BOX 7.1 What Is Health Services Research?

The Institute of Medicine defines health services research as:

a multidisciplinary field of inquiry, both basic and applied, that examines the use, costs, quality, accessibility, delivery, organization, financing, and outcomes of health care services to increase knowledge and understand the structure, processes, and effects of health services for individuals and populations.

Several features of this definition are worth noting. First, health services research is a multidisciplinary field that draws from many academic and clinical disciplines such as economics, epidemiology, biostatistics, nursing, and medicine. Its boundaries are imprecise, particularly as they relate to policy and management studies and clinical research. A clinical trial, for example, could be categorized as health services research if the effectiveness of a health care technology or intervention was assessed in a ''real-world'' rather than in an ideal or highly controlled setting. Second, the reference to basic and applied research underscores the fact that health services research involves both questions about fundamental individual, organizational, and system behaviors and questions of direct practical interest to public and private decision makers. Third, by referring to both knowledge and understanding, the definition stretches the boundaries of the field to include work of a theoretical or conceptual nature. Finally, the definition includes research that can have either a group-or an individual-level focus.

SOURCE: IOM, 1995.

Health services research can be defined broadly to include behavioral and psychological research (e.g., assessments of individuals' preferences in health care), evaluations of programs that may fall outside the purview of the traditional health care system (e.g., school-based health programs), and randomized controlled clinical trials (e.g., studies of the effectiveness of health care technologies in situations representative of community practice). The National Cancer Policy Board accepted a broad definition of health services research and for this review applied the rubric used by the National Library of Medicine to select projects for inclusion in its health services research database (i.e., HSRProj) (Box 7.2).

Status of Cancer-Related Health Services Research

Publications

Evaluating trends in research publications is one way to assess the level of activity within a discipline. A resource for tracking such studies is the National Library of Medicine (NLM) Medline bibliographic database, which stores information about individual citations including index terms used to characterize each article (articles are indexed according to a dictionary of medical subject headings called MESH terms).



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