Title: Journal of Health Services Research & Policy

Title: Journal of Health Services Research & Policy

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JCR Abbreviated Title: J Health Serv Res Policy

ISSN: 1355-8196

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? Morris, S., McGuire, A., Caro, J. and Pettitt, D. (1997), Strategies for the management of hypercholesterolaemia: A systematic review of the cost-effectiveness literature. Journal of Health Services Research & Policy, 2 (4), 231-250.

Full Text: 1997\J Hea Ser Res Pol2, 231.pdf

Abstract: OBJECTIVE: To review research addressing the management of cholesterol in the prevention of coronary heart disease in order to assess the cost-effectiveness of such interventions. METHODS: A systematic review of economic evaluations identified through searches of MEDLINE and the Social Sciences Citation Index revealed 38 studies addressing the cost-effectiveness of cholesterol management. They were distinguished according to screening approaches, dietary advice and drug treatment. Most studies were not associated directly with clinical trial results, but adopted economic modelling approaches. RESULTS: Whilst there is general agreement among the majority of analyses, studies of cholesterol management concerned with screening strategies were extremely sensitive to changes in their assumptions; so much so that only a limited emphasis may be placed on specific cost-effectiveness ratios and the conclusions drawn from them. All studies considered direct costs, though many were limited to drug costs. The cost-effectiveness of primary prevention by cholesterol-lowering drugs is highly variable, depending on age at initiation of treatment and cardiovascular risk profile. Pharmacological intervention is least cost-effective in the young and the elderly. The cost-effectiveness of cholesterol-reducing agents improves when they are targeted at those at high risk. HMG-CoA reductase inhibitors are generally more effective and more cost-effective at reducing cholesterol-related coronary events than other medications. CONCLUSION: The methods and economic data upon which these studies are based need to be improved if robust policy conclusions are to be formulated.

Keywords: Age, Analyses, Assumptions, Cardiovascular, Changes, Cholesterol, Clinical, Clinical Trial, Cost Effectiveness, Cost-Effective, Cost-Effectiveness, Costs, Data, Dietary Advice, Disease, Drug, Drugs, Economic, Economic Modelling, Elderly, Events, General, Heart, Initiation, Intervention, Interventions, Literature, Management, Medline, Methods, Modelling, Policy, Prevention, Primary, Primary Prevention, Research, Review, Risk, Risk Profile, Screening, Systematic Review, The Elderly, Treatment, Trial

? Steiner, A. and Robinson, R. (1998), Managed care: US research evidence and its lessons for the NHS. Journal of Health Services Research & Policy, 3 (3), 173-184.

Full Text: 1998\J Hea Ser Res Pol3, 173.pdf

Abstract: OBJECTIVES: To review the high quality US evidence on performance of managed health care organisations and the available US evidence on specific managed care techniques; namely, financial incentives, utilisation management and review, physician profiling and disease management. METHODS: Literature searches were conducted using numerous databases including Medline, Embase, the Social Sciences Citation Index and the National Health Service (NHS) Centre for Reviews and Dissemination library. For inclusion of evaluations of overall performance, studies had to use a comparison group (typically fee-for-service patients), make appropriate statistical adjustments for differences between groups, and be published in a peer-reviewed journal from 1980 forward. For assessments of techniques, less-demanding inclusion criteria reflected the paucity of generalisable literature; however, more current results were required (1990 forward). RESULTS: We identified 70 articles for systematic review, covering 18 dimensions of performance (e.g. utilisation, quality of care, consumer satisfaction, equity). The strength of the evidence varied by dimension. It was strongest for utilisation and quality. In general, managed care seems to reduce hospitalisation and use of high-cost discretionary services, to increase preventive screening, and to be neutral in terms of patient outcomes. As for specific techniques, we identified 19 articles for review, but limitations of these studies prevented our drawing any definite conclusions about techniques’ effectiveness. This is an important, if somewhat negative, conclusion. CONCLUSIONS: Applying US evidence is complicated by an irrelevant comparator and a higher baseline of utilisation. Managed care brought Americans the familiar NHS practices of population-based health care and resource management through gatekeeping; hence, changes due to UK adoption of managed care techniques may be modest. US evidence should be used to generate hypotheses, not to predict UK behaviour.

Keywords: Adoption, Assessments, Behaviour, Care, Changes, Comparison, Criteria, Databases, Disease, Disease Management, Effectiveness, Equity, Evidence, Familiar, Fee-for-Service, Financial Incentives, Gatekeeping, General, Health, Health Care, Incentives, Journal, Literature, Managed Care, Management, Methods, Objectives, Outcomes, Patients, Peer-Reviewed, Performance, Physician, Population Based, Population-Based, Practices, Profiling, Quality, Quality of, Quality of Care, Research, Resource Management, Review, Satisfaction, Screening, Services, Strength, Systematic Review, Techniques, UK, US, Utilisation

? Pons, J., Sais, C., Illa, C., Mendez, R., Sunen, E., Casas, M. and Cami, J. (2010), Is there an association between the quality of hospitals’ research and their quality of care? Journal of Health Services Research & Policy, 15 (4), 204-209.

Full Text: 2010\J Hea Ser Res Pol15, 204.pdf

Abstract: Objective: It is often claimed that hospitals that are leaders in biomedical research provide higher health care quality, or vice versa. Although several studies have shown a relationship between teaching status and quality of care, none has analysed the association between research output and hospital outcomes. Our aim was to determine whether there is a relationship between bibliometric measures of research output in acute hospitals and hospital mortality for two common cardiac conditions. Methods: A cross-sectional analysis of secondary data of in-hospital risk-adjusted mortality for congestive heart failure and acute myocardial infarction (2002-2004) and several bibliometric measures of publications (1996 2004) in cardiovascular disease. The setting was 50 acute Spanish public hospitals, voluntarily participating in an external quality initiative, with more than 30 medical cases of congestive heart failure and acute myocardial infarction per year, and more than five citable papers in the field of heart disease. Spearman’s rho non-parametric correlation coefficient was used to assess association. Results: There was a low-to-moderate negative correlation between the risk-adjusted mortality ratio and the weighted citations ratio: -0.43 (95% CI -0.17 to -0.63) for congestive heart failure and -0.37 (-0.10 to -0.59) for acute myocardial infarction. Teaching status and the technological level of the hospital had a stronger correlation with hospital mortality. Conclusions: Measures of research output could be considered for incorporation into comparisons of the quality of hospitals. A weighted citations ratio is the most suitable measure of research output, but more research is needed on the interplay between research and practice as complementary ways of developing medical knowledge. Journal of Health Serrates Research & Policy Vol 15 No 4, 2010: 204-209 (C) The Royal Society of Medicine Press Ltd 2010.

Keywords: Analysis, Bibliometric, Biomedical Research, Citations, Impact Factor, Index, Journals, Medicine, Mortality, Outcomes, Publications, Research, Research Output

? Garrido, M.V., Hansen, J. and Busse, R. (2011), Mapping research on health systems in Europe: A bibliometric assessment. Journal of Health Services Research & Policy, 16, 27-37.

Full Text: 2011\J Hea Ser Res Pol16, 27.pdf

Abstract: Objective: Europe’s health care decision-makers are facing an increasingly complex and rapidly changing landscape. It is crucial that health care problems are addressed with evidence-informed policy and that evidence finding is aimed at those topics most urgent on policy agendas. Research on health systems addresses the macro-level of health care delivery and aims at generating evidence for policy-making. Our aim was to assess the field of health systems research in Europe, primarily based on an analysis of the published literature. Methods: Starting from current definitions of health systems, during 2004-09 we identified four thematic areas for research and defined keywords to construct a sensitive literature search limited to European research. Results: The database search resulted in 26,945 hits between 2004-09. Until 2008, the annual number of publications on health systems research increased at an average rate of 5.2%. Most (88%) were in English. The largest producer of research on health systems has been the UK (nearly 10,000 in six years; 37% of the total for Europe), which is also the country most frequently the object of research. In contrast, seven countries had produced no publications. There were modest correlations between a country’s research production and its gross domestic product (r = 0.62) but less so with its population size (0.33). The most frequent keywords were ‘patients’ (49% of all references), ‘patient satisfaction’ (27%), ‘organization and administration’ (23%), ‘education’ (19%) and ‘attitude of health personnel’ (13%). Closer inspection of a sub-sample of 1000 abstracts revealed that only 24% met our definition of ‘health systems research’ rather than other fields of health services research. Conclusion: There is a wide-spread need to develop health systems research capacity, in particular in eastern European countries, and to address the effects of health care reform, particularly the effects of privatization and commercialization of health services.

Keywords: Analysis, Assessment, Attitude, Attitude Of Health Personnel, Bibliometric, Definitions, Education, Europe, Health Care, Health Care Delivery, Health Care Reform, Health Personnel, Health Services, Health Services Research, Literature, Methods, Patient Satisfaction, Patients, Policy, Policy Making, Publications, Research, Research Production, Topics, UK

? Hansen, J., Schafer, W., Black, N. and Groenewegen, P. (2011), European priorities for research on health care organizations and service delivery. Journal of Health Services Research & Policy, 16, 16-26.

Full Text: 2011\J Hea Ser Res Pol16, 16.pdf

Abstract: Objectives: To provide an overview of the principal areas of research on health care organization and service delivery and to identify priority areas from a European comparative perspective. Given the large quantity of articles produced on health care organizations, we focus on primary care and hospital care. Method: A combination of methods was used for describing past and current research: (i) bibliometric analyses of published research in Pubmed and Embase 2000-09; (II) a further classification of research based on a sample of 1,010 articles; and (iii) an identification of relevant EU-funded projects over the period 2000-10. An online survey of experts was carried out to identify priorities. The results were refined through conference discussions. Results: Research into health care organizations varies considerably across Europe. This is only partly associated with differences in countries’ gross domestic product or population. Studies were categorized into four main domains: intra-organizational control; inter-organizational relations; patient relations; and governance and accountability. Past and current research may not reflect future priorities as the domain of ‘inter-organizational relations’ is regarded by most experts as the top priority for the future, while the smallest share in the sample of published research and EU-funded projects fell into that category. Expert views show considerable homogeneity, regardless of their role in the health care system or their country. Specific future priorities include the integration of care across organizational boundaries (including the relationship between primary and secondary care), patient involvement and participation and workforce skill-mix. Conclusions: The research priorities identified in this study relate to important shared challenges in Europe’s health care systems. This makes cross-border learning important, especially given the clear geographical variation in health services research (HSR) funding and capacity in Europe.

Keywords: Bibliometric, Control, Europe, Funding, Health Care, Health Services, Health Services Research, Hospital, Involvement, Learning, Online Survey, Overview, Primary, Primary Care, Priorities, Priority Areas, Research, Reviews, Survey