The future of health services research in academic medicine

Building an Evidence-Base for TCM and Integrative East-West Medicine: A Review of Recent Developments in Innovative Research Design

There are many challenges to developing an evidence base for Traditional Chinese Medicine and Integrative East-West Medicine. This article offers a review of these challenges alongside an introduction and review of several innovations in healthcare research that have successfully been applied to the study of Traditional Chinese Medicine and Integrative Medicine. Such innovations include developments in Whole Systems Research, Comparative Effectiveness Research, Health Services Research, and qualitative Social Sciences Research. Each of these approaches expands upon conventional approaches to clinical research and can also be combined with clinical trial data to yield a mixed-methods approach. We conclude with a commentary on the necessity for such mixed methods studies in the continued establishment of an evidence base for TCM and IM.

The guideline implementability research and application network (GIRAnet): an international collaborative to support knowledge exchange: study protocol

BACKGROUND

Modifying the format and content of guidelines may facilitate their use and lead to improved quality of care. We reviewed the medical literature to identify features desired by different users and associated with guideline use to develop a framework of implementability and found that most guidelines do not contain these elements. Further research is needed to develop and evaluate implementability tools.

METHODS

We are launching the Guideline Implementability Research and Application Network (GIRAnet) to enable the development and testing of implementability tools in three domains: Resource Implications, Implementation, and Evaluation. Partners include the Guidelines International Network (G-I-N) and its member guideline developers, implementers, and researchers. In phase one, international guidelines will be examined to identify and describe exemplar tools. Indication-specific and generic tools will populate a searchable repository. In phase two, qualitative analysis of cognitive interviews will be used to understand how developers can best integrate implementability tools in guidelines and how health professionals use them for interpreting and applying guidelines. In phase three, a small-scale pilot test will assess the impact of implementability tools based on quantitative analysis of chart-based behavioural outcomes and qualitative analysis of interviews with participants. The findings will be used to plan a more comprehensive future evaluation of implementability tools.

DISCUSSION

Infrastructure funding to establish GIRAnet will be leveraged with the in-kind contributions of collaborating national and international guideline developers to advance our knowledge of implementation practice and science. Needs assessment and evaluation of GIRAnet will provide a greater understanding of how to develop and sustain such knowledge-exchange networks. Ultimately, by facilitating use of guidelines, this research may lead to improved delivery and outcomes of patient care.

The contribution of health services research to improved dermatologic care

To translate scientific discovery into improved health, we must study health care itself: ie, how people access health care, costs or other barriers to the provision of good care, and what happens to patients as a result of this care. Health services research (HSR) is the interdisciplinary field that studies health care and its effects. This paper reviews different types of HSR and highlights some dermatologic examples that have resulted in improved health care systems or have helped us understand access to existing systems. The paper also addresses some of the political and systematic challenges for health services research overall, and for individual investigators and program leaders.

Health services research in surgery--definitions, approaches and methods

BACKGROUND AND AIMS

Health services research (HSR) investigates the translation of clinical studies into the practice of health care in relation to quality and efficiency from the individual and socioeconomic perspective. Given the fact that HSR has become increasingly popular during the last decade, this article aims at providing an overview of the significance and benefit of HSR in general and especially in the field of surgery.

RESULTS

The first part of the overview provides various definitions that apply to the field, gives a brief historical overview of the development in Germany in contrast to the USA and Great Britain, and describes relevant theoretical frameworks and methods. In the second part it deals with gaps in patient care, patient-related outcomes, registry research, the integration of clinical and ambulatory surgery, and research on implementation of guidelines into practice.

CONCLUSIONS

This overview shows that HSR is by now regarded as an essential field, at least in developed countries, and that we are just at the beginning to understand why demonstrated effective strategies in the clinical context do not or rarely translate into routine patient's care.

[Outcomes research: definitions, methods and challenges in trauma and orthopaedic surgery]

BACKGROUND

Besides basic, illness- and patient-oriented research, outcomes research is regarded as the fourth pillar of modern health care systems. Outcomes research investigates both the desirable and adverse effects of medical and surgical interventions under day-to-day conditions.

METHOD

Because of rigorous entry criteria and selection of eligible subjects, the efficacy of a certain treatment derived from clinical experiments (i.e. classic randomized trials) may not necessarily be transferred to common patient populations or clinical settings. Apart from efficacy, a valuable (thus reimbursable) diagnostic or therapeutic procedure must prove its effectiveness in clinical practice as well. Demanding study designs are necessary to model effectiveness and to separate the observed intervention-related effects from bias and confounding.

RESULTS

Registries and pragmatic randomized trials may represent the most appropriate modalities to establish outcomes research in trauma and orthopaedic surgery. Good examples for interventions still needing proof of effectiveness are kyphoplasty and vertebroplasty, navigated surgery, damage control, interlocking implants and bone growth factors. Revealing over- and undersupply, generating negative lists (i.e. interventions of questionable or almost nil effectiveness) and integrating patients as co-therapists requires networking between hospitals and private practitioners.

CONCLUSION

Also, since outcomes research is a societal need, its development and funding must be ensured by all providers and payers of health care services.

[Tasks and development of health services research. A comparison between the USA, UK, Australia and Germany]

Given the fact that health services research has become increasingly popular in Germany during the last 5 years this article focuses on the status quo of this research field in a multinational comparison. An overview of the health services research situation in the USA, UK, Australia and Germany is given by considering development status, definition and future challenges. This overview shows that health services research is by now regarded as an essential field in these countries. Despite clear distinctions in research tradition and research infrastructure there are cross-national themes and challenges regarding research questions and organisation of research. The common challenges of the future are probably the enhancement of research capacities, the further development of adequate research methods and the question of translating research results into practice. All countries concur that the cooperation between stakeholders of the health services research field needs to be strengthened.