In a series of special commentaries published in the journal Medical Care [1-4], Rebecca Russ-Sellers, Jerry Youkey, Ronnie Horner, and Matthew Hudson raised some provocative ideas about how health services research ought to be reoriented. I found myself agreeing with some of their suggestions and in strong disagreement with others. In this post, I’ll cover some of their ideas I think make sense. In a subsequent post, I’ll push back against a few that I think do not.
I read their most recent commentary  first, so I’ll begin there. (For the reader’s convenience, full references and links to all their commentaries to date are at the end of this post.) The premise, established in the first three commentaries [1-3] is that health services research (HSR) has underachieved, failing to identify “effective or efficient approaches to the provision of health care.” I don’t fully agree with that premise, but it’s important not to be too defensive. Some valuable things can be learned by withstanding a bit of critique.
Indeed, I think the authors are on to something in writing,
[A]t the heart of the current underachievement is the pervasive lack of clinical awareness of the prototypical health services researcher. Although the majority of health services researchers do not possess the medical doctorate, the issue is not so much lack of medical credentials as it is that the perspicacious health services researcher needs an understanding of the full context in which medicine is practiced. This context includes not only the physical setting of the clinic, but the fiscal and policy pressures and, most of all, the patient-provider covenant that is at the center of medical practice.
I cannot think of a good reason why greater understanding of the practice of medicine would not improve the work of a health services researcher. I don’t mean (and neither do the authors) that every HSR practitioner need to be able to perform open heart surgery. Heavens no! But knowing just enough to be able to make one’s way through at least some of the clinical studies one encounters in, say, the New England Journal of Medicine or the Journal of the American Medical Association is important.
Why? Because we’re supposed to be in an age of ascendance of evidence-based medicine. HSR practitioners should be participants in this enterprise, if not at or near the center of it. And at the center, it is about medicine and how it’s delivered.
For this reason, I encouraged the community to beef up its understanding of medical science in a 2013 post on this blog. I still have not come across a course in any HSR-relevant program that teaches basic concepts of medicine for social scientists. (If you’re aware of one, let me know.) I wrote,
Does it strike you as odd that we are training students to be experts in health care delivery, organization, and policy without at least offering the opportunity for them to learn some details about medical science? It’s a bit like an engineer not knowing Newton’s laws. Maybe this made sense some time in the past, but given the current emphasis on evidence-based care and comparative effectiveness research, I think it is time that even health services researchers, health economists, and anybody who claims to be a health policy expert knew more about medical science. [...]
We all, as health services researchers, need to get up to speed. If we’re going to talk the “evidence-based medicine” talk, we’ve got to walk the walk.
In that post, I went on to suggest ways you can get yourself up to speed, even without a course, though that would be better. Likewise, Russ-Sellers and colleagues  argue that students and practitioners of HSR should participate in a practicum in which they are immersed in the clinical environment, experiencing “first-hand the organization, management and operation of, say, a general practice clinic or an operating room.”
This sounds great to me. Sign me up. (But also pay my salary during my immersion please!)
1. Horner RD, Russ-Sellers R, Youkey JR. Rethinking health services research. Med Care. 2013;51:1031–1033.
2. Sinopoli A, Russ-Sellers R, Horner RD. Clinically-driven health services research. Med Care. 2014;52:183–184.
3. Russ-Sellers R, Hudson M, Youkey JR, et al. Achieving effective health service research partnerships. Med Care. 2014;52:289–290.
4. Russ-Sellers R, Youkey JR, Horner RD. Reinventing the health services researcher. Med Care. 2014;52:573-575.
Austin B. Frakt, PhD, is a health economist with the Department of Veterans Affairs and an associate professor at Boston University’s School of Medicine and School of Public Health. He blogs about health economics and policy at The Incidental Economist and tweets at @afrakt. The views expressed in this post are that of the author and do not necessarily reflect the position of the Department of Veterans Affairs or Boston University.