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[Health services Research Faces New Challenges: Consequences for Definition and Concept].

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Summary

Health Services Research (HSR) in Germany now focuses on complex organizational and system interventions, expanding its scope beyond individual care to include population benefits and appropriateness. This evolution requires updated models and improved research structures.

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Area of Science:

  • Health Services Research (HSR)
  • Implementation Science
  • Health Care Policy

Background:

  • Health Services Research (HSR) in Germany has evolved from individual care methods to analyzing health care structures and processes.
  • Recent legislative changes, particularly the establishment of innovation funds in 2015, have shifted the focus towards implementing complex interventions at organizational and system levels.
  • There is increasing attention on improving patient and population health outcomes and ensuring the appropriateness of care.

Purpose of the Study:

  • To redefine Health Services Research (HSR) to encompass organizational and system interventions, incorporate a population perspective, and integrate a focus on appropriateness and improvement.
  • To update the theoretical throughput model by expanding input factors, acknowledging modulation during throughput, including population outcomes, and establishing feedback loops.
  • To highlight the critical role of "double complexity"—the interaction between complex interventions and context—in Health Services Research (HSR).

Main Methods:

  • Modification of the current definition of Health Services Research (HSR) to include organizational/system interventions and population perspectives.
  • Updating Pfaff's theoretical throughput model to incorporate complex interventions, context, population outcomes, and feedback loops.
  • Integrating concepts from improvement science and implementation research into the framework of Health Services Research (HSR).

Main Results:

  • The definition of "intervention" in HSR is expanded to include organizational and system-level changes.
  • The theoretical model now accounts for "double complexity," recognizing the sensitivity of interventions to context and the potency of context itself.
  • The updated model emphasizes the importance of feedback loops and the inclusion of population-level outcomes.

Conclusions:

  • Health Services Research (HSR) must adapt to address complex interventions and system-level changes, integrating improvement science and implementation research.
  • The interaction between complex interventions and context is a central challenge requiring careful consideration.
  • Strengthening methodological standards and research structures is crucial, especially given the political level's dual role as sponsor and demander of HSR findings.