Funded by the national library of medicine the national library of medicine nlm contracted with academyhealth to develop a core and a desired list of books, journals, bibliographic databases, web sites, and other media in the field of health services research methods. Both lists are intended to serve as a guide for librarians who want to develop a health services research methods collection. Due to the breadth of the methodological areas covered by health services research, this module is organized both by core and desired materials, as well as by topic area. As such, the module offers a framework for developing a collection of hsr methods resources.

The benefit of dividing the resources based upon core and desired resources, as well as by discipline, is that librarians will have a choice of which specific subtopics they deem to be most beneficial for their collection. Across all topic areas identified, the core listf contains 56 books, 50 journals, 6 bibliographic databases, and 23 web sites and 'other' resources such as instructional videos. Although the amount of items purchased for a collection will hinge on budgetary constraints, care was taken to define the core list as one that might be reasonable for moderately sized collections. Likewise, some of the databases and websites are free while others require large subscription fees. In the 1960's, the field of health services research was created by combining several study sections at the national institutes of health to create the health services research study section. The hsr study section sought to define hsr as a distinct field of scientific inquiry at the intersection of public health and medical care, informed by disciplinary perspectives.

Since that time, the field has evolved to encompass multiple disciplinary perspectives, including methods from cognate disciplines such as economics, statistics, political science, sociology, and many other schools of thought. The field has also developed new models and techniques to address research questions in specialized areas of inquiry such as patient safety and access to care. Due to the breadth of the field, two terms are critical to defining the scope of health services research methods. Its research domains are individuals, families, organizations, institutions, communities, and populations. An additional definition of health services research is provided by lexikon: research concerned with the organization, financing, administration, effects, and other aspects of health services.

Health services research is often concerned with the relationships among need, demand, supply, use, and outcomes of health services. Evaluation of structure is concerned with resources, facilities, and manpower process, with matters, such as where, by whom, and how health care is provided and outcome, with the results of the services such as the degree to which individuals receiving health services actually experience measurable benefits. To assess which methods are applicable to hsr, academyhealth staff developed a core definition of methodologies that are applicable to health services research, expanding from a 1994 definition of methodology in lexikon: methodology is the collection or study of methods practices, procedures, and rules used by those who work in a discipline or engage in an inquiry, as in the methodology of measuring, assessing, and improving performance. Methodology addresses the full range of issues confronted by empirical work in health services research, including conceptualization, modeling, literature review, study design, sampling, data collection, measurement, and research ethics.

By combining the definitions above, it is apparent how wide the scope of methods employed by health services researchers is. Hsr methods encompass a variety of study frameworks, designs, and analytic techniques. These include a spectrum of methods, from understanding of various epistemological perspectives on research, to study designs including focus groups and randomized controlled trials, to specific analytic techniques such as longitudinal data analysis. To help organize the array of hsr methods, core and desired resources have been divided into 18 major topic areas. These include: who has access to health care? do patients in large urban areas receive the same level of services as those in rural areas? at different levels of care, which patients have the best outcomes? many of these types of questions have policy implications. As a result, funding for health services research has often been linked to political interests.

As discussed above, econometric, epidemiological, survey research, and other widely accepted methods form the backbone of hsr. A related challenge for health services researchers is that the types of questions of interest to the field rely on the ability to generalize from data to the population at large. In order to collect information that may be generalized to the population, it is often necessary to draw associations from existing sources of data such as claims databases or large population surveys frequently referred to as observational data.

Observational data is collected in situations when it would be unethical or impractical to randomize participants to one condition or another such as having or not having health insurance. Because the data is not randomized, it is not possible to assume that an intervention causes a particular outcome rather, researchers rely on statistical analyses to draw associations between factors in a study. Despite concerns about the shortcomings of using non randomized data in hsr studies, there are major benefits to studying the implications of care delivery or policy at the population level. The scope of hsr studies often allows for greater understanding of an intervention's effectiveness, or effect in a real world population, as opposed to randomized controlled trials, which are better at assessing efficacy the outcome in an ideal, controlled population. In addition, hsr studies have always been closely linked to policy considerations, and as such, have the potential to enhance understanding of health care systems and impact care delivery for large numbers of individuals. Since the 1960s at the inception of hsr, health care spending has grown from 4 6% of gross domestic product gdp to 16% of gdp in 2004. In response to rising costs and concerns about quality and satisfaction with the current system of care, demand for new data on the appropriateness, effectiveness, and equity of medical care in the us health care system has grown in step.

In order to thoroughly evaluate these questions, it is imperative to emphasize understanding and use of the most appropriate research methods for hsr. For librarians it is becoming increasingly important to create a collection of materials that address the types of applied questions that health services research addresses. This is a daunting task because of the breadth and depth of the disciplines and subjects encompassed by hsr.

As the list of disciplines and topic areas relevant to hsr demonstrates, a wide array of disciplines are included in the health services research methodological 'toolkit'. Librarians may wish to utilize the module by choosing specific content areas that will benefit their personal library needs. Likewise, faculty developing new courses may look to this list for suggested current textbooks in the field.

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The organization of the list is intended to facilitate understanding of the array of options in different disciplines. This list of resources is not intended to define the full range of hsr methods texts, rather, to provide a set of resources considered valuable by librarians and academics in the field of health services research. The field of health services research is continually expanding and developing new methods to apply to health care and health care delivery questions.

Due to the fact that the field is growing rapidly, we recommend that users of this list search for updated versions of the resources cited here in order to ensure the most recent information on methodological topics. The following list of core books in health services research methods is divided into topic areas and alphabetized by last name of the primary author. Some of the resources focus on the application of research methods rather than on the specific method itself these are noted with an asterisk . We suggest that libraries developing a collection in health services research methods periodically check the publisher's web site for the most recent editions available.

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