Methods In Health Services Research Research Articles

Parents' experiences of caring for a child with a cleft lip and/or palate: a review of the literature

This review brings together for the first time the existing quantitative and qualitative research evidence about the experiences of parents caring for a child with a cleft. It summarizes salient themes on the emotional, social and service-related experiences of parents and critiques the literature to date, comparing it with wider, selected literature from the field of children's long-term conditions, including disability. The review suggests that there are similarities and differences between the literatures, in terms of research focus and approach. Similarities are found across children's conditions in the perspectives of parents on emotional, social and service-related aspects, although much of the cleft literature is focused on the early stages of children's lives. However, the quality of cleft research to date about parents' experiences has also been variable, with a narrow emphasis on cross-sectional, deficit-orientated psychological approaches focused mainly on mothers. Despite a substantial literature, little qualitative research has examined parents' perspectives in-depth, particularly about their child's treatment journey. This contrasts with the wider children's literature, which has traditionally drawn not only on psychological approaches but also on the broader perspectives of sociology, social policy, nursing and health services research, using both qualitative and quantitative methods, often in integrated ways. Such approaches have been able to highlight a greater range of experiences from both mothers and fathers, about caring for a child with a long-term condition and views about treatment. The review identifies a lack of comparable research in the cleft field to examine parents' experiences and needs at different stages of their children's lives. Above all, research is needed to investigate how both mothers and fathers might experience the long-term and complex treatment journey as children become older and to elicit their views about decision making for cleft treatments, particularly elective surgeries.

Introduction to Special Section: Causality in Health Services Research

Introduction to Special Section: Causality in Health Services Research

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Triangulation

Abstract There are many examples of studies in which pharmacy practice researchers have combined different types of data, methods and approaches within a single research project. Although a common practice in research across many disciplines, concerns have been expressed over combining methods underpinned by different philosophical assumptions and conceptual frameworks. The choice of methods made by pharmacy researchers is generally governed by practical considerations of the research and data requirements for fulfilling research objectives rather than these theoretical concerns. This review of the pharmacy practice research literature demonstrates how a wide variety of methods have been combined for different purposes and in a variety of study designs.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Evaluation of pharmaceutical services: (2) Methods and measures

Abstract Numerous studies have been undertaken to evaluate pharmaceutical services. These include both the evaluation of existing practice and assessments of innovative services in both hospital and community settings. Evaluation requires employment of methods and measures to ensure that relevant data on the effects of a programme are obtained. To evaluate a service from different perspectives (eg, acceptability to health professionals or patients, uptake, clinical outcomes or resource implications), a number of methods may be required. The outcomes may also be wide-ranging. Measures must be selected which provide a true reflection of the extent to which these outcomes are, or are not, achieved. Designs and frameworks used in the evaluation of pharmacy services have been discussed previously,1 this paper reviews the methods and measures that have been employed.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Survey research: (2) Survey instruments, reliability and validity

Abstract Social surveys are an important tool in health services research. They have been used in a high proportion of pharmacy practice research studies and in a wide range of settings. Extensive hand searches of published studies has enabled a review of the issues and problems that survey methods present when applied in pharmacy practice and an exploration of how they have been addressed by researchers. It is hoped that the review will enable pharmacy practice researchers to benefit from the experience of their colleagues when conducting their own research. This is the second part of a two-part review of surveys in pharmacy practice research. The first part (IJPP, 1997;5:152) focused on research questions, study design, sampling frames and procedures, response and non-response. This second part discusses the development of survey instruments and the issues of validity, reliability and generalisability.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Focus groups and observation studies

AbstractThis paper reviews research undertaken in pharmacy practice and related settings employing focus groups and observation methods. The aim of the review is to identify the main methodological considerations of these approaches to enable pharmacy practice researchers to benefit from the experiences of their colleagues when conducting their own research. The paper is in two parts. Focus groups have become increasingly prominent in pharmacy practice and health services research. They are an attractive and effective alternative to individual qualitative interviews for particular problems in pharmacy research. In this paper, the use of focus groups by researchers in pharmacy practice and related settings is reviewed. Observation studies have been applied widely to address many research questions. They are a valuable method of obtaining data, documenting actual events and activities rather than relying on self-reports of behaviours and events. Observation methods have been used both as a sole method for a research study and in combination with other methods. In the pharmacy practice literature there are examples of participant and non-participant observation studies and both quantitative and qualitative approaches. Through the experiences of pharmacy practice researchers, the methodological and ethical issues that these studies present are identified and ways in which they have been addressed are explored.

HEALTH SERVICES RESEARCH METHODS IN PHARMACY: Survey research: (1) Design, samples and response

Abstract Social survey methodology is the most widely used approach by pharmacy practice researchers, accounting for a higher proportion of published papers than any other. Survey techniques have been used to address a range of research objectives in a variety of populations and settings. Extensive hand searches of published survey research have enabled a review of the issues and problems that social survey research presents when applied in pharmacy settings, and an exploration of how they have been addressed. This review is in two parts. This first part focuses on the research questions that have been addressed by survey methods, design of the studies, sampling frames and procedures, response rates and management of non-response. A second paper will discuss the development of survey instruments, and the issues of validity, reliability and generalisability.

Health Services Research Methods In Pharmacy

Abstract The aim of this paper is to review the methodologies employed by health service and pharmacy practice researchers in the evaluation of pharmacy services. The review is in two parts. Part 1 discusses the application of different study designs and frameworks in the evaluation of existing and innovative services and interventions; part 2, to be published in a later issue, will address the methods and measures employed in the evaluation process. The studies included in this review were selected to give examples of different study objectives, designs and frameworks and their application in pharmacy settings. Although many of the issues regarding study design and evaluation frameworks may be relevant to clinical trials comparing the efficacy of alternative drug therapies, the focus of this paper is on pharmacy services.

Qualitative Methods in Health Services and Management Research: Pockets of Excellence and Progress, but Still a Long Way to Go

The 10-year systematic review of published health services and management research by Weiner et al. (2011) chronicles the contributions of qualitative methods, highlights areas of substantial progress, and identifies areas in need of more progress. This article (Devers, 2011) discusses possible reasons for lack of progress in some areas--related to the under-supply of well-trained qualitative researchers and more tangible demand for their research--and mechanisms for future improvement. To ensure a robust health services research toolbox, the field must take additional steps to provide stronger education and training in qualitative methods and more funding and publication opportunities. Given the rapidly changing health care system post the passage of national health reform and the chalresearch issues associated with it, the health services research and management field will not meet its future challenges with quantitative methods alone or with a half-empty toolbox.

Memorandum Register für die Versorgungsforschung

On August 30, 2010, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by their member societies mentioned as authors and published in this Journal [Gesundheitswesen 2010; 72: 739-748]. Registries in Health Services Research vary in their aims and research questions as well as in their designs, methods of data collection, and statistical analyses. This paper aims to provide both a methodological guideline for developers to ensure a high quality of a planned registry and, to provide an instrument for users of data from registries to assess their overall quality. First, the paper provides a definition of registries and presents an overview of objectives in Health Services Research where registries can be useful. Second, several areas of methodological importance for the development of registries are presented. This includes the different phases of a registry (i. e., conceptual and preliminary design, implementation), technical organisation of a registry, statistical analysis, reporting of results, data protection, and ethical/legal aspects. From these areas, several criteria are deduced to allow the assessment of the quality of a registry. Finally, a checklist to assess a registry's quality is presented.

Memorandum III: Methoden für die Versorgungsforschung (Teil 2)

The methodical quality of health services research studies is often subject to criticism. Common standards in the field of health services research have been lacking so far. Hence, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] decided to contribute to an improvement of this situation. The DNVF e. V. has already published part 1 of the Memorandum III"Methods for Health Services Research" for the 3 subject areas "Epidemiological Methods for Health Services Research", "Methods for Organisational Health Services Research" and "Methods for Quality of Life Research". The herewith published Part 2 of the Memorandum extends the spectrum by describing the methodological principles and minimum standards of "Methods of Health Economic Evaluations" and "Registries for Health Services Research". On 30 (th) August 2010, the member societies, mentioned as authors, approved this second part of the Memorandum III. 2 in-depth publications focussing on the 2 mentioned topics will be published in the next issues of this journal. This memorandum is intended for health services researchers who are planning, conducting and publishing studies as well as for reviewers who evaluate research proposals and publications on health services research studies. In accord with the expected advances in knowledge in health services research, it is planned to update the 2 parts of Memorandum III at appropriate intervals and to publish further parts from the huge spectrum of methods relevant to this field in the near future. Thus, the Memorandum has to be considered as work in progress.

Methoden der gesundheitsökonomischen Evaluation in der Versorgungsforschung

On August 30, 2010, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal [Gesundheitswesen 2010; 72: 739-748]. The present paper focuses on methodological issues of economic evaluation of health care technologies. It complements the Memorandum III "Methods for Health Services Research", part 2. First, general methodological principles of the economic evaluations of health care technologies are outlined. In order to adequately reflect costs and outcomes of health care interventions in the routine health care, data from different sources are required (e. g., comparative efficacy or effectiveness studies, registers, administrative data, etc.). Therefore, various data sources, which might be used for economic evaluations, are presented, and their strengths and limitations are stated. Finally, the need for methodological advancement with regard to data collection and analysis and issues pertaining to communication and dissemination of results of health economic evaluations are discussed.

Methoden für die organisationsbezogene Versorgungsforschung

On 1 July 2009, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned below and published in this journal (Gesundheitswesen 2009; 71: 505-510). The focus of this part of the Memorandum III "Methods for health services research" is on the questions and methods of organisational health services research. In a first step, we describe the central questions which are at the core of organisational health services research. In a second step, we describe the methodological standards and requirements with regard to a) sampling, b) measurement and c) research design. We present a phase model for complex intervention trials. This model allows to conduct high quality organisational health services research, to integrate different methods of social research and to show in which phase they are of special importance.

Die Erfassung von Lebensqualität in der Versorgungsforschung – konzeptuelle, methodische und strukturelle Voraussetzungen

On July 1, 2009, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal [Gesundheitswesen 2009; 71: 505-510]. This is an in-depth publication on "quality-of-life assessment in health services research". Within the context of the health sciences, quality of life (QL) encompasses the subjective well-being and functioning in the physical, psychological and social domains. QL informs about the aspects of health care that "actually get to the patient". QL is what patients primarily experience, what they talk about and what to a large degree affects the acceptance of health-care services and processes in the society. Therefore, QL can be considered as a highly important endpoint within health services research. The importance of the construct quality of life is also emphasised in German treaties on social law and utility analyses. This paper is the first account on the relations between health services research and the concept and assessment of QL. Our working group has specified key criteria for QL assessment within studies on health services research. (1) Assessment instruments need to comply with standard quality criteria (reliability, validity, sensitivity, interpretability) and the decision for a particular instrument has to be reasonably justified. (2) Study design and study population have to match with the scientific research question and the sample size has to be biometrically sound. (3) QL assessment including time points over the course of the study has to follow a standardized protocol. (4) Criteria for analysis and interpretation have to be prospectively specified. (5) Studies focusing on diagnostic/therapeutic issues need to specify standards for diagnostic criteria and related therapeutic interventions.

Epidemiologische Methoden für die Versorgungsforschung

On July 1, 2009, the German Network for Health Services Research [Deutsches Netzwerk Versorgungsforschung e. V. (DNVF e. V.)] approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors and published in this Journal (Gesundheitswesen 2009; 71: 505-510). This is an in-depth publication on the "epidemiological methods for health services research". Legal, political and economic steps of intervention in the medical care system modify the health services structures and processes but the impact of such interventions on the medical care users has, so far and in general, not been examined scientifically. Due to this lack of evaluation, there is, also with regard to the economic situation within the health system, no transparency of potentially severe effects on healthy and, particularly, on ill people. For this very reason, the main questions and focuses of medical care research deal with prevalence, causes and effects of over, under and inappropriate supply of health services, the interaction between diagnostics and therapy, the processes across different sectors and the complex interdependences of health services. This part of the Memorandum of Deutsches Netzwerk für Versorgungsforschung e. V. (DNVF e. V., German Network for Health Services Research) will enumerate the methods and instruments that will be used for planned studies and that have been applied for finished studies of health services research and for the evaluation of its quality and value. Health services research takes advantage of the theories and the methods of the disciplines that are involved in its studies. It does not need a specific research methodology; its methods are adapted to the specific research question. It is rather to be expected that certain issues of this research branch and its access to data will lead to the development of new methods.

Memorandum III: Methoden für die Versorgungsforschung (Teil I)

The methodical quality of health services research studies is often subject to criticism. Common standards in the field of health services research have been lacking so far. Hence, the German Network Health Services Research [Deutsches Netzwerk Versorgungsforschung e.V. (DNVF e.V.)] decided to contribute to improve this situation. On 1 July 2009, the DNVF e.V. approved the Memorandum III "Methods for Health Services Research", supported by the member societies mentioned as authors. For the three subject areas "Epidemiological Methods for Health Services Research", "Methods for Organisational Health Services Research" and "Methods for Quality of Life Research", this Memorandum describes the methodological principles and minimum standards which should be adhered to when conducting and publishing health services research studies. Three in-depth publications focussing on the three mentioned topics will be published in the next issues of this journal. This memorandum is intended for health services researchers who are planning, conducting and publishing studies as well as for reviewers who evaluate research proposals and publications on health services research studies. In accord with the expected advances in knowledge in health services research, it is planned to update the Memorandum III (part 1) at appropriate intervals and to publish part 2 in the near future. Thus, the Memorandum has to be considered as work in progress.

Quality Measures for Supportive Cancer Care: The Cancer Quality-ASSIST Project

Patients and physicians often cite symptom control as one of their most important goals in cancer care. Despite this, a previous systematic review found few tools for evaluating the quality of supportive cancer management. We developed a comprehensive set of quality indicators for evaluating pain and nonpain symptom management as well as care planning needs in cancer patients. Based on the prevalence and quality-of-life data, clinician-researchers prioritized pain, psychosocial distress, dyspnea, nausea and vomiting, fatigue and anorexia, treatment-associated toxicities, and information and care planning for quality-indicator development. Using search terms and selection criteria, we identified English-language documents from Medline (1997–2007) and Internet-based searches. Based on this evidence, clinician-reviewers proposed process quality indicators. We then used the VA Health Services Research and Development (VA HSR & D) appropriateness methods to compile the ratings of a multidisciplinary, international expert panel of the validity and feasibility of each indicator. The panel judged 92 out of 133 (69%) proposed quality indicators valid and feasible (15 out of 23 pain, 5 out of 6 depression, 8 out of 11 dyspnea, 15 out of 19 nausea and vomiting, 13 out of 26 fatigue and anorexia, 23 out of 32 other treatment-associated toxicities, and 13 out of 16 information and care planning). Of the final indicators, 67 are potentially useful for inpatient and 81 for outpatient evaluation, and 26 address screening, 12 diagnostic evaluation, 20 management, and 21 follow-up. These quality indicators provide evidence-explicit tools for measuring processes critical to ensuring high-quality supportive cancer care. Research is needed to characterize adherence to recommended practices and to evaluate the use of these measures in quality improvement efforts.

Actual Health Services Research Methods and Technics

As health services research is a field in continuous development, integrating methods and techniques from a large array of sciences, disciplines becomes necessary for juniors researchers and seniors as well, to summarize the most updated views and gains regarding the know how of this complex, pragmatic and useful type of research. Keywords: health services research, research methods, public health Content available only in Romanian.

Dialogues on Mixed-Methods and Mental Health Services Research: Anticipating Challenges, Building Solutions

Increasingly, contemporary mental health services research projects aim to combine qualitative and quantitative components. Yet researchers often lack theoretical and practical guidance for undertaking such studies. In September 2006 the authors convened under the auspices of the National Institute of Mental Health at a working conference, "Mixed Methods in Community-Based Mental Health Services Research." This meeting provided the opportunity for participants to share their experiences in conducting mixed-methods research, to critically consider problems they had encountered and their solutions, and to develop guiding principles for others conducting similar research. The authors' discussions, which are described in this article, emphasize that the problems encountered by mixed-methods research teams are rarely simple misunderstandings but often reflect epistemological differences that are overlooked in the study planning phases. Failure to acknowledge these different worldviews may result in significant tensions between members of the study team, use of qualitative methods that are insufficient or inappropriate for a particular research question, or serious conflicts when team members belatedly discover they are interpreting key concepts -- or each other's research techniques -- differently. The authors conclude that ongoing communication is the organizing principle for robust and effective mixed-methods research. Among the recommendations for preventing problems are collaboration between quantitative and qualitative researchers during the study design phase; open acknowledgement of the philosophical approaches brought to the study by various team members; and because not all challenges can be anticipated, a shared willingness to negotiate emerging problems.

The Use of Linear Instrumental Variables Methods in Health Services Research and Health Economics: A Cautionary Note

To investigate potential bias in the use of the conventional linear instrumental variables (IV) method for the estimation of causal effects in inherently nonlinear regression settings. Smoking Supplement to the 1979 National Health Interview Survey, National Longitudinal Alcohol Epidemiologic Survey, and simulated data. Potential bias from the use of the linear IV method in nonlinear models is assessed via simulation studies and real world data analyses in two commonly encountered regression setting: (1) models with a nonnegative outcome (e.g., a count) and a continuous endogenous regressor; and (2) models with a binary outcome and a binary endogenous regressor. The simulation analyses show that substantial bias in the estimation of causal effects can result from applying the conventional IV method in inherently nonlinear regression settings. Moreover, the bias is not attenuated as the sample size increases. This point is further illustrated in the survey data analyses in which IV-based estimates of the relevant causal effects diverge substantially from those obtained with appropriate nonlinear estimation methods. We offer this research as a cautionary note to those who would opt for the use of linear specifications in inherently nonlinear settings involving endogeneity.