Using the Knowledge Base of Health Services Research to Redefine Health Care Systems

Published in: Journal of General Internal Medicine, v. 30, no. 10, 2015, p. 1547-1556

by Robert H. Brook, Mary E. Vaiana

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Research Questions

  1. What have we learned from 50 years of health services research?
  2. How can those findings be used to change health care systems to achieve the best outcomes?

This Perspective discusses 12 key facts derived from 50 years of health services research and argues that this knowledge base can stimulate innovative thinking about how to make health care systems safer, more efficient, more cost effective, and more patient centered, even as they respond to the needs of diverse communities.

Key Findings

  • Health status, quality of care, and appropriateness of care can all be measured.
  • Quality of care varies dramatically by where one lives, by socioeconomic status, and in some cases by hospital or doctor.
  • The most powerful determinants of health are socio-economic.
  • Geography is a powerful predictor of the use of health services.
  • Integrated care for depression improves outcomes.
  • When care is free, people use more of it, but free care does not make people healthier.


  • Integrate health status measurement into the health care system, improve quality measurement, and update information about appropriateness of care.
  • Understand the social determinants of health.
  • Eliminate the effect of geography.
  • Integrate care for mental health.
  • Educate consumers, and give patients and providers smart decisionmaking tools to help them make wise choices.
  • Foster disruptive change.

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