Chapter 12

The focus of Different Types of Research

Different types of healthcare research

have clear distinctions in methods and the nature of subsequent findings

Each knowledge gain is an essential step in the quest to create a more efficient and effective healthcare system

Disciplinary-Theory

Biomedical -Organism subindividual lvl

Clinical- Patients Individual

Focuses on:

Various steps in the process of medical care early detection, diagnosis, and treatment of disease or injury

Maintenance of optimal physical, mental, and social functioning

Limitation and rehabilitation of disability palliative care of those who are irreversibly ill

Specialties of medicine, nursing, allied health and other health professionals

Often collaboration with basic sciences

Experimental research – Ex: clinical trials of diagnostic or therapeutic procedures or new drugs

Health Services- System (individual/ system lvl)

using established scientific methods in basic medical research to study the healthcare system itself

Goal: to find new and more effective means of diagnosis and treatment to improve the quality and length of life

Need to improve the efficiency and effectiveness of the healthcare system

determine which of the healthcare treatment options for each health condition produces the best outcome

Health Policy and systems research (HPSR)- an emerging field that seeks to improve how societies organize themselves in achieving collective health goals

Systems thinking: action or changes in one aspect of a health system that can affect what results in another

necessary to navigate the complexity of health systems and system-wide effects

Public Health-Community (population/system lvl)

Epidemiological research- population lvl

An observational study collecting observed or reported

information about natural phenomena, their characteristics, and

behaviors of people, aspects of their location, exposure to certain circumstances or events

Observational studies: descriptive or analytical

Descriptive patient records, interview surveys, various databases

Characteristics of biological phenomena, prevalence & magnitude of their occurrences

Analytic studies testing hypotheses to explain biological phenomena

by seeking statistical association between factors or observing

differences between two or more populations with different

characteristics or behaviors. Ex., Framingham Massachusetts study –

association between diet, weight, exercise & heart disease, etc.

Distribution and determinants of health, disease, and injuries in the human population

Agency for Healthcare Research and Quality (AHRQ)

Agency for Healthcare Research and Quality (founded 1999)

John Wennberg’s & other studies: the # of surgeons & available hospital beds in an area

correlated with the rate of hospitalizations (rather than differences among patients)!

AHRQ’s mission:

Improve the outcomes and quality of healthcare services; 2) Reduce their costs; 3) Address patient

safety; & 4) Broaden effective services through the establishment of a broad base of scientific

research that promotes improvements in clinical and health systems practices (including prevention

of disease)

AHRQ’s role: evaluating recommendations made in the clinical practice guidelines to ensure they were

based on a systematic review of the literature and were revised for currency.

Ex.: One guideline discouraged surgery as a treatment for back pain because it provided NO better outcomes than more conservative options... Lobbying efforts of MDs: The agency exceeded its authority by establishing clinical practice standards without MDs’ input...