Improving Children's Health Through Health Services Research
Evolution of Pediatric Outcomes Research
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. Clancy focused on lessons from the world of adults for pediatric outcomes research, building upon the recent report, The Outcomes of Outcomes Research (AHCPR, 1998).
One lesson to be learned is the reason for doing outcomes and effectiveness research: not just to build knowledge, but to translate that knowledge into practice. She cautioned participants that translating knowledge into practice is itself a science, that "not all paths to outcomes improvement directly traverse the clinician's cerebral cortex." Dr. Clancy pointed out that not every dependent variable is an "outcome" of care or policy variations.
Turning to pediatric outcomes research, Dr. Clancy noted that the early generation of large outcomes studies in children's health were conducted as contracts rather than grants, because researchers did not submit grant applications. Today, there are still many opportunities to conduct research in pediatric outcomes.
- A paucity of measures and lack of clarity about which measures are valid (e.g., proxy versus direct patient reports of processes or outcomes).
- Short-term versus long-term outcomes (e.g., asthma emergency department visits versus long term improvements in social and educational functioning).
- The link between the child and the family (e.g., parental productivity as an outcome related to the child's reduced school absenteeism for asthma).