HLTB15H3 Study Guide - Heredity, Global Health, Homeostasis
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HLTB15: Introduction to Research in Health Studies
Lecture 2: Health Studies: a multi-disciplinary approach
Health Services Research: 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
Research: the systematic and rigorous process of enquiry which aims to describe phenomena and to
develop and test explanatory concepts.
Types of Research Studies include:
Qualitative methods: aims to find out information on a topic in which little is known
Double-blind RCT (Randomized Controlled Trial): used to investigating cause and effect issues
A triangulated or combined methodological approach to addressing different facets of a
research issue is also a useful approach
Health Research: has an important role in informing the planning and operation of services aiming to
achieve health of individuals/populations
also systematic and rigorous
1. Health Systems Research: ultimately concerned with improving the health of a community, by
enhancing the efficiency and effectiveness of the health system as an integrated part of the
overall process of socio-economic development
a. Eg. Pumping more money in to improve SES factors
2. Health Services Research: relationships between health service delivery and the health needs of
the population – aim is evaluation
a. Eg. Looking at the types of accessibilities/service in a community. Will depend on the
needs of a population, services available and how delivered
b. More specifically HSR aims to produce reliable and valid research data on which to base
appropriate, effective, cost-effective, efficient, and acceptable health services at the
primary and secondary care levels.
3. Health Technology Research: Looks at health care interventions
a. Eg. Interested in what is done at level of health or improving health care to improve
effectiveness/efficiency but at individual level. Such as giving individuals glucose
Audit and quality assessment: aim to monitory whether predefined and agreed standards have been
Assessment of Quality: relation to its effectiveness with regard to improving the patient’s health status,
and how well it meets professionals’ the public’s standards about how the care should be provided
Donabedian: focused on measurement of structure (inputs and resources, such as staffing,
buildings, funding); process (service delivery, organization and use, including resources), output
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Maxwell: Described six dimensions of quality: appropriateness; social acceptability (patent’s
views, met expectations); effectiveness (consistent with desired effect); relevance to need;
Higginson: Defined health care as effectiveness, acceptability and humanity, equity and
Audit: aims to improve patient outcome, to develop a more cost effective use of resources and to have
an educational function for health professionals.
Consists of reviewing and monitoring current practice and evaluation against predefined
Medical Audit: the systematic critical analysis of the quality of medical care, including a review
of diagnosis and the procedures used for diagnosis, clinical decisions about treatment, use of
resources and patient outcome.
Clinical Audit: conducted by doctors and other health care professionals and is the systematic
critical analysis of the quality of clinical care.
Quality Assurance: a clinical and management approach which involves the systematic
monitoring and evaluation of predefined and agreed levels of service provision. Quality
assurance is the definition of standards, the measurement of their achievement and the
mechanisms employed to improve performance.
Quantitative research methodology is most appropriate for audit, much can be gained by
supplementing this with qualitative methods such as observation
Evaluation: the use of the scientific method, and the rigorous and systematic collection of research
data, to assess the effectiveness of organizations, services and programs.
Formative evaluation: involves the collection of data while the organization or program is active, with
the aim of developing or improving it.
Summative evaluation: involves collecting data about the active (or terminated) organization or program
with the aim of deciding whether is should be continued or repeated.
Methods for evaluation:
1. Structure: refers to the organizational framework for the activities
a. Refers to the buildings, inputs such as equipment, staff, beds, and resources needed to
meet defined standards
b. Data on structure and inputs can be obtained by questionnaire and document analysis
2. Process: refers to the activities themselves. Outputs: relate to productivity
a. Process is the documentation and analysis of dynamic events and interactions. Data on
processes are essential for the evaluation of whether scarce health service resources are
b. Outputs are types of data that is collected. These can be operationalized in relation to
rates of productivity for hospital discharge, number and type of supplies given, the
number of patient-professional contacts and their type, the number of home visits etc.
3. Appropriateness: relevant to outcome. The emphasis in health services research is on the
measurement of the appropriateness of, as well as the effectiveness of, interventions in the
a. Inappropriateness: the assessment of health outcomes and appropriateness of
treatments has been given impetus by the increasing evidence about high rates of
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