FREQUENTLY ASKED QUESTIONS (FAQ) ABOUT 

HEALTH SERVICES RESEARCH

AND

THE CENTER FOR HEALTH SERVICES RESEARCH

Questions About Health Services Research --

Q.        What is health services research?

A.        Health services research has been defined in many ways.  Some of these definitions are:

	“All strategic and applied research concerned with the health needs of the community as a whole, including the provision of services to meet these needs.” – House of Lords Select Committee on Science and Technology
	“It is a field of inquiry that examines the roles of organization, finance, manpower, technology and prevention in the provision of health care services, and their impact on utilization, cost and quality of care”  -- David Steinwachs, PhD.
	“The more traditional scope of health services research … looks to broader aspects of the health system and seeks to evaluate the impact of such structural features as the financing, staffing and organization of the health care delivery system on such dimensions as access to health care, and the cost and quality of health care.”  -Association of Academic Health Centers, 2000.

Q.        What is the goal of health services research?

A.        Dr. John Eisenberg, Commissioner of the Agency for Health Research and Quality, has concluded that the goal of health services research is

“to assure Americans that the information needed for decision making will be available; that it will be translated into knowledge about health care outcomes, effectiveness, efficiency, and quality; and that it will be used wisely to enhance the health of the public.”

Q.        How does health services research relate to other types of biomedical and health care research?

A.        Dr. John Eisenberg, Commissioner of the Agency for Health Research and Quality, described health services research as a part of the overall continuum of biomedical research that begins with basic medical science and extends through clinical investigations to research on the organization, financing and delivery of health care.  This continuum is displayed in the figure below.

Q.        Why has health services research become more visible in recent years?

A.        Health services and policy research has become an essential discipline in recent years. This increase in interest and activity has been driven by the rapid changes in health care delivery systems; the perceived and real limitations of health care resources; the increasing role of consumer choice in health care; the realization that  health care professionals know the true value of only part of what they do; the recognition that health care professionals and policy makers rely heavily on anecdotes rather than on data to formulate and assess policies and practices; and the greater technical and conceptual ability to quantify various aspects of health and health care.

Q.        Why is health services research important?

A.        Health services research is needed to evaluate, using scientific methods and evidence, what parts of the health care system truly do enhance health.   Many procedures and treatments may be expected to improve health but in reality may not.  This information is needed to avoid treatments that are potentially dangerous but that are not beneficial and to better allocate the limited resources available for health care services.

Q.        How does health services research fit into the mission of an academic health center?

A.        These studies fill a critical niche within the education, research and public service functions of an academic health center.  The educational objective is based upon the growing importance of understanding the impact of changes in the health care delivery system on the role and functions of all health care professionals.  Topics such as health care policy, health economics and evidence-based medicine have become essential ingredients of the education of future professionals.

The emerging role of health services and policy research within the research portfolio of an academic health center is motivated by the importance of knowing what works and what does not work in health care.  This need is propelled by changes in finance and delivery systems; the increasing accountability of health professionals for the clinical and financial consequences of their actions; and the greater ability to quantify more aspects of health care, including quality, outcomes and resource utilization.

A major responsibility for health services and policy research likewise exists within the public service mission of academic health centers, especially those that are state-funded.  Health services and policy research can have significant positive impact on the functions of the health care system and on the health of people.  Establishing and supporting The Center demonstrates the value that The University of Tennessee places on its role as the state’s health science center and its responsibility to participate in the formulation and analysis of health care systems for all residents of Tennessee.

An additional opportunity for the application of health services research is in the operation of the health delivery components of the academic health center.  Many of the tools and principles used in analyzing state or national health issues are directly applicable to the management of faculty practices and university-based managed care functions.

Q.        How does health services research differ from clinical trial research?

A.        Clinical trials generally assess the efficacy of a treatment, that is, the benefits of a treatment under highly controlled conditions in a selected population.  Health services research studies the effectiveness of a treatment, that is, the benefit gained from a treatment when used under normal or “real world” conditions” by practicing physicians on a broad range of patients.  It includes analysis of the appropriateness of use of the treatment as well as the outcomes of that therapy on health.

Q.        What can health services research do?

A.        Health services research can address a number of issues.  These include:  

	Provision of services	Effectiveness of services
	Use of services	Efficiency of services
	Costs of services	Health needs of community
	Financing of services	Access to care
	Organization of services	Equity of use of care
	Distribution of services	Impact of services on health
	Quality of services	Use of medical knowledge
	Planning of services	Attitudes of public and professionals

Q.        How can health services research impact health care policy?

Health services research can play five critical roles in formulating and implementing effective public policy.  These include documentation, analysis, prescription, assessment and education.

Documentation includes gathering, cataloging and correlating facts that depict the state of affairs that policy makers hope to change, illustrating problems not known to exist or emphasizing the severity of important concerns not fully appreciated.

Analysis entails examining various options for dealing with the concerns that have been documented, and demonstrating or suggesting which options are viable and which are not, and why.

Prescription involves formulating specific models or plans that may be adopted by policy makers and planners providing realistic, low risk options that are based upon tested experience and expert judgment.

Assessment is based on the quantitative evaluation of the success or failure of policy intervention in accomplishing the objectives for which it was designed, identifying the need to change policy or the implementation strategy to improve the likelihood of realizing the desired results.

Education includes providing reliable, meaningful and understandable information to policy makers and planners about general issues in health care as well as about specific topics of particular concern.

Q.        Why are academic centers for health services research important?

A.        Academic-based health services and policy research programs are in unique positions to meet these needs. They provide a knowledge of what is ‘known’, which can be useful in challenging the self-interested positions of stakeholders and, because they are at arm’s length from the policy process, academics bring an independent view to highly charged issues and a credibility to the findings.

Q.        How often do policy makers rely upon research data when making policy decisions?

A.        Policy makers do not commonly use research data when making policy decisions. 

Q.        Why not?

A.        Among the reasons research data are not utilized are the limited relevance of much research to the policy issues under discussion; the long delay in providing research data when policy decisions are to be made quickly; and the presentation of research findings in settings and in formats that are not accessible to or readily understood by the decision makers.  One objective of The Center for Health Services Research is to develop systems to rapidly inform policy makers in a manner that is targeted specifically to their interests and needs.

Q.        What are some of the findings of health services research?

A.        The major finding of health services research include:

• Geographic variation in practice

• Identification of underserved groups

• Rates of inappropriate resource use

• Analysis of cost-benefit and cost-effectiveness

• Role of patient satisfaction in quality assessment

• Evaluation of alternative delivery models  

• International comparisons of systems and outcomes  

Q.        What has health services research contributed to health policy?

A.        Health services research has contributed to the following major health policy initiatives:

• diagnosis related groups (DRGs)

• resource based relative value scales (RBRVS)

• health care report cards

• quality and process improvement activities

• health manpower planning  

Questions About The Center for Health Services Research --

Q.        What is the mission of The Center?

A.        The Vice President for Health Affairs of The University of Tennessee Health Science Center established The Center for Health Services Research to accomplish a specific mission -

to coordinate, promote and support health services and health policy research and education among the faculty and students of the University of Tennessee, Memphis, and to apply the talents of the faculty as a resource to policy makers and planners for enhancing the health of the citizens of Tennessee.

By accepting this mission, The Center strives to become a trusted and valued partner for public and private organizations to develop and to evaluate health-related public policies and programs; and an effective advocate for stimulating productive and meaningful research and education in the disciplines of health services and policy studies at the University of Tennessee.

Q.    Why was The Center formed?

A.        The formation of The Center was predicated on three principles:

	Health services and policy research is a vital component of a contemporary academic health center.
	Health services research serves an important role in defining and implementing effective health policy.
	A dedicated center promotes both the academic and public policy roles of health services and policy research.

Q.        What are the goals of The Center for Health Services Research?

A.        Goals of The Center include:

Goal 1: Promote interest and activity in interdisciplinary health services research and facilitate interaction among the faculty with interests in these areas.

Goal 2: Promoting the value of the faculty to health policy makers and planners at the local and state levels.

Goal 3: Begin efforts to impact the internal operations of health care delivery and practice systems that are part of The University of Tennessee.

Q.        What does the Center do?

A.        The Center serves

	as an integrative force promoting synergistic collaboration and collegiality among disciplines and academic units
	to demonstrate to the university and to the outside world that there is interest and expertise
	as an advocate for health services research and education within the academic health science center.

Q.        What are the advantages of a Center for health services research rather than simply relying upon individual faculty members to pursue their own interests?

A.        Advantages of a dedicated center include:

	A center demonstrates the commitment of an academic health center to health services research.
	Health services research is, by its nature, interdisciplinary, whereas the usual academic structure is highly disciplinary.  The Center serves as an integrative force to promote collaboration among faculty across the many disciplines that are required to understand, develop, evaluate and implement strategies to address critical health-related issues.
	Access to meaningful and reliable information on critical health-related issues is often delayed or even blocked because the information may be distributed among many groups of professionals. The Center facilitates the timely availability of required information by providing a centralized source for accessing current knowledge.
	A growing number of research grant opportunities require an interdisciplinary approach to specific research issues.  The Center acts as a nidus for developing successful research grant proposals that require collaboration and cooperation among several disciplines.
	The methods of health services and policy research differ from those of other types of biomedical research.  The Center fosters development of the necessary skills to aid a broad range of faculty members in planning and conducting meaningful research.
	Health services and policy research is a relatively new area of academic study.  The Center serves as an advocate for these activities and for the faculty, many of who are junior faculty and require mentoring.
	Health services and policy research involves disciplines such as economics and political science that are not found in this or in many academic health centers.  The Center forms effective alliances with other universities and groups that include the needed expertise.
	Many different programs and departments of the University of Tennessee require educational activities in areas related to health policy and delivery systems.  The Center includes a core group of faculty with the required expertise to provide these services in an effective, efficient and coordinated manner.

Q.        What are the specific activities that The Center has begun?

A.        The activities that The Center has already initiated include:

	Providing consultation to members of the state legislature, various state departments and health-related organizations in Tennessee.
	Sponsoring, in collaboration with the Department of Preventive Medicine, monthly conferences on health-related topics (see Sponsoring, in collaboration with the Department of Preventive Medicine, monthly conferences on health-related topics (see Activities section of this web site for details).
	Publishing Health Care Notes, a quarterly newsletter highlighting health-related news important to Tennessee and new activities of The Center (copies are available on-line, through the Publications page of this web site).
	Publishing Research Briefs, short presentations in nontechnical terms of research conducted by the Associates of The Center (copies are available on-line, through the Publications page of this web site).
	Coordinating a unique elective rotation for senior law, medical and pharmacy students – the Tennessee Interdisciplinary Health Policy Fellowship – through various agencies of state government that are active in health policy and regulation.
	Developing meaningful relationships with the Tennessee Departments of Health, of Mental Health and Mental Retardation, and of Correction, and with the University of Tennessee College of Law.

Q.        What is an Associate of The Center?

A.        The power of The Center lies in its ability to integrate the interests and abilities of faculty of many departments in all colleges of the University of Tennessee Health Science Center. Faculty of any department of any college with interests in health services and policy issues, whether from a research perspective or an educational perspective or both, are encouraged to participate in the activities of The Center. The Center seeks to link faculty with interests in behavioral health, biostatistics, environmental health, epidemiology, health care economics, health systems administration, medical ethics, preventive medicine, public health, public policy and administration -- in addition to allied health, dentistry, medicine and basic medical sciences, nursing, pharmacy, nursing, and social work --  to provide an integrated and interdisciplinary approach for assessing and improving health and healthcare issues, policies and programs. These faculty are designated as Associates of The Center for Health Services Research, and represent the core group that The Center supports and the group that is responsible for achieving the mission of The Center. Status as an Associate is approved by the Advisory Committee and is reviewed biennially to assure ongoing appropriateness.

Q.        What are the obligations of an Associate?

A.       Participation in the activities of The Center is purely voluntary.  An Associate may choose to participate in educational, research, or pubic service programs.

Q.        What are the advantages of becoming an Associate?

A.       It is the group of Associates that The Center will serve, whether though informational products (newsletters, etc.) or by facilitating research and educational programs.

Q.        Can people from outside the University of Tennessee become Associates of The Center?

A.        Faculty from other local and regional universities as well as staff members of other public and private organizations with related missions are encouraged to participate in the functions of The Center. These groups expand the perspectives of The Center and bring needed expertise in a broad range of health-related disciplines into The Center.

Q.        How do I become an Associate?

A.        Fill out the form on the Information page, OR

 Contact the Center

	By e-mail:  centerhs@utmem.edu
	By phone:  (901) 448-5826
	By mail:     Dr. David M. Mirvis

                              The University of Tennessee Health Science Center

                              The Center for Health Services Research

                              66 North Pauline, Suite 463

                              Memphis, TN 38163

Q.        What is the role of the Advisory Committee and who is on it?

A.        An Advisory Committee composed of senior faculty members from various colleges assists, guides and assesses the functions of The Center. Its functions include analyzing the ongoing progress of The Center in accomplishing its mission; assisting center staff in developing and implementing the sponsored activities; providing guidance for faculty developing extramural grant applications and mentoring junior faculty and students; and serving as advocates for the needs of The Center and for related programs throughout The University of Tennessee, Memphis campus.  This group will be supplemented by community leaders to involve stakeholders in the planning, conduct and assessment of the educational, research and outreach programs of The Center.   Members include: Dick R. Gourley, Dean, College of Pharmacy;  Nancy Lawhead, Special Assistant to The Mayor of Shelby County for Health; Yvonne Madlock, Director of the Memphis and Shelby County Health Department; and Cheryl Stegbauer, Professor of Nursing..

Q.        To whom does The Center report?