Research

Health services research has been defined as “the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations.” (Association for Health Services Research). 

 Faculty in the Department of Health Services, Policy and Practice engage in a broad range of health services research.  Total research funding for departmental faculty in 2008, 2009, and 2010 was $4,513,550, $4,657,841, and $6,083,226, respectively.  Much of the research is conducted through the Center for Gerontology and Health Care Studies (http://www.chcr.brown.edu/) as well as collaborations with a broad range of groups including other academic departments at Brown University, Rhode Island state government agencies, the Veterans Administration Medical Center and other Brown affiliated hospitals.

A particular strength of the department is on the care of patients with chronic conditions .  Gerontology researchers in the section are interested a variety of topics including service utilization, nursing home care quality, organizational feature of nursing homes, hospice care quality, the use and outcomes of specific technologies such as feeding tubes, improving the care of seriously ill and dying patients, medication adherence, physician-patient communication, and understanding the impact of different Medicare care systems (i.e., traditional fee-for-service versus private plans such as HMOs) on patients’ experiences and health outcomes. 

 Related to these topic areas, HSP&P researchers have studied variations in care, disparities in care, the relationships between cost and quality and between quality and patients’ health outcomes.  An important focus of this gerontology work has been the development of new measures, including measures of nursing home and hospice quality that have been adopted as national standards.  Another important focus has been the development of new methods, including the development and implementation of innovative ways to link administrative data that allows patient and their service utilization to be tracked longitudinally and risk adjustment approaches that facilitate causal inference from observational data. 

 Another area of expertise is the care of persons with HIV, and faculty members are studying adherence with antiretroviral medications, physician-patient communication, and HIV prevention in high risk groups.  Investigators have developed new methods in the self-report of medication adherence, new methods to analyze audio recordings of physician-patient visits for medication adherence content, and are conducting trials that apply techniques from behavioral economics such as conditional economic incentives to improve medication adherence and reduce sexual risk behaviors.