Thomas C. Ricketts, Ph.D

The University of North Carolina

at Chapel Hill

HSRs of the HSRs of the FutureFuture

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

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)

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

Back to the FutureBack to the Future

Who will they be?

How will they work?

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

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

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

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

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.

HSR has Generally HSR has Generally Avoided Avoided

Disciplinary SILOSDisciplinary SILOS

How do we train HSRs or How do we train HSRs or Comparative Effectiveness Comparative Effectiveness

Researchers?Researchers?

Is there a….Is there a….

““Pipeline” of HSRs/CERsPipeline” of HSRs/CERs

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

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”

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

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

““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

Two kinds of timeTwo kinds of time

Policy cycles Annual budgets2-year

Congresses4-year

Presidential cycles)

Corporate Annual Reports

THE SEMESTERTHE SEMESTER

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

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

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