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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Module 1: What is Health Services Research (HSR)? (Page 8 of 11)

Core Areas of Interest in Health Services Research

The core areas of interest in health services research are access, quality, cost, and the evaluation of the impact of a service or technology. The following section briefly defines these basic concepts and several others that are prominent in the field. The definitions are based on the Glossary of Terms Commonly Used in Health Care originally provided by the Alpha Center and on MeSH definitions.

Access:
Often defined as the potential and actual entry of a population into the health care system and by features such as private or public insurance coverage. Entry is based on the person's wants, resources, and needs, and is influenced by distance from health care, waiting time, income, and regular source of care. Researchers define access in terms of utilization rates.
 
 
Clinical practice guidelines:
A set of directions or principles to assist the health care practitioner with patient care decisions about appropriate diagnostic, therapeutic, or other clinical procedures for specific clinical circumstances. Many organizations write these guidelines, including the government (National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA)); professional associations (American College of Physicians (ACP), American College of Obstetricians and Gynecologists (ACOG)); insurance companies; HMOs; and academic medical centers, hospitals, and large group practices.
 
Cost:
Expenses incurred in the provision of services or goods. Types of costs include allowable, direct, indirect, and operating. Costs may not be equal to charges, the price of a service or the amount billed an individual or third party.
 
Effectiveness:
The benefit provided by a treatment, service or technology to a group of people under usual circumstances of everyday life.
 
Efficacy:
The benefit provided by a treatment, service or technology to a group of people under ideal or controlled conditions (i.e., not real life).
 
Evaluation:
A systematic analysis of the extent to which a program has reached its goals and objectives. In health services research and public health, the target of analysis is a group; in medicine, it is often an individual patient.
 
Managed care:
Arrangements with selected providers to furnish comprehensive services to members of the plan. It generally includes specific criteria for the selection of health care providers, financial incentives for patients to use the plan's providers, and formal programs of evaluation.
 
Meta-analysis:
A quantitative method of combining the results of independent studies (usually drawn from the published literature) and synthesizing summaries and conclusions which may be used to evaluate therapeutic effectiveness and plan new studies.
 
Outcomes research:
Measures the changes that occur in people's health and satisfaction due to specific medical and health interventions. This research requires careful discrimination between these interventions and all the other factors that influence one's health and satisfaction.
 
Public health:
The science dealing with the protection and improvement of community health by organized community effort. Public health activities are generally those which require population-level interventions as distinct from personal health care. Public health activities include immunizations; sanitation; disease control; occupational health and safety; health education; epidemiology; control of air, water, and food, and many others.
 
Technology assessment:
Examines technical, economic, and social consequences of technological applications, especially the evaluation of efficacy and safety. Some definitions restrict technology assessment to the evaluation of instruments, devices, and machines while others incorporate measures of patient preferences and quality of life.
 
Utilization:
Use of services, such as hospital care, physician visits, prescription drugs. Researchers look for patterns of use and often express utilization in terms of rates per unit of people who are at risk over a given time period.

Discussion Questions

  1. These are not the only areas of interest in health services research, just the main ones. As with other disciplines, health services research looks at the minutia of the field as well as the broad sweeps. What are some of the recent areas of health services reseach that you have had to search for information on and how easy or difficult was the information to find?
  2. What other sites dealing with health services research have you come across in your work? What is their quality? How do you determine the quality of the site?
  3. Technology assessment is mentioned above as an important term. Why is it important and how do you track changes in technology, if you do? Should you track changes in technology? Why or why not?
  4. How important is knowing the terminology of a field. Discuss with examples.
  5. Why is a definition of public health included in a course on health services research?
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