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Introduction to Health Services Research : A Self-Study Course
Module 2: Brief History of Health Services Research (Page 17 of 40)
Health Services Research Post 1945
Health Care Technology
The end of World War II boosted interest in health care technology as military technology was converted to other uses. The use of computers in biology, biomedical engineering, medical diagnosis, and health information systems developed out of this conversion (Flook, 1973).
Quality and Satisfaction
The issue of quality became more important. How does one define quality? Early outcomes researchers developed scales to measure patients' adjustments to their conditions and satisfaction with their lives.
Dr. David A. Karnofsky (1914-1969) created quality measures for cancer patients in 1948. This scale is called the Karnofsky Performance Status Scale. It allows patients to be classified as to their functional impairment. The lower the scale, the more unlikely the patient is to survive.
Outcomes Research Develops under Avedis Donabedian
Dr. Avedis Donabedian has been called the "Father of Outcomes Research" for his work in defining quality of medical care and in health care assessment.
Dr. Avedis Donabedian has been called the "Father of Outcomes Research" for his work in defining quality of medical care and in health care assessment.
Dr. Avedis Donabedian, a major figure in health care assessment, described the quality of medical care as structure, process, and outcomes in 1950. He has been called the "Father of Outcomes Research".
- Structure includes the type of setting in which the care is given, such as the financial and human resources available.
- Process encompasses patient and provider activities to diagnose and treat an illness.
- Outcome refers to the patient's health status as a result of the care provided.
Writing many years later, Dr. Donabedian noted how difficult it is to define quality, "The definition of quality also becomes narrower or more expansive, depending on how narrowly or broadly we define the concept of health and our responsibility for it. It makes a difference in the assessment of our performance whether we see ourselves responsible for bringing about improvements only in specific aspects of physical or physiological function or whether we include psychological and social function as well" (Donabedian, 1988).
Donabedian’s work in outcomes research was highlighted in a series of three volumes titled, Explorations in Quality Assessment and Monitoring that was published in 1985. An award, the ISPOR Avedis Donabedian Outcomes Research Lifetime Achievement Award, was named in honor of his work after his death in November 2000.
Quality of Life Instruments
The efforts to measure quality have generated the creation of many instruments that have joined the ranks of the Karnofsky scale, such as the:
- Activities of Daily Living (ADL) scale
- Quality of Well-Being Scale (QWB)
- SF-36 Health Survey
- Sickness Impact Profile (SIP) 1976
- other new, computerized health assessment tools (Tarlov, 1995)
Important quality of life researchers (and their research teams) are associated with each scale.
- The Sickness Impact Profile (SIP) was developed by Marilyn Bergner in the early 1970s
- Solomon Katz led the effort to develop the ADL scale beginning in the early 1970s with the first important publication appearing in 1973
- Robert Kaplan developed the QWB in the early 1980s building on the work of earlier health assessment tool developers
- The SF-36 Health Survey and later the SF-12 Health Survey were developed by John E. Ware in 1992 and 1996 respectively
These were team efforts.
View Key Projects and Milestones in Health Services Research.
Discussion Questions
- It's clear that quality is an important issue in health services research. Can you think of other researchers besides Avedis Donabedian who have published extensively in the field of quality of care and outcomes research? Who are they and what is their importance?
- What resources do you use to identify instruments that health services researchers use in their research? Is finding the full instrument hard or easy?
- Various instruments have attempted to assess quality of life (QOL) issues. Why are QOL issues so important in health services research? Is it necessary to understand the role and use of health status assessment tools? Discuss.
- Are quality of care and quality of life synonymous? Explain.
- Is the concept "quality" a flexible concept? How do you know?
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