Health services research is a part of a broad scientific continuum which addresses fundamental mechanisms of health and disease including prevention, diagnosis, treatment, and the evaluation of health care services and the system in which they are delivered.It is described by the Institute of Medicine as “the interdisciplinary field that investigates the structure, processes, and effects of health care services” (Institute of Medicine, 1995). It is different from biomedical research; however, the boundaries between the two are not distinct, nor should they be. Domains along the research continuum overlap, thereby reducing the gaps that would occur if they were totally separate (Eisenberg, 1998).
Health services research addresses issues of health care organization, delivery, financing, and utilization, as well as patient and provider behavior and the quality, outcomes, effectiveness, and cost of health care. It appraises both clinical services and the system in which these services are provided. It evaluates information about the cost of care and its effectiveness, efficiency, quality, and outcomes and it includes studies of the structure, process, and effects of health services for individuals and populations. Both basic and applied research questions are addressed, including aspects of individual and system behavior and the application of interventions in practice settings (Eisenberg, 1998).The health care environment is changing rapidly and is characterized by consolidation of health plans and movement of patients and providers into managed care settings. Efforts to contain rising health care costs are coupled with fears that cost-containment measures will lower the quality of care. Problems related to access to health care and health insurance coverage persist for many Americans.
This market-driven health care system cannot function efficiently without better information for all decision makers in health care. Purchasers are looking for value at low cost, patients want to make informed decisions about care, clinicians need information about evidence-based treatments, health plans must determine which services to cover, and institutional providers need to make organizational and management decisions. Health services research addresses the information needs of all of these groups at the clinical, system, and policy decision level (Agency for Healthcare Research and Quality, 2004).
Outcomes and effectiveness research is a type of health services research that studies the impact of interventions on patients and the effectiveness of treatments in noncontrolled settings. The terms “outcomes research” and “effectiveness research” have been used to refer to a range of studies, and no single definition for either has gained wide acceptance (Stryer, Tunis, Hubbard, & Clancy, 2000). Effectiveness research is often contrasted with efficacy research. Effectiveness research is conducted in typical practice settings with diverse patient populations; efficacy research is carried out in more controlled research settings, often with a less diverse population (Hubbard, Walker, Clancy, & Stryer, 2002). Outcomes research seeks to understand the end results of particular health care practices and interventions. In this context, end results include effects that people experience and care about, such as change in the ability to function.
Health services research is heavily invested in issues of quality, patient safety, and disparities in health care. Evidence is needed to in-form practice. Health services research provides that information on interventions related to benefits, risks, and results so that both clinicians and patients can make informed choices about care. Propelled by the Institute of Medicine report To Err Is Human (Institute of Medicine, 2000), there is growing recognition of the need for research into better methods of safeguarding health care services and delivery (Hubbard et al., 2002).
An important end result of health services research is the translation or transformation of the findings into practice and policy and the utilization of evidence-based care. Health services research will continue to improve science based information on health disparities so that the health of minorities, women, and children is enhanced.
Health services research is germane to nurses. Understanding the impact of nursing interventions is an important component of health services research because enhanced nursing care is critical for the growing number of elderly and chronically ill people. Nurses play a large and significant role in the interdisciplinary team, and many of the outcomes critical to health services research function (e.g., improved health status and satisfaction) are measures that are usually dependent on the collective practice of the entire health care team (Hubbard et al., 2002).
Nurses have always been involved in patient outcomes, and the outcome measures noted above are important components of current nursing education. Nurses’ high degree of interaction with patients makes them likely candidates as health services researchers or members of the health service research team. The Agency for Healthcare Research and Quality, a major funder of health services research, encourages nurse scientists to apply for grant support. Funding opportunities can be found at AHRQ’s nursing web site: www.ahrq.gov/about/nursing. Investigating the various components of nursing care and how they influence patient outcomes represents an essential area of research needing further development. As prime observers of and participants in health care delivery, nurses can make important and valuable contributions to health services research (Hubbard et al., 2002).