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Health Services Research is the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations. Academy reports. 2000 Oct(2):8. Available from: http://www.academyhealth.org/files/publications/academyhealthreports/oct00.pdf.
he National Information Center on Health Services Research and Health Care Technology (NICHSR) has released for testing HSR search filters for health care quality and costs at: http://www.nlm.nih.gov/nichsr/hedges/search.html.
(See Figure 1.)
These filters have been developed to make it easier to identify HSR studies in NLM's PubMed database that meet specific study design criteria. Based on the work of Wilczynski, N.L., et al.*, these search filters are intended for researchers, clinicians, health policy analysts, planners, and the information professionals who work with them to help quickly locate studies about appropriateness, process, and outcomes (quality issues in the delivery of health care) or about health care costs and cost-effectiveness. You can read the HSR Study Design Definitions in Table 1 at the end of this article or at:
http://www.nlm.nih.gov/nichsr/hedges/hsrquerycriteria.html.
To use the new HSR filters, first select a category and an emphasis by clicking on the radio buttons, enter a topic in the subject search box, and hit Enter or click on the Go button. Figure 2 shows the initial search screen for a search on the term herpes zoster ophthalmicus using the HSR Quality Related Queries where the Category is outcomes assessment and Emphasis is sensitive search.
Note that the number of results produced by the search shown in Figure 3 is 133. Had this search been conducted without using Research Methodology filters, it would have produced 930 records.
NICHSR is very interested in receiving your comments and those of your constituents about these new search filters and others you think should be developed. Such feedback is needed to determine both whether these filters should be made available from PubMed directly and to identify new filters that may be needed. A Comments form (see Figure 4) is provided and can be reached by clicking the "Contact Us" button at the bottom of the HSR search filters page (see Figure 1).
Table 1: Health Services Research Study Design Definitions
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Appropriateness category:
Defined as content pertaining directly to determining whether individuals who
are provided with a health care service had the appropriate clinical indications
to receive that service. Methodologic criteria for this category: Explicit
criteria for appropriateness of care applied; data source was independent of the
study investigators or there was an assessment of the reliability of the
application of the criteria and the auditors were blind to practitioner identity
and, if more than one institution was involved, institution identity.
Process Assessment category:
Defined as content pertaining directly to assessing the process of care for
people with a given health problem. These observational studies addressed who
did what, to whom, why, where, when and how well. Methodologic criteria for this
category: Explicit criteria for process of care applied; the data source is
independent of the study investigators, or there was an assessment of the
reliability of the application of the criteria and the auditors were blind to
practitioner identity and, if more than one institution was involved,
institution identity.
Outcomes Assessment category: Defined as content pertaining directly to the appraisal of various clinical decisions/management paths and their effects on patient well-being (outcomes). Studies were observational in nature. Methodologic criteria for this category: At least one of the outcomes is objective or derived from a data source that is independent of the study.
Clinical Practice Guidelines
category: Defined as content pertaining directly to the development or
application of statements intended to assist practitioner or patient decisions
about appropriate health care (for specific clinical circumstances).
Methodologic criteria for this category: For development, there was an explicit
methods statement describing the process for developing the guidelines including methods of evidence assembly, method of review of studies and at least 1 of: the organizations and individuals involved; methods of formulating guidelines; and methods of reaching agreement or consensus. Evidence had to be cited in support of at least 1 of the recommendations. For application, at least 1 of the exact guidelines had to be provided in a table, figure or the text of the study.
Costs category: Defined as content pertaining directly to the costs or financing of a health care issue. No methodologic criteria applied.
Economics category: Defined as content pertaining directly to a comparison of the cost and effects of at least two different forms of service provision. Methodologic criteria for this category: Question is a comparison of alternatives; alternative services or activities are compared on outcomes produced (effectiveness) and resources consumed (costs); effectiveness and cost estimated are based on individual patient data; results are presented in terms of the incremental or additional costs and outcomes of one intervention over another; sensitivity analysis is performed if there is uncertainty. Evidence of effectiveness must be from a methodologically rigorous study of diagnosis, treatment, quality improvement, or a systematic review article that involved real patients. NOTE: Economics is a subset of the Costs category.
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*Wilczynski NL, Haynes RB, Lavis JN, Ramkissoonsingh R, Arnold-Oatley A (HSR Hedges Team). Optimal search strategies for detecting health services research studies in MEDLINE. JAMA. Submitted.
By Ione Auston
National Information Center on Health Services Research and Health Care Technology
Auston I. Beta Test on Health Services Research (HSR) Filters for Searching PubMed®. NLM Tech Bull. 2004 Jan-Feb;(336):e2.
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