Health Services Outcomes Research Research Articles

RE-AIM implementation outcomes and service outcomes: what’s the connection? results of a cross-sectional survey

BackgroundImplementation science and health services outcomes research each focus on many constructs that are likely interrelated. Both fields would be informed by increased understanding of these relationships. However, there has been little to no investigation of the relationships between implementation outcomes and service outcomes, despite general acknowledgement that both types of outcomes are important in the pathway to individual and population health outcomes. Given the lack of objective data about the links between implementation and service outcomes, an initial step in elucidating these relationships is to assess perceptions of these relationships among researchers and practitioners in relevant fields. The purpose of this paper is to assess perceived relationships between Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework outcomes and service outcomes, testing five a priori hypotheses about which perceived relationships may be strongest.MethodsA cross-sectional online survey was administered to a convenience sample of implementation scientists, health services researchers, and public health and medical practitioners from a variety of settings. Respondents provided information on their discipline, training, practice and research settings, and levels of experience in health service outcomes research, implementation science, and the RE-AIM framework. Next, they rated perceived relationships between RE-AIM and service outcomes. Repeated measures analysis of variance were used to test a priori hypotheses. Exploratory analyses assessed potential differences in mean ratings across groups of respondents categorized by discipline, setting, and levels of implementation science, health services, and RE-AIM experience.ResultsSurveys were completed by 259 respondents, most of whom were employed in academic and medical settings. The majority were doctoral-level researchers and educators or physicians. Reported levels of experience with implementation research, health services research, and the RE-AIM framework varied. The strongest perceived relationships overall were between Implementation/Fidelity and Effectiveness (as a service outcome); Maintenance and Efficiency; Reach and Equity; Adoption and Equity; Implementation/Adaptation and Patient-Centeredness; Adoption and Patient-Centeredness; and Implementation/Fidelity and Safety. All but one of the a priori hypotheses were supported. No significant differences in ratings of perceived relationships were observed among subgroups of respondents.ConclusionsThis study is an initial step in developing conceptual understanding of the links between implementation outcomes, health services outcomes, and health outcomes. Our findings on perceived relationships between RE-AIM and services outcomes suggest some areas of focus and identify several areas for future research to advance both implementation science and health services research toward common goals of improving health outcomes.

Activity-based funding for safety and quality: A policy discussion of issues and directions for nursing-focused health services outcomes research.

AimsA discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing‐focused health services outcomes research directed to improve the safety and quality of health care practices.BackgroundNational activity‐based funding in Australia is a policy‐focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research.DesignDiscussion paperData SourcesThis paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee—the Clinical Advisory Committee of the Independent Hospital Pricing Authority—and is supported by relevant literature and theory.Implications for NursingTo date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity‐based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital‐acquired complications, and preventable readmissions.

Annals for Educators - 3 May 2016

<i>Annals</i> for Educators - 3 May 2016

A Community's Perceptions of Pediatric Social Outcomes in a Downsized Urban Hospital System

This article describes parental perceptions of pediatric services at Los Angeles County King/Drew Hospital and Medical Center after the hospital and its community clinics were restructured in the 1990s. Qualitative and quantitative measures are used to capture parental perceptions of service utilization, service convenience, and quality of care. The results are compared to hospital institutional operational data from patient flow analysis reports, appointment delay reports, and improving organizational performance committee reports. A comparison of parental perceptions of pediatric care is also made with findings from other post-devolution studies on access and quality of care at the Los Angeles County Department of Health Services. The implications of the findings for hospital quality assurance processes and health services outcomes research are discussed.

An outcomes research perspective on medical education: the predominance of trainee assessment and satisfaction.

A fundamental premise of medical education is that faculty should educate trainees, that is, students and residents, to provide high quality patient care. Yet, there is little research on the effect of medical education on patient outcomes. A content analysis of leading medical education journals was performed to determine the primary foci of medical education research, using a three- dimensional outcomes research framework based on the paradigm of health services outcomes research. All articles in three medical education journals (Academic Medicine, Medical Education, and Teaching and Learning in Medicine) from 1996 to 1998 were reviewed. Papers presented at the Research in Medical Education conference at the Association of American Medical Colleges annual meeting during the same period, and published as Academic Medicine supplements, were also analysed. Only data-driven articles were selected for analysis; thus editorials and abstracts were excluded. Each article was categorized according to primary participant (i.e. trainee, faculty, provider and patient), outcome (performance, satisfaction, professionalism and cost), and level of analysis (geographic, system, institution and individual(s)). A total of 599 articles were analysed. Trainees were the most frequent participants studied (68.9%), followed by faculty (19.4%), providers (8.1%) and patients (3.5%). Performance was the most common outcome measured (49.4%), followed by satisfaction (34.1%). Cost was the focus of only 2.3% of articles and patient outcomes accounted for only 0.7% of articles. Medical education research is dominated by assessment of trainee performance followed by trainee satisfaction. Leading journals in medical education contain little information concerning the cost and products of medical education, that is, provider performance and patient outcomes. The study of these medical education outcomes represents an important challenge to medical education researchers.

Speaking in tongues: integrating economics and psychology into health and mental health services outcomes research.

Speaking in tongues: integrating economics and psychology into health and mental health services outcomes research.