digital.

The Dartmouth Institute for Health Policy and Clinical Practice (TDI) has garnered significant accomplishments since its inception. Established in 1988 by John Wennberg as the Center for the Evaluative Clinical Sciences (CECS) and later reorganized in 2007 to its current form as TDI, the institute has made substantial strides in the realms of healthcare education, research, and policy

Outcomes research is a branch of public health research which studies the end results of the structure and processes of the health care system on the health and well-being of patients and populations. According to one medical outcomes and guidelines source book - 1996, Outcomes research includes health services research that focuses on identifying variations in medical procedures and associated health outcomes. Though listed as a synonym for the National Library of Medicine MeSH term "Outcome Assessment ", outcomes research may refer to both health services research and healthcare outcomes assessment, which aims at health technology assessment, decision making, and policy analysis through systematic evaluation of quality of care, access, and effectiveness.

Comparative effectiveness research (CER) is the direct comparison of existing health care interventions to determine which work best for which patients and which pose the greatest benefits and harms. The core question of comparative effectiveness research is which treatment works best, for whom, and under what circumstances. Engaging various stakeholders in this process, while difficult, makes research more applicable through providing information that improves patient decision making.

Patient participation is a trend that arose in answer to medical paternalism. Informed consent is a process where patients make decisions informed by the advice of medical professionals.

David M. Eddy is an American physician, mathematician, and healthcare analyst who has done seminal work in mathematical modeling of diseases, clinical practice guidelines, and evidence-based medicine. Four highlights of his career have been summarized by the Institute of Medicine of the National Academy of Sciences: "more than 25 years ago, Eddy wrote the seminal paper on the role of guidelines in medical decision-making, the first Markov model applied to clinical problems, and the original criteria for coverage decisions; he was the first to use and publish the term 'evidence-based'."

AcademyHealth is a nonpartisan, nonprofit professional organization dedicated to advancing the fields of health services research and health policy. It is a professional organization for health services researchers, health policy analysts, and health practitioners, and it is a nonpartisan source for health research and policy. The organization was founded in 2000, in a merger between the Alpha Center and the Association for Health Services Research). In 2008, the organization had approximately 4000 health services researcher members.

Dr. Scott B. Ransom has impacted the healthcare ecosystem for over 30 years by leveraging integrated insights from the fields of medicine, business and public health while serving as a practicing physician, researcher, teacher, author, executive, consultant, and investor.

Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

The Comparative Effectiveness Research Translation Network (CERTAIN) is a learning healthcare system in Washington State focused on patient-centered outcomes research (PCOR) and comparative effectiveness research (CER), leveraging existing healthcare data for research and healthcare improvement, incorporating patient and other healthcare stakeholder voices into research, and facilitating dissemination and implementation of research evidence into clinical practice.

Learning health systems (LHS) are health and healthcare systems in which knowledge generation processes are embedded in daily practice to improve individual and population health. At its most fundamental level, a learning health system applies a conceptual approach wherein science, informatics, incentives, and culture are aligned to support continuous improvement, innovation, and equity, and seamlessly embed knowledge and best practices into care delivery

Alternative medicine describes any practice which aims to achieve the healing effects of medicine, but which lacks biological plausibility and is untested or untestable. Complementary medicine (CM), complementary and alternative medicine (CAM), integrated medicine or integrative medicine (IM), and holistic medicine are among many rebrandings of the same phenomenon.

References

  1. ↑ Mykhalovskiy, 1999 Knowing Health Care / Governing Health Care : Exploring Health Services Research as Social Practice..
  2. ↑ AcademyHealth. What is HSR? Archived 2009-09-01 at the Wayback Machine , June 2000.
  3. 1 2 Sheikh K, et al. Building the Field of Health Policy and Systems Research: Framing the Questions. PLoS Med, 8(8): e1001073. Published August 16, 2011. Accessed August 22, 2011.
  4. ↑ Agency for Healthcare Research and Quality, February 2002.
  5. ↑ UX Magazine 14.3 - Healthy Designs, September 2014.
  6. ↑ Mills, Anne (2012). "Health policy and systems research: defining the terrain; identifying the methods". Health Policy and Planning. 27 (1): 1–7. doi:10.1093/heapol/czr006. PMID   21324972.
  7. ↑ Silva, Jaqueline Alcantara Marcelino; Mininel, Vivian Aline; Fernandes Agreli, Heloise; Peduzzi, Marina; Harrison, Reema; Xyrichis, Andreas (2022-10-10). Cochrane Effective Practice and Organisation of Care Group (ed.). "Collective leadership to improve professional practice, healthcare outcomes and staff well-being". Cochrane Database of Systematic Reviews. 2022 (10): CD013850. doi:10.1002/14651858.CD013850.pub2. PMC   9549469 . PMID   36214207.
  8. 1 2 3 4 Forsetlund, Louise; O'Brien, Mary Ann; Forsén, Lisa; Mwai, Leah; Reinar, Liv Merete; Okwen, Mbah P; Horsley, Tanya; Rose, Christopher J (2021-09-15). Cochrane Effective Practice and Organisation of Care Group (ed.). "Continuing education meetings and workshops: effects on professional practice and healthcare outcomes". Cochrane Database of Systematic Reviews. 2021 (9): CD003030. doi:10.1002/14651858.CD003030.pub3. PMC   8441047 . PMID   34523128.
  9. ↑ Diaconu, Karin; Falconer, Jennifer; Verbel, Adrian; Fretheim, Atle; Witter, Sophie (2021-05-05). Cochrane Effective Practice and Organisation of Care Group (ed.). "Paying for performance to improve the delivery of health interventions in low- and middle-income countries". Cochrane Database of Systematic Reviews. 2021 (5): CD007899. doi:10.1002/14651858.CD007899.pub3. PMC   8099148 . PMID   33951190.
  10. ↑ Frank, L. (2000). "Epidemiology. When an entire country is a cohort". Science. 287 (5462): 2398–2399. doi:10.1126/science.287.5462.2398. PMID   10766613. S2CID   38603963.
  11. ↑ "Registers". Socialstyrelsen. Retrieved 2021-10-04.
  12. ↑ "Quality registries". skr.se. Retrieved 2021-10-04.
  13. ↑ "Department of Neurobiology, Care Sciences and Society | Karolinska Institutet". ki.se. Retrieved 2021-10-04.
  14. ↑ Hallberg, Anna. "Health Services Research - Department of Public Health and Caring Sciences - Uppsala University, Sweden". www.pubcare.uu.se. Retrieved 2021-10-04.
  15. ↑ "NIHR National Institute for Health Research". www.nihr.ac.uk.
  16. ↑ "Healthcare Improvement Scotland". www.healthcareimprovementscotland.org.
  17. ↑ "Health and Care Research Wales". www.healthandcareresearch.gov.wales.
  18. ↑ "HSC Research and Development www.research.hscni.net HSC Public Health Agency". www.publichealth.hscni.net.
  19. ↑ "ResDAC" . Retrieved 30 April 2013.
  20. ↑ "AHRQ.gov" . Retrieved 30 April 2013.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.