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HSRs of the Future

HSRs of the Future. Thomas C. Ricketts, Ph.D The University of North Carolina at Chapel Hill. Health Services Research. Is a recognized “Field” Is concerned about practical applications of research Has many relevant disciplinary theories to draw on

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HSRs of the Future

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  1. HSRs of the Future Thomas C. Ricketts, Ph.D The University of North Carolinaat Chapel Hill

  2. Health Services Research • Is a recognized “Field” • Is concerned about practical applications of research • Has many relevant disciplinary theories to draw on • Is changing rapidly as the functioning field evolves

  3. To The Summit • November 2007 “Summit” on the Future of HSR held in DC to discuss • Supply • Demand • Production • Purpose: to help get a handle on where the field was going (and lobby for federal funds)

  4. My Task • Characterize the “pipeline” of health services researchers • Give an assessment of where the field was headed • Supply Data: Jean Moore, SUNY-Albany • Demand Data: Craig Thornton, Jon Brown Mathematica Policy Research Companion Tasks

  5. Back to the Future • Who will they be? • How will they work?

  6. The Trainers “Names” for Programs Included: Health Services Research, Policy, Management, Nursing, Outcomes, Epidemiology, Administration, Mental, Occupational, Pharmaceutical, Alcohol Abuse, Biostatistics, Clinical, Economics, Evaluation Technology,Evaluative Science,Geriatrics,HHR,Informatics,Knowledge Transfer, Organization, Pediatrics, Population, Sociology • We reviewed the programs that prepare HSRs in the US and Canada • Approx. 140 programs “claim” HSR • 50 masters, 65 doctoral, 25 fellowship+degree • Content and emphasis varies

  7. Size of the Trainee Pool • Contacted all academic programs in HSR to estimate current enrollment • 124 programs listed • Approx 4,500 masters, 150-300 doctoral graduates per year, some undergrad programs • Perhaps 50% of overall doctoral production relevant to HSR • Reviewed fellowship programs • Approximately 100 per year • Various structures, disciplinary orientation • Steady production but may shrink, not all slots are easily filled

  8. Content of Training • Very mixed depending on discipline • Some “core” of health services, but not always • Not all HSR is classed as such, HSR taxonomy is not widely used • Doctoral training remains very traditional • Fellowship structures vary, some very creative

  9. Training for HSR • Is diffuse and disparate • Is gaining in size and identity • Mixes clinical science with social sciences—but • Not always in a planned way • Nor in a unified manner

  10. Seeing HSR through different Disciplinary Eyes Disciplinary structures have not thwarted growth in the field but may confuse the practical policy makers.

  11. HSR has Generally Avoided Disciplinary SILOS

  12. How do we train HSRs or Comparative Effectiveness Researchers?Is there a….

  13. “Pipeline” of HSRs/CERs

  14. And does it leads to a beneficial future for health and health care…? The process surely doesn’t look like a pipeline

  15. The HSR “Flow” College/University Industry Data Manager Masters Trng ProjectExperience Clinical Training(MD DDS MSN+) ProjectExperience Analyst ProjectExperience Clinical Setting Project Leader (PI) PhD/DrPH/DSc ClinicalInvestigator Investigator ProjectExperience Government Independent P.I. Post-Doc HSR Academic Career

  16. Two Big Approaches • Formal training in academic worlds that leads to academic regeneration and academic based work • Apprenticeship in systems and industry that meets needs for efficiency

  17. HSR as “SPONGE” compared to a Pipeline Industrial or System-widelike Kaiser or the VA The Partnership Model: The Discipline-based Academic Model: many formsmany structures

  18. “spills” to soak up • TECH-DATA-METHODS Explosion • IT and data applications grow faster than academics are trained. • System processes emerge faster than Ph.D.s can write dissertations. • Computing power putscomplex decision analysis(aka research) in managers’hands. • People want dashboardsor iPhone-like interfaceand operability

  19. Two kinds of time • Policy cycles • Annual budgets • 2-year Congresses • 4-year Presidential cycles) • Corporate Annual Reports THE SEMESTER VS

  20. Education Reforms… • Very slowly • Distance/IT adoption is grafted onto traditional structures • Institutional learning if for the benefit of the academic institutions Process, apprenticeship,non-degree learning = heresy

  21. Pressures • Graduate education is being pressed to be more efficient and relevant • The health system has an accelerating pace of change in policy, operations and clinical approaches • IT advances are now moving as fast as storage used to grow • Global influences will “universalize” systems and bring more competition

  22. In sum…. • The future of HSR can lead applied education into the future because of its practical orientation. • The field is recognized, but mostly for its questions and problems. • Policy-influencing production is diffuse but has solid successes

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