Health Services Research Report of a Study (1979) / Chapter Skim
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Health Services Research Defined
Health Services Research Defined
Pages 13-32
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From page 13... ...
Existing Def initions Most existing definitions describe characteristics of the field of health services research but do not specify the features of studies that distinguish health services research f rom other types of inquiry. Such - - - ~ - - - - statements typically emphasize the variety ot disciplinary perspectives and methods employed in the f ield of health services research and note its broad substantive concerns and purposes.
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From page 14... ...
While many studies do in fact incorporate theoretical perspectives of several disciplines and are aimed at solving particular problems, it is equally true that others that should be classified as health services research employ the conceptual frameworks of particular disciplines or address problems that have no direct implications for program or policy decisions. Second, to define the scope of a field by listing its principal specific concerns both presumes that issues endure and risks omission of emerging topics.
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From page 15... ...
The second criterion places in the category of health services research all studies of personal health services that focus on at least one feature of their structure, processes, or effects defined in terms of some conceptual framework other than that of contemporary applied biomedical science.* That framework views the human organism in terms of its anatomical structure and physiological processes, and identifies, classifies, and explains diseases, which usually are defined as structural malformations, chemical lesions, or behavioral abnormalities.~4]
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From page 16... ...
However, behavioral and health services research interests come together in studies of effects of life styles on the use of personal health services and in research on the effects of personal health services on individual's health-related habits. Biomedical Research The second criterion differentiates health services research from contemporary applied biomedical research.
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From page 17... ...
Nevertheless, these studies are not considered health services research unless they take explicit account of factors other than interventions and outcomes conceptualized in terms of the framework of biomedical science. Studies of the relative effectiveness of coronary bypass surgery versus drug therapy on reducing chest pain, for example, are extensions of biomedical research.
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From page 18... ...
Levels of Health Services Research Studies of health services may be categorized according to the four general levels of problems they address: clinical, institutional, systemic, or environmental. These levels are depicted in Figure 1 in order of increasing generality, proceeding from the core of studies of clinical practice to the most global level of research on relationships between characteristics of the health services system and events in the larger social, political, and economic environment that affect them.
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From page 19... ...
19 FIGURE 1 LEVELS OF HEALTH SERVICES RESEARCH Health Problems Environmental Systemic / I Institutional \ I' ,~, Clinical \ it: Social, Political, Economic Institutions J /
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From page 20... ...
Systemic Studies System studies deal with features of the health services system that affect the inter-relationships among providers and health care institutions and the population's aggregate demand for health services. At this level, attention is given to the influences of financing mechanisms, regulatory programs, and other features of the system on such matters as the capital expenditures of hospitals, choices of specialties and practice sites by physicians, the development of group practices, and expenditures for various types of personal health services.
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From page 21... ...
The series of estimates of national health care expenditures produced by the Social Security Administration (and now by the Health Care Financing Administration) provide invaluable information on the amounts and
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From page 22... ...
The logical and practical necessities that set the limits of analytic studies encourage investigators, working from different theoretical perspectives, to focus on selected aspects of problems and to disregard others. As no conceptual framework takes into account all aspects of a problem or is inherently superior to others, health services research encompasses a great variety of perspectives.
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From page 23... ...
These difficulties inherent in health services research account to a large extent for the seeming inconclusiveness of much of the research, and underscore the need for studies aimed at improving research methods and for replications using various perspectives and methods. As the field has developed, significant advances in knowledge have been achieved through the application and integration of theoretical perspectives and methods that either were unknown or undeveloped two decades ago.
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From page 24... ...
The field is characterized as an applied endeavor whose products should be assessed primarily in terms of their usefulness to people with decision making responsibilities, whether they be clinicians, administrators of health care institutions or government programs, or officials charged with formulating national health care policy. Although the committee agrees that these are legitimate expectations and grounds for assessing health services research, it notes that discussions of the usefulness of studies in this area are often clouded by simplistic analogies to research and development in the physical and natural sciences, misunderstandings of decision making processes in various settings, and narrowly defined conceptions of the audiences for health services research.
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From page 25... ...
Develop knowledge about Knowledge about impacts impacts of technologies of technologies on due to their diffusion system-wide demand for and applications services, costs, rela tionships between their supplies and needs of populations, etc.
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From page 26... ...
At the systemic level, studies in health services research focus on impacts of such matters as the influences of financing and regulatory programs on the diffusion of technologies. Also, they examine the effects of their organization on the demand for services, per capita expenditures for health services, and inter-organizational arrangements among health care and other institutions.
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From page 27... ...
27 FIGURE 3 RELATIONSHIPS BETWEEN STEPS IN THE DECISION PROCESS AND TYPES OF RESEARCH STEPS IN THE DECISION PROCESS Recognition of a Problem Establish Causes of the Problem Establish Alternative Solutions Select and Implement Decision Monitor Effects of Program TYPE OF RESEARCH Problem Identification Problem Specification Assessment of Alternative Interventions < .
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From page 28... ...
The series of descriptive reports of the National Center for Health Statistics and of the Center for Health Administration Studies of the University of Chicago on the use of health services and those of the Office of Policy, Planning, and Research of the Health Care Financing Administration (formerly of the Office of Research and Statistics of the Social Security Administration) on expenditures for health care are notable contemporary examples of this type of research.
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From page 29... ...
Because policy analysis usually takes into account a broader range of criteria in evaluating alternatives than is considered in particular studies, it typically involves synthesizing findings of existing research and extrapolating their implications. Limitations of Rational Models The foregoing schemes were intended to identify potential uses of health services research in decision making, not to describe what actually occurs.
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From page 30... ...
They are the substance of formal education in health care administration and much of clinical medicine and a source of knowledge, attitudes, and expectations on the part of the public. Moreover, as government involvement in the health care industry expands and the scope of political decisions affecting health care enlarges, information from health services research, if effectively transmitted, becomes an increasingly crucial ingredient of the public's abilities to choose the types of health services it desires and to hold providers, planners, and government accountable for what is delivered.
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From page 31... ...
Feinstein, "Scientific Methodology in Clinical Medicine II. Classification of Human Disease by Clinical Behavior," Annals of Internal Medicine (October-December 1964~: 757-781.
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