Health services research is a field of research that crosses many disciplines. It represents a novel way to address the Accreditation Council for Graduate Medical Education requirements for scholarly activity of residents and faculty in academic radiology departments. In addition to meeting training requirements, it offers future radiologists the opportunity to develop skills that will be essential as we transition from a volume based health care delivery system to an outcome based delivery system. This report introduces examples of health services research projects and the types of data resources that are available to facilitate such projects.
The United States is consistently one of the highest ranked countries in the percentage of gross domestic product spending on health care . The United States may have some of the world’s best physicians and health facilities; however, a perception exists that there is a systematic failure in the delivery of reliable high-quality health care. Health care costs and insurance premiums have been growing substantially faster than the economy and family incomes . Despite this spending, a substantive gap in quality and care metrics persists .
Advanced medical imaging has been identified as the most important medical innovation in recent history . This innovation is due to the efforts of researchers and engineers around the world, and represents the traditional strength of radiology research . However, these technologic advances drive increasing health care costs and complexity. For example, the Medicare Payment Advisory Commission (MedPAC) reported that the volume and complexity of imaging services grew nearly twice as fast as all physician services between 2002 and 2007, with some slowing between 2006 and 2007 . This spending is an obvious target when looking at the excesses in the US medical system . Pressure is growing to identify and reward efficient quality care and penalize inappropriate, ineffective care, and excess resource utilization .
Health care in the United States is in transition from a fee-for-service (volume-based) system to an outcome (value-based) system . Increasingly, both government and private payers are indexing payment to quality and other outcome metrics. Research is necessary to support this move and define these metrics. The specific area of research that fulfills these aims is health services research (HSR). HSR is a research discipline that has been defined by the Academy for Health Services Research and Health Policy as :
…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.
Radiology is best positioned to define how imaging is used while balancing the health and safety of both individual patients and groups of patients (covered lives) included in accountable care organization (ACO) populations . In the setting of ACOs, all health care providers will have a role in shared risk and reward when containing costs of health care. To ensure its validity and standing at the health care reform table, radiology as a profession must lead this transition.
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Health services research
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Table 1
Recent Examples from the Literature of Studies of Medical Imaging at Differing Levels of the Technology Assessment Hierarchy
Technical performance Murase K, Kitamura A, et al. Quantitative assessment of early experimental diabetes in rats using dynamic contrast-enhanced computed tomography. Eur J Radiol 2010;74:280–286. Diagnostic performance Sangwaiya MJ, Boland GW, et al. Incidental adrenal lesions: accuracy of characterization with contrast-enhanced washout multidetector CT: 10-minute delayed imaging protocol revisited in a large patient cohort. Radiology 2010;256:504–510. Diagnostic Impact Goldwyn E, Pensy R, et al. Do traction radiographs of distal radial fractures influence fracture characterization and treatment? J Bone Joint Surg Am 2012;94:2055–2062. Therapeutic Impact Pritchett CV, Levinsky NC, et al. Management of acute appendicitis: the impact of CT scanning on the bottom line. J Am Coll Surg 2010;210: 699–707. Impact on health Søgaard R, Fischer BM, et al. The optimality of different strategies for supplemental staging of non-small-cell lung cancer: a health economic decision analysis. Value Health 2013;16:57–65.
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Radiology resident education
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Data sources
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Table 2
Online Databases of Health Data
Website URL ∗ Information and Purpose http://www.hospitalcompare.hhs.gov/ Compares quality metrics between hospitals http://www.census.gov/# United States population demographics http://seer.cancer.gov/ Cancer data http://www.100tophospitals.com/ Profile of clinical outcomes and quality metrics for Top 100 Hospitals, Top 15 Health Systems and Top 50 Cardiovascular Hospitals http://www.healthypeople.gov/2020/default.aspx Nearly 600 objectives with 1200 measures to improve health of population http://www.medpac.gov/documents/Jun12DataBookEntireReport.pdf Annual report of Medicare metrics http://www.healthstatus2020.com/owh/index.html Woman’s health and mortality by state http://wonder.cdc.gov/ CDC data bases on public health measures http://www.oecd.org/health/healthpoliciesanddata/oecdhealthdata2012.htm Comparison of statistics on health and health systems across multiple nations http://healthdata.gov/ Health data managed by U.S. Department of Health & Human Services http://www.leapfroggroup.org/cp Comparison of hospital quality metrics including Errors, ICU staffing, Infections, Steps to avoid harm http://www.cdc.gov/nchs/nhanes.htm National Health and Nutrition Examination Survey (NHANES) assesses the health and nutritional status of adults and children http://www.cdc.gov/nchs/dhcs.htm National Health Care Survey answers questions of interest to health care policy makers, public health professionals, and researchers http://www.cdc.gov/nchs/nhis.htm National Health Interview Survey (NHIS) health information collected through personal household interviews http://www.cdc.gov/nchs/nvss.htm National Vital Statistics System includes births deaths, fetal deaths, and causes of death http://www.framinghamheartstudy.org/research/index.html Epidemiologic data from the Framingham Heart Study http://www.acrin.org/RESEARCHERS/POLICIES/DATAANDIMAGESHARINGPOLICY/DATAACCESSPOLICYDOCUMENT.aspx Data from American College of Radiology Imaging Network (ACRIN) trials can be accessed for additional research projects
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Protection of human subjects and institutional review board
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Conclusion
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