Health Services Research Work Force and Educational Issues (1995) / Chapter Skim
Currently Skimming:
2 Overview of Health Services Research
2 Overview of Health Services Research
Pages 25-42
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From page 25... ...
Health care organizations are 25
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From page 26... ...
A BRIEF LOOK BACK Although an extensive historical review was beyond the scope ofthis project, a brief look back is useful in understanding the field of health services research as it exists today. Not surprisingly, given the relatively imprecise boundaries of the field of health services research, any effort to trace its history involves some subjectivity, especially the further back in time one goes.
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, the 42-member committee and its 75-person staff produced 27 field studies and a final report between 1928 and 1932 (CCMC, 1932~.2 The CCMC studies and associated surveys provided the first extensive investigations of such matters as the incidence of illness and disability; the levels and kinds of care involved in treating specific illnesses and the implications for health work force and facilities planning; the distribution and organization of health care services; the level and types of health care expenditures; the uneven burden of medical expenses and access to medical care; and the development of group practice, prepayment, and other innovations in organizing and financing care. The scope and depth of the CCMC analyses have, arguably, not been approached again, and many subsequent analyses have come to generally similar conclusions, even several decades later.
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From page 28... ...
In the private, nonprofit sector, the Health Insurance Plan of Greater New York and three Kaiser Pennanente regions pioneered health services research in the group practice setting after the end of World War II (Denser, Shapiro, and Einhorn, 1959; Greenlick, Freenborn, and Pope, 1988~. Beginning in the 1950s, some Blue Cross and Blue Shield plans also undertook applied health services research, for example to understand patterns of hospital use (Koen, 1965; Young, 1965)
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In 1965, the White House Conference on Health recommended the creation of a National Institute of Community Health Services to coordinate and stimulate health services research related to these and other federal health interests. Subsequently, the 1967 Report to the President on Medical Care Prices recommended a role for a national center in conducting research on cost containment, prepaid group practice, and community health care systems (Flook and Sanazaro, 1973~.
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From page 30... ...
Experience acquired in two of these R&D areas had particular policy significance in the 1970s. In the quality arena, the Experimental Medical Care Review Organization program developed and partially tested the structures and processes for quality assurance that became the basis for the Professional Standards Review Organization program, created in 1972 mainly for the Medicare nro~ram.
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In addition to the units cited above, several other federal agencies developed health services research agendas. For example, the Office of Economic Opportunity initiated (but only briefly oversaw)
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Other parts of the NIH and the Departments of Agriculture, Defense, Education, and Energy also have sponsored some activities that could be counted as health services research, although they may not be explicitly described as such.5 Other Sponsors of Health Services Research Private foundations, state governments, industry, and other sources have also supported health services research, although specific data on the level and distribution of such Finding are largely unavailable. The HSRProj database maintained by the National Library of Medicine, however, provides some information on foundation funding of health services research studies.
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From page 33... ...
Some notable examples of state-supported health services research include the New York State Department of Health's analyses of physician-specif~c mortality rates for cardiac surgery (Hannan, Kilburn, Racz, et al., 1994; Green and Whitfield, 1995) and the work of the Oregon Health Resources Commission to develop a priority list or rank ordering of combinations of medical conditions and treatments as a basis for allocating limited resources for health care (Eddy, 1991~.
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The discussion of health research issues below is quite selective, but it illustrates the central themes of the field: the organization and financing of health services; access to health care; practitioner, patient, and consumer behavior; quality of care; clinical evaluation and outcomes research; informatics and clinical decisionmaking; and the health professions work force. Although categorizations of research areas inevitably emphasize separation, cross-cutting inquiry is an important characteristic of the field.
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From page 35... ...
It has also devised tools and techniques that have facilitated the development of various alternative methods of paying for health services. As described earlier, these mechanisms include case-based payment for hospital services related to broad diagnostic groups, relative value scales for individual physician services, and adjusted per capita payments to health care organizations responsible for enrolled populations.
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, define and identify quality problems such as unnecessary or inappropriate care, underuse of appropriate care, and poor technical or interpersonal care. Drawing on concepts and techniques from industrial quality management, statistics, informatics, and operations research, health services researchers have been investigating strategies for monitoring performance and strengthening accountability.
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From page 37... ...
. That means that large health care organizations need not only leadership but also people and continuing processes for establishing objectives, designing strategies for meeting those objectives, implementing the strategies, collecting and analyzing evidence about their impact, and redesigning activities as appropriate.
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The scope of clinical evaluations and outcomes studies is wide. Examples include evaluations of oral health outcomes in countries with different approaches to preventing and treating oral disease and organizing oral health services, assessments of the effectiveness of home-based intervention for people caring for a family member with dementia, and studies of whether treatment for skin ulcers in people with diabetes varies according to the type of doctor seen.
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From page 39... ...
Important challenges for health services researchers, computer scientists, and others remain in such areas as linking patient records across inpatient and outpatient care settings; establishing protocols for ensuring the confidentiality and accuracy of information; and developing more userfriendly hardware and software for entering, retrieving, or analyzing information. In these activities, the federally sponsored National Information Infrastructure initiative will permit a wide variety of parties, including health services researchers, to transmit, store, process, analyze, and display data in different forms such as text, still images, sound, and video (Lasker, Humphreys, and Braithewaite, 1995~.
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In a restructured health care system, managers can look to past research on physician responses to economic incentives, guidelines for clinical practice, data on practice patterns, and other management or policy tools. variations rib r- , Health Professions Work Force Some of the most sensitive questions asked of health services researchers involve the education and supply of health care workers.
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From page 41... ...
Third, demands for internal management information and external accountability should provide employment opportunities for health services researchers as large medical care organizations, integrated health systems, and accrediting agencies establish health services research units to provide information and analyses. Fourth, public resources for health services research are vulnerable when attempts are made to pare government budgets, which complicates efforts to determine how many health services researchers should be trained.
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