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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.

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April 1, 2013 Volume 77, Number 4
Policy Matters: The Call for Health Services and Health Policy Research Thomas R. Miller, Ph.D., M.B.A.


How does the quality and cost of anesthesia services vary by geographic market, practice model, attributes of the hospital or health system, and characteristics of the patient? What is the demand for and supply of physicians and nurses who provide anesthesia services? What impact will a new regulation have on the cost, quality and accessibility of anesthesia services?

Addressing key questions such as these to help inform policymakers is a primary goal of health policy research (HPR). HPR is a subset of a broader field of study referred to as health services research (HSR). But what is HSR?

HSR 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.1 That is, HSR examines how people get access to health care, how much care costs and what happens to patients as a result of this care.2

Several medical societies have developed HPR as an integral part of their core business. For example, the Robert Graham Center, part of the American Academy of Family Physicians, conducts policy studies in family medicine and primary care.3 The American College of Surgeons Health Policy Research Institute “studies and reports on issues related to the state of the surgical profession, the surgical workforce, and surgical utilization in the United States.”4 The Harvey L. Neiman Health Policy Institute within the American College of Radiology studies “the value and role of radiology in evolving health care delivery and payment systems, including quality based approaches to care and the impact of medical imaging on overall health care costs.”5

The American Society of Anesthesiologists (ASA) Health Policy Research Department was established on August 27, 2012 with the hiring of a director to guide its implementation and help establish a long-term vision for HPR within ASA. An 18-member physician advisory group, which includes five members of ASA’s Administrative Council, meets regularly via conference call to discuss progress on the implementation of the HPR initiative6 and reviews implementation challenges, priority of specific action items and potential new research opportunities. As one of its first tasks, the advisory group developed a mission statement for HPR and associated goals.

HPR’s mission is to review, support, and conduct analyses and research relevant to anesthesiology and its advocacy; and to inform the public, health care providers and policymakers to help improve care delivery, quality and patient safety. To achieve its mission, HPR established the following four major goals: 1) Develop and implement a plan for sustainable HPR; 2) Identify and develop critical information for HPR; 3) Conduct analyses and research to support ASA’s advocacy efforts and demonstrate the value of anesthesiologists; and 4) Work with ASA-related organizations and foster relationships with selected academic centers to encourage health services and health policy research relevant to anesthesiology.

HPR as a Sustainable Strategic Pillar: HPR is a fundamental strategic pillar for ASA, and future planning efforts will focus on its sustainability and long-term effectiveness. The importance of HSR and HPR will be highlighted in the Emery A. Rovenstine Memorial Lecture at the ANESTHESIOLOGY™ 2013 annual meeting. John B. Neeld, M.D. (1999 ASA President) will discuss the investment in outcomes research as a key to help demonstrate the anesthesiology value proposition.

HPR as an Information Resource: HPR will acquire and develop information pertinent to understanding trends in anesthesia services, including trends in population and socioeconomic characteristics of patients, surgical volume and types by setting, hospital profiles, distribution of anesthesia workforce, utilization of and payment for anesthesia services (e.g., based on National Anesthesia Clinical Outcomes Registry and Medicare claims data), and trends in practice of care models and physician markets. HPR will work jointly with the Anesthesia Quality Institute, State Affairs, Quality and Regulatory Affairs, Payment and Practice Management, and Congressional and Political Affairs to develop and maintain relevant information for ASA’s advocacy efforts.

HPR as a Conductor of Analysis and Research: In addition to conducting original analyses and research studies, HPR will respond to ad hoc questions from ASA leadership. The scope of activities will range from literature reviews to primary data collection to retrospective statistical analyses of secondary data sets. To support these efforts, HPR plans to add a research analyst and senior researcher to the team in 2013.

HPR as a Connector of Researchers: There is substantial ongoing anesthesiology-related health services research at several academic centers. One of HPR’s roles is to keep abreast of the policy-related studies and help connect researchers across health care organizations and universities. In addition, HPR is pleased to participate in the Foundation for Anesthesia Education and Research Mentored Research Training Grant – Health Services Research Study Section.



Thomas R. Miller, Ph.D., M.B.A. is ASA’s Director of Health Policy Research.

References:
1. Lohr KN, Steinwachs D. Health services research: an evolving definition of the field. Health Services Research 2002;37(1):7-9.
2. Agency for Healthcare Research and Quality, February 2002, AHRQ Pub. No. 02-0011.
3. See http://www.graham-center.org/online/graham/home.html.
4. See http://www.acshpri.org/.
5. See http://www.acr.org/Research/Health-Policy-Institute.
6. Implementation of the health policy research initiative is one of ASA’s advocacy-related strategies in its current strategic plan.