State of the Science
Improving Children's Health
Through Health Services Research was a special 1-day meeting held June 26, 1999, in Chicago. The state of the science in children's health services research
was explored, including public and private funding opportunities, networks for
conducting research, and uses of research in policy and practice. The meeting
was co-sponsored by the National Association of Children's Hospitals and Related
Institutions (NACHRI), with the Agency for Health Care Policy and Research (AHCPR),
the American Academy of Pediatrics (AAP), the David and Lucille Packard Foundation, the
Association for Health Services Research (AHSR), the Robert Wood Johnson Foundation, and Data
Harbor, Inc.
Dr. Starfield provided a brief history
of child health services research, identified issues, and described principles
to guide the work of health services researchers. She noted that in the 1950s
and 1960s child health services research was more advanced than adult-oriented
health services research. With the introduction of Medicare, health services
research shifted to focus on adults when Medicare data became available to researchers.
Dr. Starfield challenged child health
services researchers to focus on why children's health in the United States
is so much worse than children's health in other industrialized countries. She
contrasted four current CHSR foci with future directions that could help to
improve children's health:
- For example, CHSR should consider
external relevance in addition to its current focus on internal elegance.
- In the past, CHSR has focused
on diseases; in the future, it might do well to focus on people.
- Relative risk has been a traditional
measure; CHSR should also consider population-attributable risk. Underlying
determinants are as important as proximal determinants of health.
A model of health determinants Dr.
Starfield first published in 1998 (Starfield, B, Primary Care: Balancing
Health Needs, Services, and Resources. New York: Oxford University Press,
1998. p. 6), and which she continues to modify, can help the field to develop
and better specify improved conceptual frameworks to guide child health services
researchers. CHSR has an opportunity to develop these frameworks for the overall
field of HSR.
Internet Citation:
Starfield B. State of
the Science. Presentation Summary, Improving Children's Health Through Health
Services Research, Chicago, June 26, 1999. http://www.ahrq.gov/research/statsci.htm
540 Gaither Road Rockville, MD 20850 