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Integrating Medical Informatics and Health Services Research: The Need for Dual Training at the Clinical Health Systems and Policy Levels

Mandl, Kenneth D.; Lee, Thomas H.
Fonte: American Medical Informatics Association Publicador: American Medical Informatics Association
Tipo: Artigo de Revista Científica
Publicado em //2002 EN
Relevância na Pesquisa
95.82%
Reams of data pertaining directly to the core health services research mission are accumulating in large-scale organizational and clinical information systems. Health services researchers who grasp the structure of information systems and databases and the function of software applications can use existing data more effectively, assist in establishing new databases, and develop new tools to survey populations and collect data. At the same time, informaticians are needed who can structure databases that serve the needs of health service research and who can design and evaluate applications that effectively improve health care delivery. As long as health services researchers and informaticians work in separate spheres, however, opportunities to use data from health care encounters to improve care, expand knowledge, and develop more effective policies will be missed. This paper provides a brief exploration of 1) existing successful collaborations between health services researchers and informaticians and 2) needs and opportunities for additional joint work in several core research areas.

Bridging the Gap in Medical Informatics and Health Services Research: Workshop Results and Next Steps

Corn, Milton; Rudzinski, Karen A.; Cahn, Marjorie A.
Fonte: American Medical Informatics Association Publicador: American Medical Informatics Association
Tipo: Artigo de Revista Científica
Publicado em //2002 EN
Relevância na Pesquisa
95.78%
In January 2000, the Agency for Healthcare Research and Quality (AHRQ) and the National Library of Medicine (NLM) cosponsored an invitational workshop entitled “Medical Informatics and Health Services Research: Bridging the Gap.” Planned by a small committee of representatives from NLM and AHRQ institutional training centers, the workshop was designed to address the need for education of researchers interested in working at the intersection of the fields of medical informatics and health services research. More than 100 educators and researchers from AHRQ- and NLM-sponsored training programs in medical informatics and health services research participated in the workshop. Through a series of plenary presentations and breakout sessions, the workshop addressed ways of increasing the pool of persons interested, trained, and experienced in addressing specific areas of synergy between the two fields. This paper reports on the results of the workshop.

The quality of health services research in medical practice in the United Kingdom.

Fowkes, F G; Garraway, W M; Sheehy, C K
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /06/1991 EN
Relevância na Pesquisa
75.82%
STUDY OBJECTIVE--The aim was to determine the scope and quality of published health services research concerned with medical practice in the United Kingdom. DESIGN--Scope of health services research was reviewed in articles published in 41 medical and public health journals in 1985. In random sample of 60 papers stratified by study design, 18 key research parameters were assessed for the quality of reporting and application in the studies. MAIN RESULTS--Over 80% of the research described in 246 articles was carried out by clinicians, mostly without acknowledged epidemiological or statistical assistance. More than half the studies were descriptive and only 17% were trials. In studies of hospital services, 4% covered long term care, in contrast to 67% concerned with inpatient care. One third of studies were conducted in general practice but only 10% of these included an assessment of clinical outcome. Important research parameters were often not reported; for example, response rates were missing in 52% of the studies, and comparability of cases and controls was not stated in 42% of relevant studies. Major inadequacies were found in the conduct of research, particularly in the selection of controls, allowance for confounding factors, objectivity of measurements...

The roles of race and socioeconomic factors in health services research.

Schulman, K A; Rubenstein, L E; Chesley, F D; Eisenberg, J M
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1995 EN
Relevância na Pesquisa
75.78%
For decades data have been collected comparing health care in racial and ethnic groups. The use of such groups in health services research assumes that standard, reliable, and valid definitions of race and ethnicity exist and that these definitions are used consistently. In fact, race is a term often used, but ill defined. It can incorporate biological, social, and cultural characteristics of patients and can refer to both genetic and behavioral traits. Various investigators have reported differences between racial and ethnic groups in health status, disease manifestation and outcome, resource utilization, and health care access, often specifying neither a definition of race nor the measurement they used to classify their study populations. The role of race as an explanatory variable in health services research requires greater scrutiny than many researchers currently provide. Many studies use race as a proxy for other socioeconomic factors not collected in the research effort. This article explores the ambiguities about race as an explanatory variable that render such research difficult to interpret. We suggest that health services researchers focus on nonracial socioeconomic characteristics that might be both more informative and more useful in guiding policy formation.

Expanding the frame of health services research in the drug abuse field.

Weisner, C; Schmidt, L A
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/1995 EN
Relevância na Pesquisa
75.77%
OBJECTIVE. This article examines the distribution of heavy drug users across health and social service agencies in a community, and ways in which organizational and social policy factors influence pathways to services. DATA SOURCES/STUDY SETTING. Data are from the Community Epidemiology Laboratory, a project that includes comparable surveys of a wide variety of client, service provider, and general population groups in a single northern California county. STUDY DESIGN. The design is a cross-sectional analysis of patterns of service use and referral by heavy drug users distributed across a variety of service settings and in the general population. DATA COLLECTION. In-person, structured interviews by trained interviewers were conducted using comparable instruments, measures, sampling strategies, and fieldwork procedures. PRINCIPAL FINDINGS. The specialty drug treatment system serves only a small proportion of heavy drug users in the community. Large proportions of drug users are found in criminal justice, primary health, and welfare agencies. Patterns of service encounter and referral suggest that drug treatment clients typically have been in jail or on welfare prior to attending treatment, and are far less likely to have been referred to or from treatment by health providers. CONCLUSIONS. Health services research on drug abuse should expand its frame of reference to include services outside the specialty treatment sector. Drug treatment facilities are somewhat remote from other agencies in community service networks and are organizationally dependent on criminal justice and welfare systems. Further research should investigate both the costs and benefits of screening and providing services at earlier points of institutional involvement with drug abusers and the implications of interorganizational dependencies among criminal justice...

How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research.

Devers, K J
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /12/1999 EN
Relevância na Pesquisa
75.77%
OBJECTIVE: To lay the foundation for an explicit review and dialogue concerning the criteria that should be used to evaluate qualitative health services research. Clear criteria are critical for the discipline because they provide a benchmark against which research can be assessed. DATA SOURCES: Existing literature in the social sciences and health services research, particularly in primary care and medicine. PRINCIPAL FINDING: Traditional criteria for evaluating qualitative research are rooted in the philosophical perspective (positivism) most closely associated with quantitative research and methods. As a result, qualitative research and methods may not be used as frequently as they can be and research results generated from qualitative studies may not be disseminated as widely as possible. However, alternative criteria for evaluating qualitative research have been proposed that reflect a different philosophical perspective (post-positivism). Moreover, these criteria are tailored to the unique purposes for which qualitative research is used and the research designs traditionally employed. While criteria based on these two different philosophical perspectives have much in common, some important differences exist. CONCLUSION: The field of health services research must engage in a collective...

Multiple Chronic Conditions and Disabilities: Implications for Health Services Research and Data Demands

Iezzoni, Lisa I
Fonte: Blackwell Science Inc Publicador: Blackwell Science Inc
Tipo: Artigo de Revista Científica
Publicado em /10/2010 EN
Relevância na Pesquisa
85.76%
Increasing numbers of Americans are living with multiple chronic conditions (MCCs) and disabilities. Addressing health care needs of persons with MCCs or disabilities presents challenges on many levels. For health services researchers, priorities include (1) considering MCCs and disabilities in comparative effectiveness research (CER) and assessing quality of care; and (2) identifying and evaluating the data needed to conduct CER, performance measure development, and other research to inform health policy and public health decisions concerning persons with MCCs or disabilities. Little information is available to guide CER or treatment choices for persons with MCCs or disabilities, however, because they are typically excluded from clinical trials that produce the scientific evidence base. Furthermore, most research funding flows through public and private agencies oriented around single organ systems or diseases. Likely changes in the data landscape—notably wider dissemination of electronic health records (EHRs) and moving toward updated coding nomenclatures—may increase the information available to monitor health care service delivery and quality for persons with MCCs and disabilities. Generating this information will require new methods to extract and code information about MCCs and functional status from EHRs...

Creating and Supporting a Mixed Methods Health Services Research Team

Bowers, Barbara; Cohen, Lauren W; Elliot, Amy E; Grabowski, David C; Fishman, Nancy W; Sharkey, Siobhan S; Zimmerman, Sheryl; Horn, Susan D; Kemper, Peter
Fonte: Blackwell Science Inc Publicador: Blackwell Science Inc
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
85.7%
Objective. To use the experience from a health services research evaluation to provide guidance in team development for mixed methods research.

Improving Aboriginal maternal and infant health services in the 'Top End' of Australia; synthesis of the findings of a health services research program aimed at engaging stakeholders, developing research capacity and embedding change

Barclay, L.; Kruske, S.; Bar-Zeev, S.; Steenkamp, M.; Josif, C.; Narjic, C.W.; Wardaguga, M.; Belton, S.; Gao, Y.; Dunbar, T.; Kildea, S.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
85.87%
BACKGROUND: Health services research is a well-articulated research methodology and can be a powerful vehicle to implement sustainable health service reform. This paper presents a summary of a five-year collaborative program between stakeholders and researchers that led to sustainable improvements in the maternity services for remote-dwelling Aboriginal women and their infants in the Top End (TE) of Australia. METHODS: A mixed-methods health services research program of work was designed, using a participatory approach. The study area consisted of two large remote Aboriginal communities in the Top End of Australia and the hospital in the regional centre (RC) that provided birth and tertiary care for these communities. The stakeholders included consumers, midwives, doctors, nurses, Aboriginal Health Workers (AHW), managers, policy makers and support staff. Data were sourced from: hospital and health centre records; perinatal data sets and costing data sets; observations of maternal and infant health service delivery and parenting styles; formal and informal interviews with providers and women and focus groups. Studies examined: indicator sets that identify best care, the impact of quality of care and remoteness on health outcomes, discrepancies in the birth counts in a range of different data sets and ethnographic studies of 'out of hospital' or health centre birth and parenting. A new model of maternity care was introduced by the health service aiming to improve care following the findings of our research. Some of these improvements introduced during the five-year research program of research were evaluated. RESULTS: Cost effective improvements were made to the acceptability...

Parallel Systems and Human Resource Management in India's Public Health Services : A View from the Front Lines

La Forgia, Gerard; Raha, Shomikho; Shaik, Shabbeer; Maheshwari, Sunil Kumar; Ali, Rabia
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
75.88%
There is building evidence in India that the delivery of health services suffers from an actual shortfall in trained health professionals, but also from unsatisfactory results of existing service providers working in the public and private sectors. This study focusses on the public sector and examines de facto institutional and governance arrangements that may give rise to well-documented provider behaviors such as absenteeism, which can adversely affect service delivery processes and outcomes. The paper considers four human resource management subsystems: postings, transfers, promotions, and disciplinary practices. The four subsystems are analyzed from the perspective of front line workers, that is, physicians working in rural health care facilities operated by two state governments. Physicians were sampled in one post-reform state that has instituted human resource management reforms and one pre-reform state that has not. The findings are based on quantitative and qualitative measurement. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often determined by political connections and side payments. The evidence suggests an institutional environment in which formal rules of accountability are trumped by a parallel set of accountabilities. These systems appear so entrenched that reforms have borne no significant effect.

Health Services Research and Development: the Veterans Administration Program.

Goldschmidt, P G
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/1986 EN
Relevância na Pesquisa
75.82%
Health expenditures are rising inexorably; health status shows relatively little gain; technological possibilities are outstripping our ability or willingness to provide a commensurate level of resources. Clinical and administrative managers face increasingly difficult choices among alternative interventions in attempting to resolve these problems. If health services research is to succeed as a tool for assisting these decisions, clinicians, administrators, and researchers must view it as an integral part of management. This paper describes this concept of health services research and its implementation by the VA HSR&D Service, results from 1981 to date, and future directions. Four programs implement the Service's system to make relevant, valid information accessible to VA staff who can use it to improve veterans' health care: Investigator-Initiated Research (IIR) Program; HSR&D Field Program, which implements the Service's mission in various local areas VA-wide; Special Projects Program, responsive to system-wide issues, including technology assessment and transfer; and Resources Program, the Service's own management system. The Service's impact on improving veterans health care is already apparent. However, the true value of the HSR&D system will become apparent only in the 1990s...

Collaboration in health services research: on developing relationships between VA researchers and those in other institutions.

Greenlick, M R; Freeborn, D K
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/1986 EN
Relevância na Pesquisa
75.8%
This article explores the potential for collaboration between investigators in institutions outside of the VA and those engaged in research within the VA. The focus is on the potential for collaborative work in health services research; our perspective is that of researchers in a freestanding HMO research center affiliated with the Veterans Administration's Northwest Health Services Research and Development Field Program. The paper begins with a review of the reasons that make collaboration between VA researchers and other health services researchers so appropriate at this time. An example of collaboration is presented, drawing on the experience of the Northwest Field Program and the Kaiser Permanente Center for Health Research. Finally, some difficulties inherent in collaboration between VA and other health services researchers are discussed.

Training Synergies Between Medical Informatics and Health Services Research: Successes and Challenges

Shortliffe, Edward H.; Garber, Alan M.
Fonte: American Medical Informatics Association Publicador: American Medical Informatics Association
Tipo: Artigo de Revista Científica
Publicado em //2002 EN
Relevância na Pesquisa
95.83%
Stanford's two decades of success in linking medical informatics and health services research in both training and investigational activities reflects advantageous geography and history as well as natural synergies in the two areas. Health services research and medical informatics at Stanford have long shared a quantitative, analytic orientation, along with linked administration, curriculum, and clinical activities. Both the medical informatics and the health services research curricula draw on diverse course offerings throughout the university, and both the training and research overlap in such areas as outcomes research, large database analysis, and decision analysis/decision support. The Stanford experience suggests that successful integration of programs in medical informatics and health services research requires areas of overlapping or synergistic interest and activity among the involved faculty and, hence, in time, among the students. This is enhanced by a mixture of casual and structured contact among students from both disciplines, including social interactions. The challenges to integration are how to overcome any geographic separation that may exist in a given institution; the proper management of relationships with those sub-areas of medical informatics that have less overlap with health services research; and the need to determine how best to exploit opportunities for collaboration that naturally occur.

The whole is greater than the sum of its parts: the anatomy of the Department of Veterans Affairs Medical District 17 Health Services Research and Development Field Program.

Demakis, J G; Turpin, R S; Conrad, K J; Stiers, W M; Weaver, F M; Sinacore, J M; Cowper, D C; Darcy, L A; Huck, M N; Friedman, B S
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1990 EN
Relevância na Pesquisa
75.85%
The Medical District 17 Health Services Research and Development (HSR&D) Field Program was funded by the Veterans Administration (now the Department of Veterans Affairs--VA) in January 1983. This article describes the organization, progress, and accomplishments of this field program, and it provides a review of the breadth of health services research that is being conducted in Medical District 17. Overall, the field program has conducted research that addresses significant problems in the delivery of health care within the VA system. Resource utilization, cost effectiveness, and the care of geriatric patients have been some of the areas in which the Medical District 17 HSR&D Field Program has provided important research findings for VA. The field program plans to continue its response to the needs of VA. Moreover, HSR&D investigators will be collaborating with researchers of other services to conduct research that is both enlightening and highly relevant to the delivery of health care to the nation's veterans. The proposal for an HSR&D field program was developed by the Edward A. Hines Jr. VA Hospital in collaboration with the Center for Health Services and Policy Research (CHSPR) of Northwestern University. The program was funded in January 1983...

Epistemic dialog between health services and operations research

Lobo,Maria Stella de Castro; Lins,Marcos Pereira Estellita
Fonte: Sociedade Brasileira de Pesquisa Operacional Publicador: Sociedade Brasileira de Pesquisa Operacional
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2010 EN
Relevância na Pesquisa
75.78%
The study proposes a dialogical approach between OR and Health Services Planning and Epidemiology based on the similarities of their own epistemological experiences, according to Habermas' Theory of Knowledge. As a field of application, healthcare services planning and epidemiology are characterized as Complex Societal Problems, requiring multidisciplinary and multi dimensional approaches. A review of the literature on OR efficiency healthcare services applications is made to confront the perspective of the OR analyst and that of the health manager. Finally, an agenda is proposed to enhance the interaction between the disciplines, by increasing actuality of the OR methods' findings, to guarantee that the results of health services research will really be put in practice by health policy decision makers.

Anthropology in research on the quality of health services

Atkinson,Sarah J.
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/1993 EN
Relevância na Pesquisa
75.81%
Current crisis in the health sector has increased research directed towards quality of health services. Public health research on quality of services commonly assessed adherence to predefined criteria for building structure, equipment and technical procedures. The paper explores the contribution anthropology can make to health services research by including a lay perspective in quality evaluation. Rapid approaches to the lay perspective assume that conflict between the providers and users of health services result only from the different explanatory models and are thus resolvable through training and education. The holistic approach of anthropology demonstrates that service quality must be located in the wider contexts of health service structure, and the socio-economic circumstances of user's lives as well as differences between medical and lay models of health.

The Delivery of Mental Health Services in the Xenia Tornado

Dynes, Russell R.; Quarantelli, E. L.
Fonte: Disaster Research Center Publicador: Disaster Research Center
Tipo: Outros Formato: 20804421 bytes; application/pdf
EN_US
Relevância na Pesquisa
75.82%
The report consists of seven chapters and an appendix. The first chapter is background: it sets forth rather briefly the history of the organized delivery of mental health services in American disasters, the general research and analytical framework we used to study the delivery of such services in Xenia, and concludes with a discussion of the nature of the data we obtained in the study, including its limitations. Chapter II selectively describes pre-impact Xenia, the damage, destruction and disruption of community life occasioned by the tornado, and the expected as well as the actual post-impact reactions manifested by victims as well as others in the general population. The pre-impact mental health delivery service system existing in Xenia is described in Chapter III; it is seen as having evolved out of a general historical context. Chapter IV details the characteristics of the mental health delivery services attempted and provided after the tornado hit: it answers such questions as what services were delivered, how, where, and by whom. The following chapter analyzes the specific post-impact conditions, both those which arose after the tornado impact and those that were carried over from before the disaster, which lead to the kind of services described in Chapter IV. In Chapter VI we trace out at system...

La provisión de servicios de salud en Chile: aspectos históricos, dilemas y perspectivas; The provision of health services in Chile: historical aspects, dilemmas and prospects

Carlos Azevedo, Antonio
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; ; Formato: application/pdf
Publicado em 01/04/1998 SPA
Relevância na Pesquisa
75.78%
Realiza-se breve análise histórica do sistema de saúde no Chile, a partir do Serviço Nacional de Saúde, com ênfase nas reformas ocorridas desde 1980,durante o regime militar, e as mudanças introduzidas a partir de 1990 pelos governos democráticos. Compara a oferta atual de serviços pelo sistema público com a do setor privado utilizando como indicadores por mil beneficiários: a taxa de consultas, de exames de laboratório, de hospitalização, de altas e de cirurgias e a satisfação dos usuários. Analisa os principais dilemas do sistema de saúde e suas perspectivas à luz das medidas presentemente tomadas. Há boas perspectivas de que o subsistema público mantenha sua liderança histórica na condução e oferta de serviços no Chile devido à rigorosa lógica geográfica e demográfica na prestação de serviços, a disponibilidade estável de recursos financeiros, uma rede de serviços suficiente e ainda a considerável motivação de seus recursos humanos. São mencionados aspectos inovadores que podem ser aproveitados por outros sistemas, especialmente na América Latina, como: organização e gestão de serviços regionais de saúde, metodologias inovadoras de remuneração de serviços, sistema de vigilância sanitária e a regulamentação estatal do financiamento privado em saúde.; Se hace un breve análisis histórico del Sistema de Salud en Chile...

Anthropology in research on the quality of health services

Atkinson,Sarah J.
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/1993 EN
Relevância na Pesquisa
75.81%
Current crisis in the health sector has increased research directed towards quality of health services. Public health research on quality of services commonly assessed adherence to predefined criteria for building structure, equipment and technical procedures. The paper explores the contribution anthropology can make to health services research by including a lay perspective in quality evaluation. Rapid approaches to the lay perspective assume that conflict between the providers and users of health services result only from the different explanatory models and are thus resolvable through training and education. The holistic approach of anthropology demonstrates that service quality must be located in the wider contexts of health service structure, and the socio-economic circumstances of user's lives as well as differences between medical and lay models of health.

Developing nursing capacity for health systems and services research in Cuba, 2008-2011

Nelcy Martínez,MPH
Fonte: Medical Education Cooperation with Cuba Publicador: Medical Education Cooperation with Cuba
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2012 EN
Relevância na Pesquisa
75.88%
INTRODUCTION: Health systems and services research by nursing personnel could inform decisionmaking and nursing care, providing evidence concerning quality of and patient satisfaction. Such studies are rather uncommon in Cuban research institutes, where clinical research predominates. OBJECTIVE: Assess the results of a strategy implemented between 2008 and 2011 to develop nursing capacity for health systems and services research in 14 national research institutes based in Havana. METHODS: The study comprised four stages: description of approaches to health systems and services research by nurses worldwide and in Cuba; analysis of current capacities for such research in Cuba; intervention design and implementation; and evaluation. Various techniques were used including: literature review, bibliometric analysis, questionnaire survey, consultation with experts, focus groups, and workshops for participant orientation and design and followup of research projects. Qualitative information reduction and quantitative information summary methods were used. Initially, 32 nursing managers participated; a further 105 nurses from the institutes were involved in research teams formed during intervention implementation. RESULTS: Of all published nursing research articles retrieved...