Health Services Research – serie

The second volume in the Health Services Research series provides a series of perspectives on comparative effectiveness research. Motivated by concern from the general public, governments in virtually all countries with developed and rapidly developing economies have been actively seeking and promoting ways of improving the patient experience of health care, improving the health of populations, and reducing the per capita cost of health care. While comparing treatment outcomes is not a new concept, appreciation of its potential application has grown in recent years. In addition to traditional health sciences methods, modern approaches to comparative effectiveness research now include greater emphasis on social sciences frameworks such as economics, ethics, and implementation science. Moreover, a key feature of the modern approach to comparing treatment outcomes is a focus on the individual patient through explicit consideration of inter-patient variability and patient-reported outcomes.  Comparative Effectiveness Research presents a series of chapters of relevance including introductions to areas that are being incorporated when comparing treatments, country-specific applications, patient-centred approaches, and modern methods. Included are chapters on the following areas that are being considered in treatment comparisons: ethics, economics and costs, implementation science, modern payment schemes (coverage with evidence development), and priority setting. Country-specific examples include an overview chapter on national approaches from various countries in Europe, Australia, and Canada, as well as specific chapters on comparative effectiveness research in Brazil and in the United States. The focus on the individual patient is described through chapters on patient-centred comparative effectiveness research, individualized treatment, the link with personalized medicine, and incorporating patient and public inputfor treatment. Methodological chapters include overviews of data sources, study designs, new statistical methods of combining results, the link with evidence-based medicine, specific issues when comparing drug and non-drug technologies, and dissemination of results.

This title deals with internationally documented variations in medical practice and health service that exist across countries as well as regions across a specific country. Such variations raise critical concerns about the quality, equity and efficiency of health care resources across the world. Health services researchers have long been aware of large variations in the use of medical care across regions and medical providers. In the 1930s, the British pediatrician J.A. Glover observed that the rates of tonsillectomy in British schoolchildren varied widely, depending on the district where the students lived and the doctors who examined them. This volume provides a contextual landscape for the study of health care utilization through the lens of medical practice variations. It is grounded in the pioneering work by medical care epidemiologist, Dr. John Wennberg, who revealed wide variations in elective surgical rates across small areas in the U.S. and his findings that these variations were generally not explained by differences in population illness rates or patient preferences but rather, there were strong associations between supply of health care resources, such as hospital beds and physicians and health care utilization.This volume introduces the concept of medical practice variations and its early history, outlines established concepts and frameworks, with an overview of methods used to understand the variations in medical care. It makes the case for outcomes research in determining what works in health care and policy reforms to rationalize how care is delivered. Each chapter synthesizes the current published literature in the field and covers a description of medical practice variations in the area, determinants of these variations and outcomes. It outlines the most current research on specific types of utilization such as inpatient care, emergency services, elective surgery, primary care, obstetric and gynaecological care, mental health care and end-of-life care, among others. Studies of variation in condition-specific care focus on common conditions such as acute myocardial infarction, congestive heart failure, stroke, diabetes and procedures such as cancer surgery and joint replacement. Special topics include health care spending and quality, shared decision making and disparities.