National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Access to Care (2)
- Behavioral Health (3)
- Brain Injury (1)
- Cancer (2)
- Care Coordination (2)
- Case Study (1)
- Children/Adolescents (5)
- Chronic Conditions (2)
- Colonoscopy (1)
- Community-Based Practice (1)
- Critical Care (2)
- Data (1)
- Emergency Department (3)
- Emergency Medical Services (EMS) (2)
- Evidence-Based Practice (6)
- Guidelines (1)
- Healthcare Cost and Utilization Project (HCUP) (1)
- Healthcare Costs (3)
- (-) Healthcare Delivery (40)
- Healthcare Utilization (1)
- Health Information Technology (HIT) (1)
- Health Literacy (2)
- (-) Health Services Research (HSR) (40)
- Health Systems (2)
- Hospital Discharge (1)
- Hospitalization (1)
- Implementation (3)
- Inpatient Care (1)
- Maternal Care (1)
- Medicare (1)
- Mortality (1)
- Organizational Change (4)
- Outcomes (1)
- Patient-Centered Healthcare (4)
- Patient-Centered Outcomes Research (4)
- Patient Experience (1)
- Patient Safety (1)
- Policy (1)
- Practice Improvement (2)
- Pregnancy (1)
- Prevention (1)
- Primary Care (7)
- Primary Care: Models of Care (2)
- Provider (2)
- Provider: Nurse (1)
- Provider Performance (1)
- Quality Improvement (2)
- Quality Measures (1)
- Quality of Care (4)
- Research Methodologies (9)
- Screening (1)
- Shared Decision Making (2)
- Sickle Cell Disease (1)
- Simulation (2)
- Social Determinants of Health (1)
- Stroke (1)
- Surgery (1)
- System Design (1)
- Teams (2)
- Telehealth (3)
- Tools & Toolkits (1)
- Transitions of Care (2)
- Trauma (2)
- Women (1)
- Workforce (1)
- Young Adults (1)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 40 Research Studies DisplayedTugwell P, Welch V, Magwood O
AHRQ Author: Chang C
Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses.
The objectives of this protocol were to: Identify, map, and synthesize findings related to engagement in evidence syntheses; Explore how engagement in evidence synthesis promotes health equity; Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement. The authors intended to use their findings to develop draft guidance checklists and assess agreement with each item through an international survey. The guidance checklists will be co-produced and after being finalized at a consensus meeting, an international team will develop guidance for collaborators and partner engagement. The authors concluded that incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.
AHRQ-authored.
Citation: Tugwell P, Welch V, Magwood O .
Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses.
Syst Rev 2023 Aug 2; 12(1):134. doi: 10.1186/s13643-023-02279-1..
Keywords: Evidence-Based Practice, Health Services Research (HSR), Healthcare Delivery
Bierman AS, Wang J, O'Malley PG
AHRQ Author: Bierman AS, Wang J, O'Malley PG, Moss DK
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
This article describes issues addressing the needs of those with multiple chronic conditions and discusses the AHRQ research agenda.
AHRQ-authored.
Citation: Bierman AS, Wang J, O'Malley PG .
Transforming care for people with multiple chronic conditions: Agency for Healthcare Research and Quality's research agenda.
Health Serv Res 2021 Oct;56(Suppl 1):973-79. doi: 10.1111/1475-6773.13863..
Keywords: Chronic Conditions, Health Services Research (HSR), Healthcare Delivery, Quality of Care, Primary Care, Guidelines, Evidence-Based Practice
Kuo YF, Lin YL, D Jupiter, et al.
How to identify team-based primary care in the United States using Medicare data.
The authors assessed whether analyses using different sets of Medicare data can produce results similar to those from analyses using 100% data from an entire state in identifying primary care teams through social network analysis. They found that, depending on specific study purposes, researchers could use either 100% data from Medicare beneficiaries in randomly selected primary care services areas or data from a 20% national sample of Medicare beneficiaries to study team-based primary care in the United States.
AHRQ-funded; HS020642.
Citation: Kuo YF, Lin YL, D Jupiter, et al..
How to identify team-based primary care in the United States using Medicare data.
Med Care 2021 Feb;59(2):118-22. doi: 10.1097/mlr.0000000000001478.
.
.
Keywords: Teams, Primary Care: Models of Care, Primary Care, Medicare, Health Services Research (HSR), Healthcare Delivery
Singer SJ, Sinaiko AD, Tietschert MV
Care integration within and outside health system boundaries.
The purpose of this study was to examine care integration-efforts to unify disparate parts of health care organizations to generate synergy across activities occurring within and between them-to understand whether and at which organizational level health systems impact care quality and staff experience. The investigators concluded that measures of clinical process integration related to higher staff ratings of quality and experience.
AHRQ-funded; HS024067.
Citation: Singer SJ, Sinaiko AD, Tietschert MV .
Care integration within and outside health system boundaries.
Health Serv Res 2020 Dec;55(Suppl 3):1033-48. doi: 10.1111/1475-6773.13578..
Keywords: Health Systems, Healthcare Delivery, Health Services Research (HSR), Research Methodologies
Santry HP, Strassels SA, Ingraham AM
Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach.
Acute Care Surgery (ACS) was developed as a structured, team-based approach to providing round-the-clock emergency general surgery (EGS) care for adult patients needing treatment for diseases such as cholecystitis, gastrointestinal perforation, and necrotizing fasciitis. In this study, the investigators sought to use a Donabedian approach to elucidate potential EGS structures and processes that might be associated with improved outcomes as an initial step in designing the optimal model of acute care surgery care for EGS patients.
AHRQ-funded; HS022694.
Citation: Santry HP, Strassels SA, Ingraham AM .
Identifying the fundamental structures and processes of care contributing to emergency general surgery quality using a mixed-methods Donabedian approach.
BMC Med Res Methodol 2020 Oct 2;20(1):247. doi: 10.1186/s12874-020-01096-7..
Keywords: Surgery, Critical Care, Healthcare Delivery, Health Services Research (HSR), Research Methodologies
Callejo-Black A, Wagner DV, Ramanujam K
A systematic review of external validity in pediatric integrated primary care trials.
This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. A literature search was conducted to identify relevant literature from 1998 to 2018 reporting on open, randomized or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. The authors included 39 publications describing 25 studies in the review. Publications rarely reported indicators of external validity, including the representatives of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies also included key pragmatic factors such as cost or organizational change processes related to implementation and maintenance.
AHRQ-funded; HS022981.
Citation: Callejo-Black A, Wagner DV, Ramanujam K .
A systematic review of external validity in pediatric integrated primary care trials.
J Pediatr Psychol 2020 Oct 1;45(9):1039-52. doi: 10.1093/jpepsy/jsaa068..
Keywords: Children/Adolescents, Primary Care, Behavioral Health, Healthcare Delivery, Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Brach C, Borsky A
AHRQ Author: Brach C, Borsky A
How the U.S. Agency for Healthcare Research and Quality promotes health literate health care.
This AHRQ-authored study traces the history of the AHRQ Health Literacy Action Plan to promote health literate health care delivery systems. This Plan has been developed and implemented for almost 15 years and serves as the framework for AHRQ’s efforts to 1) Develop measures; 2) Improve the evidence base and create implementation tools; 3) Create and support change; 4) Disseminate and transfer knowledge and tools; and 5) Practice what we preach.
AHRQ-authored.
Citation: Brach C, Borsky A .
How the U.S. Agency for Healthcare Research and Quality promotes health literate health care.
Stud Health Technol Inform 2020 Jun 25;269:313-23. doi: 10.3233/shti200046..
Keywords: Health Literacy, Healthcare Delivery, Health Services Research (HSR), Implementation
Norton WE, Zwarenstein M, Czajkowski S
AHRQ Author: Kato E
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
This article describes a workshop put together by the authors for program scientists at the National Cancer Institute (NCI) to help them become better researchers and stewards of research funds. The workshop got good reviews from the attendees and many felt it will help them develop funding opportunities and advise grantees.
AHRQ-authored.
Citation: Norton WE, Zwarenstein M, Czajkowski S .
Building internal capacity in pragmatic trials: a workshop for program scientists at the US National Cancer Institute.
Trials 2019 Dec 27;20(1):779. doi: 10.1186/s13063-019-3934-y..
Keywords: Research Methodologies, Health Services Research (HSR), Cancer, Healthcare Delivery
Broder-Fingert S, Kuhn J, Sheldrick RC
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Researchers describe a study protocol for a large randomized controlled trial using the Multiphase Optimization Strategy (MOST), a novel framework developed to optimize interventions. They apply this framework to delivery of Family Navigation (FN), an evidence-based care management strategy designed to reduce disparities and improve access to behavioral health services, and test four components related to its implementation. In this paper, they describe how the MOST framework can be used to improve intervention delivery. These methods will be useful for future studies testing intervention delivery strategies and their impact on implementation.
AHRQ-funded; HS022242.
Citation: Broder-Fingert S, Kuhn J, Sheldrick RC .
Using the Multiphase Optimization Strategy (MOST) framework to test intervention delivery strategies: a study protocol.
Trials 2019 Dec 16;20(1):728. doi: 10.1186/s13063-019-3853-y..
Keywords: Research Methodologies, Health Services Research (HSR), Healthcare Delivery, Behavioral Health, Evidence-Based Practice, Access to Care
Stadnick NA, Sadler E, Sandall J
Comparative case studies in integrated care implementation from across the globe: a quest for action.
There are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. In this paper, the investigators use a multiple case study design to highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and to synthesize the shared and unique challenges and successes across studies using the EPIS framework.
AHRQ-funded; HS024192.
Citation: Stadnick NA, Sadler E, Sandall J .
Comparative case studies in integrated care implementation from across the globe: a quest for action.
BMC Health Serv Res 2019 Nov 27;19(1):899. doi: 10.1186/s12913-019-4661-5..
Keywords: Healthcare Delivery, Health Services Research (HSR), Health Systems, Implementation, Case Study
Kaufman A, Dickinson WP, Fagnan LJ
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
The states of New Mexico, Oklahoma, Oregon, Colorado, and Washington stand out in stretching the boundaries of health extension; their stories reveal lessons learned regarding the successes and challenges. All states saw the need for long-term, sustained fundraising beyond grants in an environment expecting a short-term return on investment, and they were challenged operating in a shifting health system landscape where the creativity and personal relationships built with small primary care practices was hindered when these practices were purchased by larger health delivery systems.
AHRQ-funded; HS020890; HS020972; HS23904; HS023908.
Citation: Kaufman A, Dickinson WP, Fagnan LJ .
The role of health extension in practice transformation and community health improvement: lessons from 5 case studies.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S67-s72. doi: 10.1370/afm.2409..
Keywords: Community-Based Practice, Health Services Research (HSR), Healthcare Delivery, Organizational Change, Primary Care, Social Determinants of Health, Practice Improvement
Wooldridge A, Carayon P, Hoonakker P
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Trauma is the leading cause of disability and death in children and young adults in the US. While much is known about the medical aspects of inpatient pediatric trauma care, not much is known about the processes and roles involved in in-hospital care. Using human factors engineering (HFE) methods, the investigators combined interview, archival document and trauma registry data to describe how intra-hospital care transitions affect process and team complexity.
AHRQ-funded; HS023837.
Citation: Wooldridge A, Carayon P, Hoonakker P .
Complexity of the pediatric trauma care process: implications for multi-level awareness.
Cogn Technol Work 2019 Aug;21(3):397-416. doi: 10.1007/s10111-018-0520-0..
Keywords: Care Coordination, Children/Adolescents, Critical Care, Health Services Research (HSR), Healthcare Delivery, Inpatient Care, Patient Safety, Teams, Trauma, Young Adults
Hatch BA, Tillotson CJ, Huguet N
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
There is an increasing need for the development of new methods to understand factors affecting delivery of preventive care. This study applied a new measurement approach and assessed clinic-level factors associated with preventive care delivery. The investigators concluded that approaches that use individual preventive ratios and aggregate prevention indices are promising for understanding and improving preventive service delivery over time.
AHRQ-funded; HS024270.
Citation: Hatch BA, Tillotson CJ, Huguet N .
Use of a preventive index to examine clinic-level factors associated with delivery of preventive care.
Am J Prev Med 2019 Aug;57(2):241-49. doi: 10.1016/j.amepre.2019.03.016..
Keywords: Prevention, Healthcare Delivery, Health Services Research (HSR)
Aouad M, Brown TT, Whaley CM
Reference pricing: the case of screening colonoscopies.
In this study, the investigators studied the introduction of reference pricing to the California Public Employees' Retirement System. The investigators found a 10 percentage point increase in the share of patients using an ambulatory surgery center (ASC), leading to a $2300 to $1700 reduction in prices paid for patients who switched to ASCs. They indicated that their results suggested the use of ASCs had a causal effect on prices paid and had no negative effect on patient health outcomes.
AHRQ-funded; HS022098.
Citation: Aouad M, Brown TT, Whaley CM .
Reference pricing: the case of screening colonoscopies.
J Health Econ 2019 May;65:246-59. doi: 10.1016/j.jhealeco.2019.03.002..
Keywords: Colonoscopy, Shared Decision Making, Health Services Research (HSR), Healthcare Costs, Healthcare Delivery, Screening
Riley AR, Freeman KA
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
This commentary discusses the role that behavioral analysts can have in partnership with pediatric medicine. There have been advances, but there has been limited impact for the daily practice of pediatrics. The authors discuss why behavioral pediatrics has failed to gain traction in primary care, describe possible opportunities for an expanded portfolio of research, and identify several examplars from the behavior analytic literature that has influenced pediatric primary care, and make further recommendations for producing influential data.
AHRQ-funded; HS022981.
Citation: Riley AR, Freeman KA .
Impacting pediatric primary care: opportunities and challenges for behavioral research in a shifting healthcare landscape.
Behav Anal 2019 Feb;19(1):23-38. doi: 10.1037/bar0000114..
Keywords: Behavioral Health, Children/Adolescents, Health Services Research (HSR), Healthcare Delivery, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Primary Care, Primary Care: Models of Care, Research Methodologies
Brennan-Cook J, Bonnabeau E, Aponte R
Barriers to care for persons with sickle cell disease: the case manager's opportunity to improve patient outcomes.
The purpose of this paper was to review the barriers to care for patients with sickle cell disease (SCD). Chronic pain and the perception of addiction, implicit bias, frequent hospitalizations and emergency department visits, clinician and patient knowledge deficits, and SCD stigma all impede the ability to provide evidence-based care for patients with SCD. The authors assert that case managers can coordinate and advocate for appropriate care that improves patient outcomes.
AHRQ-funded; HS024501.
Citation: Brennan-Cook J, Bonnabeau E, Aponte R .
Barriers to care for persons with sickle cell disease: the case manager's opportunity to improve patient outcomes.
Prof Case Manag 2018 Jul/Aug;23(4):213-19. doi: 10.1097/ncm.0000000000000260..
Keywords: Access to Care, Healthcare Delivery, Health Services Research (HSR), Patient-Centered Outcomes Research, Sickle Cell Disease
Auger KA, Shah SS, Tubbs-Cooley HL
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
The purpose of this study was to determine whether a single nurse-led telephone call after pediatric discharge decreased the 30-day reutilization rate for urgent care services and enhanced overall transition success. The investigators concluded that although postdischarge nurse contact did not decrease the reutilization rate of postdischarge urgent health care services, the method showed promise to bolster postdischarge education.
AHRQ-funded; HS024735.
Citation: Auger KA, Shah SS, Tubbs-Cooley HL .
Effects of a 1-time nurse-led telephone call after pediatric discharge: the H2O II randomized clinical trial.
JAMA Pediatr 2018 Sep;172(9):e181482. doi: 10.1001/jamapediatrics.2018.1482..
Keywords: Care Coordination, Children/Adolescents, Health Information Technology (HIT), Health Services Research (HSR), Healthcare Delivery, Healthcare Utilization, Hospital Discharge, Outcomes, Provider, Provider: Nurse, Telehealth, Transitions of Care
de Cordova PB
Excess mortality associated with weekend hospital admissions may be due to patient-level differences, rather than reduced staffing or services.
The author comments on a study by Walker that explained the weekend effect as arising from differences in patient characteristics among patients who present to the emergency department on the weekend. For staffing, Walker used a proxy measure because staffing information was not available. The author cautions that, although a clear rationale was provided, there should be acknowledgement that use of a proxy, whether for illness severity or staffing, may alter results.
AHRQ-funded; HS024339.
Citation: de Cordova PB .
Excess mortality associated with weekend hospital admissions may be due to patient-level differences, rather than reduced staffing or services.
Evid Based Nurs 2018 Apr;21(2):49. doi: 10.1136/eb-2017-102779.
.
.
Keywords: Healthcare Delivery, Health Services Research (HSR), Hospitalization, Mortality, Provider Performance
Bond WF, Hui J, Fernandez R
The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes.
The Academic Emergency Medicine (AEM) Consensus Conference "Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcome" was conceived to foster discussion among experts in EM, engineering, and social sciences, focusing on key barriers and opportunities in simulation-based research. This executive summary describes the overall rationale for the conference, conference planning, and consensus-building approaches and outlines the focus of the eight breakout sessions.
AHRQ-funded; HS024820.
Citation: Bond WF, Hui J, Fernandez R .
The 2017 Academic Emergency Medicine Consensus Conference: Catalyzing System Change Through Healthcare Simulation: Systems, Competency, and Outcomes.
Acad Emerg Med 2018 Feb;25(2):109-15. doi: 10.1111/acem.13302..
Keywords: Emergency Department, Healthcare Delivery, Health Services Research (HSR), Simulation
Laker LF, Torabi E, France DJ
Understanding emergency care delivery through computer simulation modeling.
This article is a product of a breakout session from the 2017 Academic Emergency Medicine conference entitled “Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes.” This article explores the role that computer simulation modeling can and should play in developing emergency room care delivery systems. The four approaches to computer simulation modeling were described and each of their benefits and risks. An introduction to available software modeling platforms and how to determine the best one for the readers situation is also included.
AHRQ-funded; HS021749.
Citation: Laker LF, Torabi E, France DJ .
Understanding emergency care delivery through computer simulation modeling.
Acad Emerg Med 2018 Feb;25(2):116-27. doi: 10.1111/acem.13272..
Keywords: Emergency Department, Healthcare Delivery, Simulation, Health Services Research (HSR)
Phillippi JC, Hartmann KE
Differentiating research, quality improvement, and case studies to ethically incorporate pregnant women.
This article discusses the need to involve pregnant women in research, quality improvement, and case studies and how to involve them in an ethical way with high standards to protect participants. This review includes vignettes to distinguish between the different types of studies and emphasizes that perinatal care providers will need to seek institutional review board approval for all research to be conducted.
AHRQ-funded; HS024733.
Citation: Phillippi JC, Hartmann KE .
Differentiating research, quality improvement, and case studies to ethically incorporate pregnant women.
J Midwifery Womens Health 2018 Jan;63(1):104-14. doi: 10.1111/jmwh.12673..
Keywords: Health Services Research (HSR), Healthcare Delivery, Maternal Care, Pregnancy, Quality of Care, Quality Improvement, Research Methodologies, Women
Kim LY, Rose DE, Soban LM
Primary care tasks associated with provider burnout: findings from a Veterans Health Administration survey.
The purpose of this study was to investigate (1) the extent to which primary care providers (PCPs) share responsibility for 14 discrete primary care tasks with other team members, and (2) which, if any, of the primary care tasks performed by the PCPs (without reliance on team members) are associated with PCP burnout.
AHRQ-funded; HS000046.
Citation: Kim LY, Rose DE, Soban LM .
Primary care tasks associated with provider burnout: findings from a Veterans Health Administration survey.
J Gen Intern Med 2018 Jan;33(1):50-56. doi: 10.1007/s11606-017-4188-6..
Keywords: Healthcare Delivery, Health Services Research (HSR), Patient-Centered Healthcare, Primary Care, Provider, Workforce
Cohen GR, Jones DJ, Heeringa J
AHRQ Author: Furukawa MF, Miller D
Leveraging diverse data sources to identify and describe U.S. health care delivery systems.
Health care delivery systems are a growing presence in the U.S., yet research is hindered by the lack of universally agreed-upon criteria to denote formal systems. This study assesses available data sources to identify and describe systems, including system members and relationships among the members.
AHRQ-authored.
Citation: Cohen GR, Jones DJ, Heeringa J .
Leveraging diverse data sources to identify and describe U.S. health care delivery systems.
eGEMS 2017 Dec 15;5(3):9. doi: 10.5334/egems.200..
Keywords: Healthcare Delivery, Data, Health Services Research (HSR), System Design
Zachrison KS, Hayden EM, Schwamm LH
Characterizing New England emergency departments by telemedicine use.
The primary objective of this study was to describe the prevalence of telemedicine use in New England EDs and the clinical applications of use. It concluded that telemedicine is commonly used in New England EDs. In 2014, use was more common among rural EDs and EDs with limited neurology consultant availability. In contrast, telemedicine use was less common among very low-volume EDs.
AHRQ-funded; HS024561.
Citation: Zachrison KS, Hayden EM, Schwamm LH .
Characterizing New England emergency departments by telemedicine use.
West J Emerg Med 2017 Oct;18(6):1055-60. doi: 10.5811/westjem.2017.8.34880.
.
.
Keywords: Emergency Department, Emergency Medical Services (EMS), Healthcare Delivery, Health Services Research (HSR), Telehealth
Aarons GA, Sklar M, Mustanski B
"Scaling-out" evidence-based interventions to new populations or new health care delivery systems.
This paper introduces a new concept for implementation called "scaling-out" when evidence-based interventions are adapted either to new populations or new delivery systems, or both. Using existing external validity theories and multilevel mediation modeling, the authors provide a logical framework for determining what new empirical evidence is required for an intervention to retain its evidence-based standard in this new context.
AHRQ-funded; HS024192.
Citation: Aarons GA, Sklar M, Mustanski B .
"Scaling-out" evidence-based interventions to new populations or new health care delivery systems.
Implement Sci 2017 Sep 6;12(1):111. doi: 10.1186/s13012-017-0640-6..
Keywords: Healthcare Delivery, Evidence-Based Practice, Health Services Research (HSR)