October 30, 2019 | Health Affairs
The Field Of Health Services Research: Time To Change Its Paradigm
Risa Lavizzo-Mourey, MD, MBA, writes in Health Affairs:
How can health services research better ensure that high-value health care is consistently and affordably provided to different people, communities, and populations? That’s a fundamental question that this sector must answer if it’s to remain viable.
Over the past 50 years, health services research has inarguably contributed to our understanding of how health systems work and how care is most effectively and affordably delivered. For example, it has helped those responsible for the design, delivery, and financing of health care to better understand the effects of cost sharing on consumption and quality of care; how expanding Medicaid can improve health outcomes for low-income patients; and what everyone can do to reduce medical errors.
At its core, the goal of health services research is to provide evidence that helps policy makers, clinicians, provider organizations, patients, and others make informed decisions that result in better health. When such research is well conceived, executed, shared, and acted upon, it has a real-life impact. It shapes transformative decisions about policy, from building the evidence base to support mandatory screening for post-traumatic stress disorder (PTSD) and traumatic brain injury among servicemen and -women to helping inform the majority opinion in the challenge to the Affordable Care Act brought before the Supreme Court in 2015.
The health care landscape is rapidly changing, and health services research must keep pace to ensure its promise and potential to improve health and the delivery of health care. But what happens when the very processes and methods that have reinforced the rigor of health services research stand in the way of its being effective and relevant? Rigor of the field—key to our credibility—can come at a cost in terms of timeliness. We know too well that it can take years to get funding support for, conduct, report, and publish health services research—and that translation of that research into policy and practice can take many more years. Yet the window for decision making in policy and practice can be days or weeks.
When processes and methods stand in the way, it’s time to question the established assumptions, roles, organizations, and incentives long used in the health services research community. It requires developing and adapting to a new paradigm.