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 Interdisciplinarity or interdisciplinary studies involves the combination of multiple academic disciplines into one activity (e.g., a research project). It draws knowledge from several other fields like sociology, anthropology, psychology, ec ...

scientific field that examines how people get access to health care practitioners and health care services, how much care costs, and what happens to

patient A patient is any recipient of health care services that are performed by healthcare professionals. The patient is most often ill or injured and in need of treatment by a physician, nurse, optometrist, dentist, veterinarian, or other health c ...

s 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 Health policy can be defined as the "decisions, plans, and actions that are undertaken to achieve specific healthcare goals within a society".World Health Organization''Health Policy'' accessed 22 March 2011(Web archive)/ref> According to the ...

, 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 Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health profe ...

, the quality and cost of health care, and quantity and

quality of life Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...

. Compared with

medical research Medical research (or biomedical research), also known as experimental medicine, encompasses a wide array of research, extending from "basic research" (also called ''bench science'' or ''bench research''), – involving fundamental scientif ...

, HSR is a relatively young science that developed through the bringing together of

social science Social science is one of the branches of science, devoted to the study of societies and the relationships among individuals within those societies. The term was formerly used to refer to the field of sociology, the original "science of soc ...

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 Patient safety is a discipline that emphasizes safety in health care through the prevention, reduction, reporting and analysis of error and other types of unnecessary harm that often lead to adverse patient events. The frequency and magnitude of a ...

. 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 Geography (from Greek: , ''geographia''. Combination of Greek words ‘Geo’ (The Earth) and ‘Graphien’ (to describe), literally "earth description") is a field of science devoted to the study of the lands, features, inhabitants, and ...

nursing 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 ...

economics Economics () is the social science that studies the Production (economics), production, distribution (economics), distribution, and Consumption (economics), consumption of goods and services. Economics focuses on the behaviour and intera ...

political science Political science is the scientific study of politics. It is a social science dealing with systems of governance and power, and the analysis of political activities, political thought, political behavior, and associated constitutions and la ...

epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...

medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pract ...

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 experime ...

, operations,

management Management (or managing) is the administration of an organization, whether it is a business, a nonprofit organization, or a government body. It is the art and science of managing resources of the business. Management includes the activities o ...

engineering Engineering is the use of scientific method, scientific principles to design and build machines, structures, and other items, including bridges, tunnels, roads, vehicles, and buildings. The discipline of engineering encompasses a broad rang ...

pharmacy Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links heal ...

psychology Psychology is the scientific study of mind and behavior. Psychology includes the study of conscious and unconscious phenomena, including feelings and thoughts. It is an academic discipline of immense scope, crossing the boundaries betwe ...

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 User experience design (UX design, UXD, UED, or XD) is the process of defining the experience a user would go through when interacting with a digital product or website. Design decisions in UX design are often driven by research, data analysis, an ...

. 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 c ...

, 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 health, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World H ...

. 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 ...

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 M ...

(i.e. the third pillar: "research respecting health systems and services"). Others include the

Institute for Clinical Evaluative Sciences ICES (formerly known as the Institute for Clinical Evaluative Sciences) is an independent, non-profit corporation that applies the study of health informatics for health services research and population-wide health outcomes research in Ontario ...

(ICES) in

Toronto Toronto ( ; or ) is the capital city of the Canadian province of Ontario. With a recorded population of 2,794,356 in 2021, it is the most populous city in Canada and the fourth most populous city in North America. The city is the ancho ...

, and the

Canadian Collaborative Study of Hip Fractures A hip fracture is a break that occurs in the upper part of the femur (thigh bone). Symptoms may include pain around the hip, particularly with movement, and shortening of the leg. Usually the person cannot walk. They most often occur as a res ...

. 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 Healthcare Improvement Scotland (HIS) is the national healthcare improvement organisation for Scotland. It is a public body which is part of the Scottish National Health Service, created in April 2011. History NHS Quality Improvement Scotland ( ...

;

Health and Care Research Wales Health and Care Research Wales is a networked organisation, supported by the Welsh Government, which brings together a wide range of partners across NHS Wales, universities and research institutions, local authorities, and others. The organisation ...

; 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 Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...

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 The National Academy of Medicine (NAM), formerly called the Institute of Medicine (IoM) until 2015, is an American nonprofit, non-governmental organization. The National Academy of Medicine is a part of the National Academies of Sciences, E ...

, 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 The Indiana University School of Medicine (IUSM) is a major multi-campus medical school in the state of Indiana. There are nine campuses throughout the state; the principal research and medical center is located on the Indiana University–Purdu ...

*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 The Leonard Davis Institute of Health Economics (LDI) is the center for health services research, health policy, and health care management education at the University of Pennsylvania. It is based in the Colonial Penn Center on Locust Walk, at the ...

, U.S.-based center for HSR at the University of Pennsylvania Think Tank or Professional Society Sponsored *

Society of General Internal Medicine The Society of General Internal Medicine (SGIM) is an American professional society composed of physicians engaged in internal medicine research and teaching. It was originally named "The Society for Research and Education in Primary Care Interna ...

, U.S.-based professional organization in internal medicine research *

Commonwealth Fund The Commonwealth Fund is a private foundation (United States), private U.S. foundation whose stated purpose is to "promote a high-performing health care system that achieves better access, improved quality, and greater efficiency, particularly fo ...

, U.S.-based center for HSR * Rand Corporation Health Division, U.S.-based center for HSR

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 Research

Canadian Foundation for Healthcare Improvement

Canadian Knowledge Transfer and Exchange Community of Practice

United States Veterans Affairs: Health Services Research & Development

AcademyHealth
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

Goals

Approaches

Data Sources

Research in different countries

Canada

Denmark

Data availability

France

Sweden

Data Availability

Centers

United Kingdom of Great Britain and Northern Ireland (UK)

United States

Data availability

Centers

See also

References

External links