Health services research (HSR) became a burgeoning field in North America in the 1960s, when scientific information and policy deliberation began to coalesce. 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. 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.
Studies in HSR investigate how social factors,
health policy, financing systems, organizational structures and processes,
medical technology
Health technology is defined by the World Health Organization as the "application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures, and systems developed to solve a health problem and improve quality of liv ...
, 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.
[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.
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. 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.
Health services researchers come from a variety of specializations, including
geography,
nursing,
economics,
political science,
epidemiology,
public health,
medicine,
biostatistics
Biostatistics (also known as biometry) are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experimen ...
,
operations,
management,
engineering,
pharmacy,
psychology,
usability
Usability can be described as the capacity of a system to provide a condition for its users to perform the tasks safely, effectively, and efficiently while enjoying the experience. In software engineering, usability is the degree to which a soft ...
and
user experience design. While health services research is grounded in theory, its underlying aim is to perform research that can be applied by
physicians
A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
,
nurses
Nursing is a profession within the health care sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other health ca ...
,
health managers and administrators, and other people who make decisions or deliver care in the
health care system
Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organiz ...
. 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 The use of epidemiological tools in health care management can be described as managerial epidemiology. Several formal definitions have been proposed for managerial epidemiology. These include:
* The use of epidemiology for designing and managing h ...
.
Approaches
A common distinction of approaches to HSR is between levels of analysis:
* Macro (architecture and oversight of systems)
* Meso (functioning of organizations and interventions)
* Micro (the individual in the system)
Another distinction can be made between the intent of the research question as either normative/evaluative or exploratory/explanatory.
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.
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
The Canadian Institute for Health Information (CIHI) is a government-controlled not-for-profit Crown corporation that provides essential information on Canada's health systems and the health of Canadians. CIHI provides comparable and actionable ...
and the
Canadian Institutes of Health Research
The Canadian Institutes of Health Research (CIHR; french: Instituts de recherche en santé du Canada; IRSC) is a federal agency responsible for funding health and medical research in Canada. Comprising 13 institutes, it is the successor to the ...
(i.e. the third pillar: "research respecting health systems and services"). Others include the
Institute for Clinical Evaluative Sciences (ICES) in
Toronto, and the
Canadian Collaborative Study of Hip Fractures.
There are some universities which train in health services research
Atlantic Regional Training Centre
Denmark
Data availability
Several registries are available for research use, such as Danish Twin Register or Danish Cancer Register.
France
Public Health Research Laboratory.
* HeSPeR (Health Services and Performance Research), Université Claude Bernard Lyon 1
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. Over 100 clinically oriented quality registries exist oriented towards an array of specific patient populations and sub-domains.
Centers
A number of Swedish universities host research groups focusing on the Health Services Research, including the Karolinska institute, Lund University, and Uppsala University.
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
The National Institute for Health and Care Research (NIHR) is the British government’s major funder of clinical, public health, social care and translational research. With a budget of over £1.2 billion in 2020–21, its mission is to "impr ...
(NIHR) and its constituent infrastructure (including the CLAHRC programme);
Healthcare Improvement Scotland;
Health and Care Research Wales; and Health and Social Care Research and Development.
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
The Centers for Medicare & Medicaid Services (CMS), is a federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer M ...
(CMS) delegates some data export functions to a Research Data Assistance Center.
23 Claims data from various states that are not limited to any particular insurer are also available for analysis via
AHRQ
The Agency for Healthcare Research and Quality (AHRQ; pronounced "ark" by initiates and often "A-H-R-Q" by the public) is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered i ...
's HCUP project.
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
*
U.S. Department of Veterans Affairs Award in Health Services Research
*
Institute of Medicine, U.S.-based policy research organization
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
*
Society of General Internal Medicine, U.S.-based professional organization in internal medicine research
*
Commonwealth Fund, U.S.-based center for HSR
* Rand Corporation Health Division, U.S.-based center for HSR
See also
*
Health economics
Health economics is a branch of economics concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and healthcare. Health economics is important in determining how to improv ...
*
Health workforce research
*
Health insurance
*
Health policy
*
Managed care
The term managed care or managed healthcare is used in the United States to describe a group of activities intended to reduce the cost of providing health care and providing American health insurance while improving the quality of that care ("man ...
*
Nursing
*
Pharmacy Practice Research
*
Priority-setting in global health
In global health, priority-setting is a term used for the process and strategy of deciding which health interventions to carry out. Priority-setting can be conducted at the disease level (i.e. deciding which disease to alleviate), the overall strat ...
*
Public health
Publications:
*''
BMC Health Services Research
''BMC Health Services Research'' is an open access healthcare journal, which covers research on the subject of health services. It was established in 2001 and is published by BioMed Central.
Abstracting and indexing
''BMC Health Services Rese ...
'', scientific journal
*''
Health Affairs
''Health Affairs'' is a monthly peer-reviewed healthcare journal established in 1981 by John K. Iglehart; since 2014, the editor-in-chief is Alan Weil. It was described by ''The Washington Post'' as "the bible of health policy".
Abstracting a ...
'', scientific journal
*''
Health Services Research journal'', scientific journal
*
Medical Care', scientific journal
*''
Medical Care Research and Review'', scientific journal
*
''World Health Report 2013: Research for universal health coverage'', publication of the World Health Organization
Conferences and events:
*
Fifth Global Symposium on Health Systems Research', 8 - 12 October, 2018 in Liverpool, UK
References
External links
Alliance for Health Systems and Policy Research global partnership for health systems research
Health Systems Global a membership society which aims to convene researchers, policy-makers and implementers from around the world to develop the field of health systems research
portal on public health research of the European Union
Canadian Association for Health Services & Policy ResearchCanadian Foundation for Healthcare Improvement
Canadian Knowledge Transfer and Exchange Community of PracticeUnited States Veterans Affairs: Health Services Research & DevelopmentAcademyHealth a U.S.-based professional development center for health services research
Cedar Associates LLC a U.S.-based center for clinical effectiveness decision analytical research
{{DEFAULTSORT:Health Services Research
Biostatistics
Epidemiology
Clinical research
Health care quality
Health economics