Page 247 - Encyclopedia of Nursing Research

214 n HeAlTH SerVIceS reSeArcH

to a scholarly audience. Knowledge trans- influencing policy decisions that address the
lation models provide a framework that financing, organization, management, and
H can facilitate the use of research findings delivery of health care services. Findings
by policy makers. Knowledge exchange is from health service research are used to
the exchange, synthesis, and application guide organizational, institutional, and pub-
of knowledge by relevant stakeholders for lic policy decisions. For example, the centers
the purpose of health system improvement. for Medicare and Medicaid Services uses
Knowledge transfer models range from lin- health services research to inform payment
ear to complex organic depictions of inter- and benefit issues. professional associations,
actions from identification of the problem advocacy and interest groups, organizations,
through dissemination (Sudsawad, 2007). and others looking to change or create policy
A framework that can be used to plan use findings from health services research to
dissemination activities is Kingdon’s (2003) support their position.
model of three families of agenda setting The roots of health services research
processes: problems, policies, and politics traces to the 1920s. philanthropic founda-
streams. When the three streams converge, tions funded research to improve lives of
the greatest agenda change occurs. Kingdon’s those living in poor socioeconomic condi-
framework can help researchers strategize tions (Mullner, 2009). It was not until the mid-
when to disseminate their findings. Windows 1960s that health services research emerged
open quickly in policy streams and provide as a discipline (Institute of Medicine [IOM],
opportunities for action. One of the strategic 1979). In 1967, president lyndon B. Johnson
goals of the American Academy of Nursing created the National center for Health
is to “influence policy through dissemina- Services research charged with coordinat-
tion of nursing’s contribution to improved ing research efforts to reach national health
health outcomes and care delivery” (Gilliss, care objectives. currently, health services
2010). The American Academy of Nursing research is positioned within the Department
acknowledges that nursing needs to be pol- of Health and Human Services as the Agency
icy ready and that nursing can influence pol- for Healthcare policy and research (AHrQ),
icies that impact our health. although many branches of the government
also house health services research. Some
Susan Tullai-McGuinness include the centers for Disease control, the
centers for Medicare and Medicaid Services,
and the Veterans’ Administration. The
congress often sets direction for allocation
HealtH serviCes researCH of health services research dollars. As part
of the 2003 Medicare Modernization Act,
the congress mandated AHrQ to conduct
Health services research is defined as a mul- and support the comparative-effectiveness
tidisciplinary field of inquiry that studies research on specific issues.
how a broad range of social, financial, tech- The IOM (1979) identified four levels
nological, and organizational factors and of health services research: clinical, insti-
personal behaviors impact the accessibility, tutional, systematic, and environmental.
cost, efficiency, and quality of health care at clinically oriented studies examine charac-
the individual, population, organization, and teristics of providers, patients, and resources
institution levels (lohr & Steinwachs, 2002). that impact the processes and outcomes of
The overall goals of health services research care. The focus is on the broader range of out-
are to reduce disparities and to improve comes, such as patient satisfaction, cost, and
safety, quality, and cost-effectiveness by effectiveness of care. Institutional studies