Health services research (HSR) is an interdisciplinary field that studies health care itself, and its effects. The methods of HSR are those of the social sciences, including epidemiology, biostatistics, economics, sociology, anthropology, and psychology, but the focus of HSR studies is different; for HSR, the goal is, most simply, to assess the provision and quality of health care.
The continuum of clinical research is depicted in the Figure. In so-called T1 Translational Research, basic biomedical research at the bench, focused largely on molecular medicine, is translated into potentially efficacious therapies to treat disease at the bedside, in patients. The cornerstone of this efficacy research is the clinical trial (which is discussed in another paper). In T2 Translational Research, efficacious therapies may be demonstrated to be effective in the population of patients with a condition. Archie Cochrane, a premier clinical epidemiologist of the last century, referred to the research questions in efficacy research as “Can this work?” and in effectiveness research as “Does this work?” (Haynes, 1999
). The health services researcher focuses farther along the continuum, and asks “Is this working to improve health overall?” Subsets of HSR include, for example, outcomes research (in which the effects of a condition or treatment on a patient or society are precisely measured) and implementation research (which studies the adoption of research findings into routine healthcare). The overall goal, however, is to learn how health care can best and most efficiently improve health.
HSR studies themselves can be basic or applied (Vargas et al., 2004
). For example, the development of outcomes measures or risk adjustment methods provides tools that can then be used for measuring and comparing care in highly rigorous ways. Similarly, health services researchers often develop and use advanced statistical methods to analyze complex clinical data about care and its provision. Applied HSR, on the other hand, can seem almost activist in its outlook, since it often addresses or informs pressing questions that have significant policy implications. For example, why is there disparity in melanoma stage at diagnosis among patients of different races (Hu et al., 2009
)? Why are there unexplained variations in care for skin conditions seen in different practice settings (Chren et al., 2004
)? How often do medical errors and adverse events occur in dermatologic practice, and how can they be reduced (Gawkrodger, 2011
)? Addressing these types of questions requires the multidisciplinary resources of health services research.