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

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.