HSRs of the Future
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Transcript of HSRs of the Future
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Thomas C. Ricketts, Ph.D
The University of North Carolina
at Chapel Hill
HSRs of the HSRs of the FutureFuture
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Health Services ResearchHealth Services Research
Is a recognized “Field”Is concerned about practical
applications of researchHas many relevant disciplinary
theories to draw onIs changing rapidly as the
functioning field evolves
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To The SummitTo The Summit
November 2007 “Summit” on the Future of HSR held in DC to discussSupplyDemandProduction
Purpose: to help get a handle on where the field was going (and lobby for federal funds)
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My TaskMy TaskCharacterize the “pipeline” of health services
researchersGive an assessment of where the field was
headed
Supply Data: Jean Moore, SUNY-AlbanyDemand Data: Craig Thornton, Jon Brown
Mathematica Policy Research
Companion TasksCompanion Tasks
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Back to the FutureBack to the Future
Who will they be?
How will they work?
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The TrainersThe Trainers We reviewed the
programs that prepare HSRs in the US and Canada Approx. 140
programs “claim” HSR
• 50 masters, 65 doctoral, 25 fellowship+degree
Content and emphasis varies
“Names” for Programs Included:Health Services Research, Policy, Management, Nursing, Outcomes, Epidemiology, Administration, Mental, Occupational, Pharmaceutical, Alcohol Abuse, Biostatistics, Clinical, Economics, Evaluation Technology,Evaluative Science,Geriatrics,HHR,Informatics,Knowledge Transfer, Organization, Pediatrics, Population, Sociology
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Size of the Trainee PoolSize of the Trainee Pool
Contacted all academic programs in HSR to estimate current enrollment 124 programs listed Approx 4,500 masters, 150-300 doctoral graduates per
year, some undergrad programs Perhaps 50% of overall doctoral production relevant to
HSRReviewed fellowship programs
Approximately 100 per year Various structures, disciplinary orientation Steady production but may shrink, not all slots are easily
filled
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Content of TrainingContent of Training
Very mixed depending on disciplineSome “core” of health services, but not
alwaysNot all HSR is classed as such, HSR
taxonomy is not widely usedDoctoral training remains very traditionalFellowship structures vary, some very
creative
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Training for HSRTraining for HSR
Is diffuse and disparateIs gaining in size and identityMixes clinical science with social
sciences—but Not always in a planned wayNor in a unified manner
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Seeing HSR through different Seeing HSR through different DisciplinaryDisciplinary Eyes Eyes
Disciplinary structures have not thwarted growth in the field but may confuse the practical policy makers.
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HSR has Generally HSR has Generally Avoided Avoided
Disciplinary SILOSDisciplinary SILOS
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How do we train HSRs or How do we train HSRs or Comparative Effectiveness Comparative Effectiveness
Researchers?Researchers?
Is there a….Is there a….
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““Pipeline” of HSRs/CERsPipeline” of HSRs/CERs
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And does it leads to a beneficial And does it leads to a beneficial future for health and health care…?future for health and health care…?
The process surely doesn’t look like a The process surely doesn’t look like a pipelinepipeline
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Independent P.I.
Project Leader (PI)
Data Manager
Clinical Setting
Analyst
Investigator
Government
Industry
ClinicalInvestigator
PhD/DrPH/DSc
Academic Career
Post-Doc HSR
ProjectExperience
Clinical Training(MD DDS MSN+)
College/University
Masters Trng
ProjectExperience
ProjectExperience
ProjectExperience
The HSR “Flow”
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Two Big ApproachesTwo Big Approaches
Formal training in academic worlds that leads to academic regeneration and academic based work
Apprenticeship in systems and industry that meets needs for efficiency
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HSR as “SPONGE” compared to a HSR as “SPONGE” compared to a PipelinePipeline
Industrial or System-widelike Kaiser or the VA The
PartnershipModel:
The Discipline-basedAcademic Model: many formsmany structures
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““spills” to soak upspills” to soak upTECH-DATA-METHODS Explosion
IT and data applications grow faster than academics are trained.
System processes emerge faster than Ph.D.s can write dissertations.
Computing power putscomplex decision analysis(aka research) in managers’hands.
People want dashboardsor iPhone-like interfaceand operability
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Two kinds of timeTwo kinds of time
Policy cycles Annual budgets2-year
Congresses4-year
Presidential cycles)
Corporate Annual Reports
THE SEMESTERTHE SEMESTER
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Education Reforms…Education Reforms…Very slowlyDistance/IT
adoption is grafted onto traditional structures
Institutional learning if for the benefit of the academic institutions
Process, apprenticeship,non-degree learning = heresy
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PressuresPressures
Graduate education is being pressed to be more efficient and relevant
The health system has an accelerating pace of change in policy, operations and clinical approaches
IT advances are now moving as fast as storage used to grow
Global influences will “universalize” systems and bring more competition
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In sum….In sum….
The future of HSR can lead applied education into the future because of its practical orientation.
The field is recognized, but mostly for its questions and problems.
Policy-influencing production is diffuse but has solid successes