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work of biochemists, physiologists, biologists, pharmacologists and others concerned with science
- Most research is at the cellular level and takes place in labs
-Other research involves animal or human studies
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conducted by those in clinical specialties of medicine, nursing, allied health
-Focuses on the various steps in the process of medical care (early detection, diagnosis and treatment of disease or injury, maintenance of optimal physical, mental and social functions, the limitation and rehabilitation of disability, and palliative care)
- Most research is experimental involving carefully controlled clinical trials of diagnostic and therapeutic procedures, drugs and technology |
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| test new treatment of drugs against a prevailing standard of care. One group is given a placebo and the other is given the new drug. Random selection is key. |
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| neither the patient nor the researcher knows who is receiving the test drug or treatment until the study is finished |
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| Research is observational – collection of information about natural phenomena, characteristics and behavior of people, aspects of their location or environment and exposure to certain circumstances or events |
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| descriptive or analytical |
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| use patient records, interview surveys, various databases and other information sources to identify factors and conditions of health and disease in populations |
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| to observe difference between two or more populations with different characteristics |
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| Experimental epidemiology |
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| the investigator actively intervenes by manipulating one variable to see what happened with the other |
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| improve the efficiency and effectiveness of the health care system and to determine which health care treatment option for each condition produces the best outcomes. |
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documented large difference in the use of medical and surgical procedures among physicians in small geographic areas in late 1980s
- He noted that the rate of surgeries correlated with the number of surgeons and numbers hospital beds rather then the difference among patients
- This sparked interest amongst the federal government with the establishment of the National Institutes of Health → it became clear that there were problems in the ways to diagnose and treat medical issues |
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| - The Agency for Health Care Policy and Research (AHCPR) 1989 |
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| successor of National Center for Health Services Research and Health Care Technology. It was one of eight agency of the Public Health Service |
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| responsible for updating and promoting the development and review of clinically relevant guidelines to assist healthcare practitoners in prevention, diagnosis, treatment and management of clinical conditions |
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| - Healthcare Research and Quality Act 1999 |
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| was passed and re titled AHCPR to Agency for Healthcare Research and Quality (AHRQ) |
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| mission: 1. Improve the outcomes and quality of healthcare services 2. Reduce costs 3. Address patient safety 4. Broaden effective services through establishment of a broad base of scientific research that promotes improvement in clinical and health systems → pushed to get research results into consumers hands |
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| Health Services Research and Health Policy |
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| • Contributions: wennburg studies, prospective payment system, research on inappropriate medical procedures, resource based relative value scale, and background research that supported health maintenance organizations |
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| • RAND Health Insurance Experiment |
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| contributed information on the effects of cost sharing on the provision and outcomes of health services. |
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| where hospitals focused on poor care (bad apples). It was believed that it was the best way to ensure quality by removing them |
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| characterized the concept of health care as divided into components of structure, process and outcomes and the research paradigm of the linkages → suggested that the number, kinds and skills of providers and the physical resources should influence the quality of outcomes |
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| rely on the internalized judgments of the expert individuals involved in the quality assessment |
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| developed and agreed on in advance of the assessment, minimize variation |
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| • The systematic application of the best available evidence to the evaluation of options and decisions in clinical practice, management and policy making |
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| • Functional status has three components |
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1. Physical functioning
2. Role functioning – extent to which health interferes with usual daily activities
3. Social functioning- whether health affects normal social activities
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| - Responses gathered from: surveys, mailed questionnaires, and other means of gathering patient input |
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| databases of gene and protein sequences and sructure/fuction information. The future of biotechnology |
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| the study of genetic material in the chromosomes of specific organisms |
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-Research priorities are shifting from an individual patient perspective to a population orientation and toward continuous scrutiny of the efficiency and effectiveness of the care delivered
- Basic science research will continue to contribute to the diagnostic and therapeutic healthcare
- Bioinformatics: databases of gene and protein sequences and sructure/fuction information. The future of biotechnology
-Genomics: the study of genetic material in the chromosomes of specific organisms |
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