Nursing Research and Health Services
Health Services Research
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).
Purpose of Health Services Research
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).
Change Along the Time
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 inform 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.
Impact on Nursing Services
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 (eg, 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).