Health services research and systemic lupus erythematosus: a reciprocal relationship

Many other statistical and epidemiologic approaches have been used in studies of systemic lupus erythematosus. Many of these, such as multivariate analysis and cost-benefit analysis, have substantially added to our understanding of the disease. However, in these instances it has been a clear application of the technique to a clinical problem. In the four areas I described, there was a convergence of clinical dilemmas and methodologic improvements, with the clinical problem actually contributing to the development of the methodologic technique used to address the question. In conclusion, major methodologic advancements in health services research and clinical epidemiology have developed pari passu with studies of the natural history of systemic lupus erythematosus. In some circumstances the clinical questions drove methodologic innovation and in other cases the methodologic studies were rapidly adopted and adapted to clinical investigation. It is unlikely that this was happenstance. We can anticipate that future investigations in lupus will utilize innovative techniques in health services research.