Memoirs have gotten a bad name recently. Nonetheless, that is exactly what this article represents. My writing this piece was motivated by a session of the 2006 meeting of the Radiology Alliance for Health Services Research celebrating the 10 years of existence of the society. I was asked to speak (and then write) about what we have learned from the history of health services research in our specialty. This is no easy task. Lessons learned are necessarily idiosyncratic. Hence, what follows is necessarily very personal and may not jibe with your own impressions. That’s the nature of memoir.
Definition of and rationale for conducting health services research
Given that prelude, what is health services research? The Institute of Medicine defines this genre of academic endeavor as follows:
Health services research is a multidisciplinary field of inquiry, both basic and applied, that examines access to, and the use, costs, quality, delivery, organization, financing and outcomes of health care services to produce new knowledge about the structure, processes, and effects of health services for individuals and employers ( ).
This is a somewhat convoluted explanation and falls short of something that we can practically apply to medical imaging. Let’s try something easier and more directive of my own device:
Health services research is the investigation of technologies, facilities, and processes that represent or support the delivery of health care, including organization and management, financing, manpower, quality, decision-making, and technology assessment and diffusion.
Still problematic, right? The difficulty is that the concept of health services research is so all-encompassing that a great deal of flexibility and inclusiveness is necessary in approaching any discussion of the field. That is, metaphorically speaking, if it walks like a duck and quacks like a duck, then it must be … health services research.
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Iconic publications of health services research in radiology
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Neuhauser and Lewicki’s “What do we get from the sixth stool guiac?”
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Doubilet, Weinstein, and McNeil’s “Use and misuse of the term ‘cost-effective’ in medicine”
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Hillman and colleagues’ “The frequency and costs of diagnostic imaging in office practice: A comparison of self-referring and radiologist-referring physicians”
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Rifkin and colleagues’ “Comparison of magnetic resonance imaging and ultrasonography in staging prostate cancer: Results of a multi-institutional cooperative trial”
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Fryback and Thornbury’s “The Efficacy of Diagnostic Imaging”
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A key feature of this model is that for an imaging procedure to be efficacious at a higher level in this hierarchy, it must be efficacious at lower levels, but the reverse is not true…. This asymmetry is often lost to view in research reports at Levels 1 and 2.
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Blackmore and Magid’s “Methodlogic evaluation of the radiology cost-effectiveness literature”
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Conclusions and lessons learned
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References
1. Field M.J.Tranquada R.E.Feasley J.C.Health Services Research.1995.National Academy PressWashington DC:
2. Donabedian A.: The quality of care: how can it be assessed?. JAMA 1988; 260: pp. 1743-1748.
3. Neuhauser D., Lewicki A.M.: What do we gain from the sixth stool guiac?. N Engl J Med 1975; 293: pp. 226-228.
4. Doubilet P., Weinstein M.C., McNeil B.J.: Use and misuse of the term “cost-effective” in medicine. N Engl J Med 1986; 314: pp. 253-256.
5. Hillman B.J., Joseph C.A., Mabrey M.R., et. al.: The frequency and costs of diagnostic imaging in office practice: A comparison of self-referring and radiologist-referring physicians. N Engl J Med 1990; 323: pp. 1604-1608.
6. Rifkin M.D., Zerhouni E.A., Gatsonis C.G., et. al.: Comparison of magnetic resonance imaging and ultrasonography in staging early prostate cancer: Results of a multi-center cooperative trial. N Engl J Med 1990; 323: pp. 621-626.
7. Fryback D.G., Thornbury J.R.: The efficacy of diagnostic imaging. Med Decis Making 1991; 11: pp. 88-94.
8. Blackmore C.C., Magid M.J.: Methodologic evaluation of the radiology cost-effectiveness literature. Radiology 1997; 203: pp. 87-91.