Improving Children's Health Through Health Services Research
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.