Services Research Perspective Research Articles

When health technologies do not reach their effectiveness potential: A health service research perspective

This paper tries to unravel the following question: why do we sometimes obtain results that are worse than expected despite having used technologies that are provenly efficacious or effective and having eliminated major groups of causes leading to poor performance? Inductive analysis and synthesis based on nine areas of health service research show that to effectively adopt some health technologies, it is not enough to simply choose an efficacious or effective change strategy. It sometimes becomes necessary to change the behavior of the health workers that will use it, and to modify certain environmental elements. Technology's effectiveness also depends on intervening simultaneously at various levels. Using a mix of evidence-based change (multifaceted) strategies is often mandatory. Improving health service calls for permanent, not sporadic, efforts; for ensuring universal access to information, and for adopting regulations to prevent poor or potentially harmful service delivery. A portion of the service improvements that have been attained have resulted from the use not of isolated change measures, but of combinations of the most effective measures as part of a single integrated intervention. To further reduce the gap between observed and expected effectiveness we should pilot behavior change strategies before adopting some health technologies, and to permanently install in our health system the multifactorial, integrated technology adoption mechanisms that we still lack. Failure to do this will mean being inefficient and pursuing short-term results at the expense of feasible and legitimate medium-term objectives.

Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet system.

Personal health records (PHRs) are designed to help people manage information about their health. Over the past decade, there has been a proliferation of PHRs, but research regarding their effects on clinical, behavioral, and financial outcomes remains limited. The potential for PHRs to facilitate patient-centered care and health system transformation underscores the importance of embracing a broader perspective on PHR research. Drawing from the experiences of VA staff to evaluate the My HealtheVet (MHV) PHR, this article advocates for a health services research perspective on the study of PHR systems. We describe an organizing framework and research agenda, and offer insights that have emerged from our ongoing efforts regarding the design of PHR-related studies, the need to address PHR data ownership and consent, and the promotion of effective PHR research collaborations. These lessons are applicable to other PHR systems and the conduct of PHR research across different organizational contexts.

Interventions to Improve Cancer Screening: Commentary from a Health Services Research Perspective

Interventions to Improve Cancer Screening: Commentary from a Health Services Research Perspective

Care provision for patients with eating disorders in Europe: what patients get what treatment where?

In this paper, we report on the similarities and differences between patients with eating disorders and the services provided to them across 80 centres participating in a European collaboration (COST Action B6). Differences in patient characteristics as well as differences in treatment regimen, especially length of treatment, are described. The relationship between patient characteristics, treatment setting and length of treatment is investigated by multilevel analysis. The findings show a rich diversity in service conditions and traditions across European countries. Patients with anorexia nervosa are mostly treated in inpatient settings, patients with bulimia nervosa are treated mostly as outpatients—with the exception of German-speaking countries. Day-patient settings were generally rare. Clinical characteristics of the patients—e.g. severity of symptoms or illness duration—contributed only little to the differences in treatment length (within as well as between centres), whereas organizational factors explained the largest proportion of between centre variability. The findings are discussed from a service research perspective. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.

A health services research perspective on the use of ancillary services to retain persons living with HIV/AIDS in primary care

(2002). A health services research perspective on the use of ancillary services to retain persons living with HIV/AIDS in primary care. AIDS Care: Vol. 14, No. sup1, pp. 133-136.

Alcohol and Eating Disorders: Implications for Alcohol Treatment and Health Services Research

Background: This paper focuses on the co-occurrence of alcoholism and eating disorders and the clinical implications for treating this comorbidity in women with alcohol use disorders. There is substantial literature that supports higher than expected rates of co-occurrence of these two disorders. In addition, there is evidence that the co-occurrence of alcoholism and eating disorders is more likely to occur in the presence of other psychiatric disorders. A critical analysis of the studies on the comorbidity of these disorders is conducted along with a review of the possible etiologic association between the two disorders. Crucial questions related to pharmacological and behavioral treatments for this subgroup of alcoholic women with eating disorders are raised from a health services research perspective. Conclusions: There is substantial evidence that alcoholism and eating disorders co-occur at high rates. However, as this review points out, several important research questions remain regarding both the clinical manifestations of each problem in women who are comorbid for both disorders and the treatment implications.

Comments on the report card from a services research perspective.

FROM THE perspective of services delivery and services research, the Institute of Medicine (IOM) 1 and the report card by the IOM Committee for the Study of Research on Child and Adolescent Mental Disorders 2 in this issue of theArchivesreflect a flawed and circumscribed perspective. That perspective needs revision. The original IOM limited itself to research relating primarily to diagnosable mental disorders. It dealt with phenomena such as drug abuse, teen pregnancy, and dropping out of school as consequences of or risk factors for developing mental disorders. A POLICY-FOCUSED PERSPECTIVE Conditions that significantly affect large numbers of lives warrant a high priority. Examples of such conditions are conduct disorder, substance abuse, violence, abuse/neglect, and the use of psychotropic medication in the treatment of children and adolescents. Unfortunately, the attention and resources these prevalent problems receive is meager. Research expenditures per year of potential life lost

Need for change in standards of caries diagnosis–epidemiology and health services research perspective

Need for change in standards of caries diagnosis–epidemiology and health services research perspective