Introduction to Health Services Research : A Self-Study Course
Module 2: Brief History of Health Services Research (Page 26 of 40)
Health Services Researchers Move the Field Forward in the Late 1980s
Association for Health Services Research
In 1981 a small group of academically based health services researchers organized the Association for Health Services Research in order to defend the field and educate the public and policy makers about its importance.
AcademyHealth "promotes interaction across the health research and policy arenas by bringing together a broad spectrum of players to share their perspectives, learn from each other, and strengthen their working relationships."
The Association promoted all types and styles of health services research (including studies on the needs of children, the elderly, and the rural poor). Its education arm was called the Foundation for Health Services Research.
The Association merged with the Alpha Center to form Academy Health. More on AcademyHealth (http://www.academyhealth.org/) in Module 3.
Agency for Health Care Policy and Research
Then, in 1989, the government decided to reinvigorate its program of research support for health services with the creation of the Agency for Health Care Policy and Research as part of the Omnibus Budget Reconciliation Act of 1989.
The AHCPR was the successor to NCHSR and, as such, inherited its personnel, assets, liabilities, and functions.
The new Agency, however, had a new agenda -- emphasizing outcomes of care and a commitment to the development and dissemination of "practice guidelines, quality standards, performance measures, and medical review criteria."
To examine clinical practice issues and outcomes research, AHCPR funded 11 PORTs as of October 1990. PORTS is the acronym for patient outcomes research teams. Actual funding started in 1989. These PORTS were large multidisciplinary, multi-institutional projects that employed larger and more diverse groups of researchers than is typical in health services research.
The PORTS specialized in a specific acute or chronic condition that occurs frequently in the population. Researchers would do a comprehensive literature review and synthesis on the condition or treatment being assessed; collect and analyze data about variations in medical practice and associated patient outcomes; disseminate findings about practice effectiveness; and evaluate the effects of dissemination of their research.
The eleven PORTS included research into a variety of clinical practices such as
- Therapies for Benign Prostatic Hypertropy and Localized Prostate Cancer
- Back Pain Outcome Assessment
- Total Knee Replacement
- Hip Fracture Repair and Osteoarthritis
- Ischemic Heart Disease
Research from the various PORTS has been published widely and many reports and research findings can be found on the AHRQ Web site.
Research from the various PORTS has been published widely and many reports and research findings can be found on the AHRQ Web site. Starting in 1993, a "second generation" of projects known as PORT-IIs were funded. Overall approximately $100 million has been spent to answer critical questions about the effectiveness and cost-effectiveness of available treatments for common clinical conditions.
The work of the PORTS is very important. Articles from the PORTS are high quality and worth examining for their methodology.
National Guideline Clearinghouse (NGC)
In 1999 AHCPR set up the Web-based National Guideline Clearinghouse (NGC) (http://www.guideline.gov/).
The NGC is a repository for evidence-based clinical practice guidelines that were developed by the Agency for Health Care Policy and Research in partnership with the American Medical Association (AMA) and the American Association of Health Plans (AAHP).
Research Methods Books Appear
Shi's Health Services Research Methods
Health services research methods continued to evolve over time. In 1996 Leiyu Shi published one of the first compilations of health services research methods in his book titled, Health Services Research Methods. The book "provides comprehensive coverage of the major components involved in conducting health services or health related research." (Shi, 1996)
More recently, Researching Health: Qualitative, Quantitative and Mixed Methods was published. This book "covers the background to conducting health research, qualitative and quantitative methods employed in researching health, contemporary issues such as research ethics, comparative research and the use of mixed methods, and how to disseminate health research. As such, it provides the perfect package to help readers carry out their own research projects and use the research of others more effectively in their work" (Researching, 2007).
Wennberg's Dartmouth Atlas of Health Care in the United States
Also in 1996, John Wennberg published The Dartmouth Atlas of Health Care. It uses very large health care claims databases (including Medicare, Blue Cross organizations, and other sources of data) to document the differences in how Americans use health care resources, and the influence of the local supply of resources on the rates of use of those resources. The book demonstrates that the kind of health care you get can depend very much on where you happen to live (Wennberg, 1996)
View Key Projects and Milestones in Health Services Research.
- How do you search for research published by the various PORTS? Why is it important to know about the research that was done by the PORTS? Was the work done by the PORTS researchers as important as the work done by the researchers in the Rand Health Insurance Experiment? How can you tell?
- How significant was Wennberg's Atlas in health services research? To our understanding of how health care is provided? To issues of standards of care?
- Why is Shi's book, Health Services Research Methods, often used as a textbook in academic departments offering a PhD? Have you looked inside this textbook to see what kinds of research methods are being taught in academic settings? How does what the students know affect how you interact with them on projects?