Scope and purpose of health services research

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Scope and purpose of health services research

• Marion Campbell/Zoe Skea

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Objectives

• To set HSR in the wider context
• introductions and housekeeping
• format and aims of the course
• scope and purpose of HSR
• range of research disciplines
• range of levels of interest

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Where to find Zoë

• z.skea_at_abdn.ac.uk
• Health Sciences Building, 3rd floor
• (5)54674

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Aims of the course

• To equip students with the skills and information
  needed to appraise and undertake health services
  research
• design a rigorous evaluation
• implement an evaluation
• critically appraise research evidence

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Format of the course

• 23 x 2 hour seminars
• Teaching style has two parts
• information
• application
• Assessments
• exam
• assignment

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• What is HSR?

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What is HSR?

• The identification of the health care needs of
  communities and the study of the provision,
  effectiveness and use of health services MRC
  (1992)
• HSR seeks knowledge which will lead to
  improvements in the delivery of health care
  Crombie IK (1996)

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more definitions

• Health services research is the multidisciplinary
  field of scientific investigation that studies
  how social factors, financing systems,
  organizational structures and processes, health
  technologies, and personal behaviors affect
  access to health care, the quality and cost of
  health care, and ultimately our health and
  well-being. Its research domains are individuals,
  families, organizations, institutions,
  communities, and populations.
• AcademyHealth, 2000

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and another

• Health services research examines how people get
  access to health care, how much care costs, and
  what happens to patients as a result of this
  care. The main goals of health services research
  are to identify the most effective ways to
  organize, manage, finance, and deliver high
  quality care reduce medical errors and improve
  patient safety.
• --Agency for Healthcare Research and Quality,
  2002

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Scope of HSR

• Organisation quality of care
• Impact of health care on health outcomes
• Efficacy, Effectiveness, Efficiency, Equity (the
  four Es)
• Acceptability and user/public participation
• Dissemination and implementation

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Organisation and quality of care

• Health care organisation and distribution
• the extent to which the needs of the patient are
  being met by the balance and delivery of
  resources and services
• Quality of care
• the extent to which the care provided is safe,
  appropriate, effective and efficient

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Impact of health careon patient outcomes

• The extent to which different health care
  policies or interventions impact on outcomes for
  the patient
• mortality
• morbidity
• quality of life
• treatment costs e.g., waiting time, stress

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Efficacy, effectiveness, efficiency and equity

• The four Es
• Efficacy - does it work?
• Effectiveness - does it work in routine care?
• Efficiency - is it value for money?
• Equity is it distributed fairly?

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Acceptability

• The extent to which different health care
  policies
• Are acceptable to the people who will use it
  (user acceptability)
• Impact upon the outcomes which are of importance
  to those who will use it (user perspective)

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Dissemination and implementation

• Dissemination
• how best to get the message to the target
  audience
• Implementation of change
• how best to facilitate appropriate care

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MRC description
The hot water bottle
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Disciplines involved in HSR

• Health services researchers
• Clinical specialities
• Epidemiology
• Statistics
• Sociology
• Psychology
• Healthcare management
• Economics
• IT
• and more

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Stakeholders in HSR

• Public
• Patient
• Clinician
• Manager
• Purchaser
• System

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Methods used in HSR

• Descriptive
• observational
• surveys and case studies
• Intervention/evaluative studies
• randomised controlled trials
• quasi-experimental studies
• Systematic reviews
• Qualitative studies
• and..

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• HSR in practice

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The verdict

• claims that NICE did not properly evaluate the
  impact of the drugs on the quality of life of
  carers and that the figures on the cost of
  long-term care used in their analysis were too
  low were not upheld by the court.
• ie the quality of the HSR stood up to judicial
  review

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Keating et al. J Bone Joint Surg Am. 2006
88(2)249-60
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STARS trial

• Background
• surgical management of hip fracture (3 approaches
  available)
• the operation you would get varied by day of week
  and by surgeon
• needed to know what method was best
• large trial conducted
• High failure rates seen with one operation
  (reduction and fixation)
• Significantly less use of this procedure in
  Scotland as a result of this trial

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Conclusion

• The aim of HSR is to improve health services -
  rigorous methods essential
• Are the findings of this research trustworthy and
  can they be applied in another setting?
• bias
• imprecision
• generalisability