research topics related to health services

Research Topics & Ideas: Healthcare

100+ Healthcare Research Topic Ideas To Fast-Track Your Project

Finding and choosing a strong research topic is the critical first step when it comes to crafting a high-quality dissertation, thesis or research project. If you’ve landed on this post, chances are you’re looking for a healthcare-related research topic , but aren’t sure where to start. Here, we’ll explore a variety of healthcare-related research ideas and topic thought-starters across a range of healthcare fields, including allopathic and alternative medicine, dentistry, physical therapy, optometry, pharmacology and public health.

NB – This is just the start…

The topic ideation and evaluation process has multiple steps . In this post, we’ll kickstart the process by sharing some research topic ideas within the healthcare domain. This is the starting point, but to develop a well-defined research topic, you’ll need to identify a clear and convincing research gap , along with a well-justified plan of action to fill that gap.

If you’re new to the oftentimes perplexing world of research, or if this is your first time undertaking a formal academic research project, be sure to check out our free dissertation mini-course. In it, we cover the process of writing a dissertation or thesis from start to end. Be sure to also sign up for our free webinar that explores how to find a high-quality research topic.

Overview: Healthcare Research Topics

• Allopathic medicine
• Alternative /complementary medicine
• Veterinary medicine
• Physical therapy/ rehab
• Optometry and ophthalmology
• Pharmacy and pharmacology
• Public health
• Examples of healthcare-related dissertations

Allopathic (Conventional) Medicine

• The effectiveness of telemedicine in remote elderly patient care
• The impact of stress on the immune system of cancer patients
• The effects of a plant-based diet on chronic diseases such as diabetes
• The use of AI in early cancer diagnosis and treatment
• The role of the gut microbiome in mental health conditions such as depression and anxiety
• The efficacy of mindfulness meditation in reducing chronic pain: A systematic review
• The benefits and drawbacks of electronic health records in a developing country
• The effects of environmental pollution on breast milk quality
• The use of personalized medicine in treating genetic disorders
• The impact of social determinants of health on chronic diseases in Asia
• The role of high-intensity interval training in improving cardiovascular health
• The efficacy of using probiotics for gut health in pregnant women
• The impact of poor sleep on the treatment of chronic illnesses
• The role of inflammation in the development of chronic diseases such as lupus
• The effectiveness of physiotherapy in pain control post-surgery

Topics & Ideas: Alternative Medicine

• The benefits of herbal medicine in treating young asthma patients
• The use of acupuncture in treating infertility in women over 40 years of age
• The effectiveness of homoeopathy in treating mental health disorders: A systematic review
• The role of aromatherapy in reducing stress and anxiety post-surgery
• The impact of mindfulness meditation on reducing high blood pressure
• The use of chiropractic therapy in treating back pain of pregnant women
• The efficacy of traditional Chinese medicine such as Shun-Qi-Tong-Xie (SQTX) in treating digestive disorders in China
• The impact of yoga on physical and mental health in adolescents
• The benefits of hydrotherapy in treating musculoskeletal disorders such as tendinitis
• The role of Reiki in promoting healing and relaxation post birth
• The effectiveness of naturopathy in treating skin conditions such as eczema
• The use of deep tissue massage therapy in reducing chronic pain in amputees
• The impact of tai chi on the treatment of anxiety and depression
• The benefits of reflexology in treating stress, anxiety and chronic fatigue
• The role of acupuncture in the prophylactic management of headaches and migraines

Topics & Ideas: Dentistry

• The impact of sugar consumption on the oral health of infants
• The use of digital dentistry in improving patient care: A systematic review
• The efficacy of orthodontic treatments in correcting bite problems in adults
• The role of dental hygiene in preventing gum disease in patients with dental bridges
• The impact of smoking on oral health and tobacco cessation support from UK dentists
• The benefits of dental implants in restoring missing teeth in adolescents
• The use of lasers in dental procedures such as root canals
• The efficacy of root canal treatment using high-frequency electric pulses in saving infected teeth
• The role of fluoride in promoting remineralization and slowing down demineralization
• The impact of stress-induced reflux on oral health
• The benefits of dental crowns in restoring damaged teeth in elderly patients
• The use of sedation dentistry in managing dental anxiety in children
• The efficacy of teeth whitening treatments in improving dental aesthetics in patients with braces
• The role of orthodontic appliances in improving well-being
• The impact of periodontal disease on overall health and chronic illnesses

Tops & Ideas: Veterinary Medicine

• The impact of nutrition on broiler chicken production
• The role of vaccines in disease prevention in horses
• The importance of parasite control in animal health in piggeries
• The impact of animal behaviour on welfare in the dairy industry
• The effects of environmental pollution on the health of cattle
• The role of veterinary technology such as MRI in animal care
• The importance of pain management in post-surgery health outcomes
• The impact of genetics on animal health and disease in layer chickens
• The effectiveness of alternative therapies in veterinary medicine: A systematic review
• The role of veterinary medicine in public health: A case study of the COVID-19 pandemic
• The impact of climate change on animal health and infectious diseases in animals
• The importance of animal welfare in veterinary medicine and sustainable agriculture
• The effects of the human-animal bond on canine health
• The role of veterinary medicine in conservation efforts: A case study of Rhinoceros poaching in Africa
• The impact of veterinary research of new vaccines on animal health

Topics & Ideas: Physical Therapy/Rehab

• The efficacy of aquatic therapy in improving joint mobility and strength in polio patients
• The impact of telerehabilitation on patient outcomes in Germany
• The effect of kinesiotaping on reducing knee pain and improving function in individuals with chronic pain
• A comparison of manual therapy and yoga exercise therapy in the management of low back pain
• The use of wearable technology in physical rehabilitation and the impact on patient adherence to a rehabilitation plan
• The impact of mindfulness-based interventions in physical therapy in adolescents
• The effects of resistance training on individuals with Parkinson’s disease
• The role of hydrotherapy in the management of fibromyalgia
• The impact of cognitive-behavioural therapy in physical rehabilitation for individuals with chronic pain
• The use of virtual reality in physical rehabilitation of sports injuries
• The effects of electrical stimulation on muscle function and strength in athletes
• The role of physical therapy in the management of stroke recovery: A systematic review
• The impact of pilates on mental health in individuals with depression
• The use of thermal modalities in physical therapy and its effectiveness in reducing pain and inflammation
• The effect of strength training on balance and gait in elderly patients

Topics & Ideas: Optometry & Opthalmology

• The impact of screen time on the vision and ocular health of children under the age of 5
• The effects of blue light exposure from digital devices on ocular health
• The role of dietary interventions, such as the intake of whole grains, in the management of age-related macular degeneration
• The use of telemedicine in optometry and ophthalmology in the UK
• The impact of myopia control interventions on African American children’s vision
• The use of contact lenses in the management of dry eye syndrome: different treatment options
• The effects of visual rehabilitation in individuals with traumatic brain injury
• The role of low vision rehabilitation in individuals with age-related vision loss: challenges and solutions
• The impact of environmental air pollution on ocular health
• The effectiveness of orthokeratology in myopia control compared to contact lenses
• The role of dietary supplements, such as omega-3 fatty acids, in ocular health
• The effects of ultraviolet radiation exposure from tanning beds on ocular health
• The impact of computer vision syndrome on long-term visual function
• The use of novel diagnostic tools in optometry and ophthalmology in developing countries
• The effects of virtual reality on visual perception and ocular health: an examination of dry eye syndrome and neurologic symptoms

Topics & Ideas: Pharmacy & Pharmacology

• The impact of medication adherence on patient outcomes in cystic fibrosis
• The use of personalized medicine in the management of chronic diseases such as Alzheimer’s disease
• The effects of pharmacogenomics on drug response and toxicity in cancer patients
• The role of pharmacists in the management of chronic pain in primary care
• The impact of drug-drug interactions on patient mental health outcomes
• The use of telepharmacy in healthcare: Present status and future potential
• The effects of herbal and dietary supplements on drug efficacy and toxicity
• The role of pharmacists in the management of type 1 diabetes
• The impact of medication errors on patient outcomes and satisfaction
• The use of technology in medication management in the USA
• The effects of smoking on drug metabolism and pharmacokinetics: A case study of clozapine
• Leveraging the role of pharmacists in preventing and managing opioid use disorder
• The impact of the opioid epidemic on public health in a developing country
• The use of biosimilars in the management of the skin condition psoriasis
• The effects of the Affordable Care Act on medication utilization and patient outcomes in African Americans

Topics & Ideas: Public Health

• The impact of the built environment and urbanisation on physical activity and obesity
• The effects of food insecurity on health outcomes in Zimbabwe
• The role of community-based participatory research in addressing health disparities
• The impact of social determinants of health, such as racism, on population health
• The effects of heat waves on public health
• The role of telehealth in addressing healthcare access and equity in South America
• The impact of gun violence on public health in South Africa
• The effects of chlorofluorocarbons air pollution on respiratory health
• The role of public health interventions in reducing health disparities in the USA
• The impact of the United States Affordable Care Act on access to healthcare and health outcomes
• The effects of water insecurity on health outcomes in the Middle East
• The role of community health workers in addressing healthcare access and equity in low-income countries
• The impact of mass incarceration on public health and behavioural health of a community
• The effects of floods on public health and healthcare systems
• The role of social media in public health communication and behaviour change in adolescents

Examples: Healthcare Dissertation & Theses

While the ideas we’ve presented above are a decent starting point for finding a healthcare-related research topic, they are fairly generic and non-specific. So, it helps to look at actual dissertations and theses to see how this all comes together.

Below, we’ve included a selection of research projects from various healthcare-related degree programs to help refine your thinking. These are actual dissertations and theses, written as part of Master’s and PhD-level programs, so they can provide some useful insight as to what a research topic looks like in practice.

• Improving Follow-Up Care for Homeless Populations in North County San Diego (Sanchez, 2021)
• On the Incentives of Medicare’s Hospital Reimbursement and an Examination of Exchangeability (Elzinga, 2016)
• Managing the healthcare crisis: the career narratives of nurses (Krueger, 2021)
• Methods for preventing central line-associated bloodstream infection in pediatric haematology-oncology patients: A systematic literature review (Balkan, 2020)
• Farms in Healthcare: Enhancing Knowledge, Sharing, and Collaboration (Garramone, 2019)
• When machine learning meets healthcare: towards knowledge incorporation in multimodal healthcare analytics (Yuan, 2020)
• Integrated behavioural healthcare: The future of rural mental health (Fox, 2019)
• Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis (Gilmore, 2021)
• Mindfulness-Based Interventions: Combatting Burnout and Compassionate Fatigue among Mental Health Caregivers (Lundquist, 2022)
• Transgender and gender-diverse people’s perceptions of gender-inclusive healthcare access and associated hope for the future (Wille, 2021)
• Efficient Neural Network Synthesis and Its Application in Smart Healthcare (Hassantabar, 2022)
• The Experience of Female Veterans and Health-Seeking Behaviors (Switzer, 2022)
• Machine learning applications towards risk prediction and cost forecasting in healthcare (Singh, 2022)
• Does Variation in the Nursing Home Inspection Process Explain Disparity in Regulatory Outcomes? (Fox, 2020)

Looking at these titles, you can probably pick up that the research topics here are quite specific and narrowly-focused , compared to the generic ones presented earlier. This is an important thing to keep in mind as you develop your own research topic. That is to say, to create a top-notch research topic, you must be precise and target a specific context with specific variables of interest . In other words, you need to identify a clear, well-justified research gap.

Need more help?

If you’re still feeling a bit unsure about how to find a research topic for your healthcare dissertation or thesis, check out Topic Kickstarter service below.

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15 Comments

I need topics that will match the Msc program am running in healthcare research please

Hello Mabel,

I can help you with a good topic, kindly provide your email let’s have a good discussion on this.

Can you provide some research topics and ideas on Immunology?

Thank you to create new knowledge on research problem verse research topic

Help on problem statement on teen pregnancy

This post might be useful: https://gradcoach.com/research-problem-statement/

can you provide me with a research topic on healthcare related topics to a qqi level 5 student

Please can someone help me with research topics in public health ?

Hello I have requirement of Health related latest research issue/topics for my social media speeches. If possible pls share health issues , diagnosis, treatment.

I would like a topic thought around first-line support for Gender-Based Violence for survivors or one related to prevention of Gender-Based Violence

Please can I be helped with a master’s research topic in either chemical pathology or hematology or immunology? thanks

Can u please provide me with a research topic on occupational health and safety at the health sector

Good day kindly help provide me with Ph.D. Public health topics on Reproductive and Maternal Health, interventional studies on Health Education

may you assist me with a good easy healthcare administration study topic

May you assist me in finding a research topic on nutrition,physical activity and obesity. On the impact on children

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NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

Chapter 8 health services research: scope and significance.

Donald M. Steinwachs ; Ronda G. Hughes .

Affiliations

The provision of high-quality, affordable, health care services is an increasingly difficult challenge. Due to the complexities of health care services and systems, investigating and interpreting the use, costs, quality, accessibility, delivery, organization, financing, and outcomes of health care services is key to informing government officials, insurers, providers, consumers, and others making decisions about health-related issues. Health services researchers examine the access to care, health care costs and processes, and the outcomes of health services for individuals and populations.

The field of health services research (HSR) is relied on by decisionmakers and the public to be the primary source of information on how well health systems in the United States and other countries are meeting this challenge. The “goal of HSR is to provide information that will eventually lead to improvements in the health of the citizenry.” 1 Drawing on theories, knowledge, and methods from a range of disciplines, 2 HSR is a multidisciplinary field that moves beyond basic and applied research, drawing on all the health professions and on many academic disciplines, including biostatistics, epidemiology, health economics, medicine, nursing, operations research, psychology, and sociology. 3

In 1979, the Institute of Medicine defined HSR as “inquiry to produce knowledge about the structure, processes, or effects of personal health services” 4 (p. 14). This was expanded upon in 2002 by AcademyHealth, the professional organization of the HSR field, with the following definition, which broadly describes the scope of HSR:

Health services research is 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. Its research domains are individuals, families, organizations, institutions, communities, and populations. 5

More specifically, HSR informs and evaluates innovations in health policy. These include changes in Medicare and Medicaid coverage, disparities in access and utilization of care, innovations in private health insurance (e.g., consumer-directed health plans), and trends among those without health insurance. 6–10 The health care industry continues to change, and HSR examines the impact of organizational changes on access to care, quality, and efficiency (e.g., growth in for-profit hospital systems). As new diagnostic and treatment technologies are introduced, HSR examines their impact on patient outcomes of care and health care costs.

The definition of HSR also highlights the importance of examining the contribution of services to the health of individuals and broader populations. HSR applied at the population level is particularly important in understanding health system performance and the impact of health policy on the public’s health. In the United States, the National Healthcare Quality Report, 11 National Healthcare Disparities Report, 12 and Healthy People Year 2010 13 exemplify our capacity for monitoring quality and assessing change. These reports tell us that the American quality of care is inconsistent and could be substantially improved. The associated cost of health care services is monitored by the Centers for Medicare & Medicaid Services (CMS). CMS reports tell us that American health care is the most expensive in the world, consuming approximately 16 percent of America’s gross domestic product. 14

Beyond health policy, HSR examines the process of care and the interactions of patients and providers. For example, HSR methods have been developed to describe doctor-patient communication patterns and examine their impact on patient adherence, satisfaction, and outcomes of care. 15–17

Advances in HSR measurement methodologies have made possible policy innovations. Prospective payment of hospitals, nursing homes, and home health care by Medicare became possible with the development of robust case-mix measurement systems. 18 CMS was able to initiate a pay-for-performance demonstration, rewarding hospitals with better quality performance, using valid and robust measures of quality. 14 Innovations in health care policy are frequently made possible by advances in measurement of indicators of health system performance.

• History of Health Services Research

The history of HSR is generally considered to have begun in the 1950s and 1960s with the first funding of grants for health services research focused on the impact of hospital organizations. 19 , 20 On the contrary, HSR began with Florence Nightingale when she collected and analyzed data as the basis for improving the quality of patient care and outcomes. 21 Also significant in the history of HSR was the concern raised about the distribution, quality, and cost of care in the late 1920s that led to one of the first U.S. efforts to examine the need for medical services and their costs, undertaken in 1927 by the Committee on the Costs of Medical Care. 22 The committee published a series of 28 reports and recommendations that have had a significant impact on how medical care is organized and delivered in the United States. 23 Other key reports of historical importance to HSR were, for example, the national health survey in 1935–1936 by the Public Health Service, the inventory of the nation’s hospitals by the American Hospital Association’s Commission on Hospital Care in 1944, and studies by the American Hospital Association’s Commission on Chronic Illness on the prevalence and prevention of chronic illness in the community. 23

In 1968, the National Center for Health Services Research and Development was established as part of the U.S. Public Health Services to address concerns with access to health services, quality of care, and costs. The Center funded demonstration projects to measure quality and investigator-initiated research grants. In 1989, Congress created the Agency for Health Care Policy and Research and broadened its mission to focus attention on variations in medical practice, patient outcomes of care, and the dissemination of evidence-based guidelines for the treatment of common disorders. Later Congress reauthorized and renamed the agency, Agency for Healthcare Research and Quality (AHRQ). AHRQ provides Federal leadership for the field, investing in methods for quality measurement, development of patient safety methods, and health information technology (e.g., electronic health records and decision support systems).

The Federal role in HSR has expanded over time, and investments in HSR are made by multiple Federal agencies. In addition to AHRQ, the U.S. Department of Veterans Affairs, Centers for Disease Control and Prevention, the National Institutes of Health, CMS, and other Federal agencies fund HSR. The diversification of funding comes, in part, from the recognition that HSR is important in managing health care systems, such as the Veterans Health Administration, and provides essential information on the translation of scientific discoveries into clinical practice in American communities, such as those funded by National Institutes of Health. It is estimated that total Federal funding of HSR was $1.5 billion in 2003, of which AHRQ was responsible for approximately 20 percent. 24

Private funding of HSR has also grown over time. Funding by private foundations has a significant role and complements Federal funding. Among the many foundations funding HSR are the Robert Wood Johnson Foundation, Commonwealth Fund, Kaiser Family Foundation, Kellogg Foundation, and Hartford Foundation. Other private funding sources include the health care industry, for example, pharmaceutical companies, health insurers, and health care systems.

• Goals for Health Services and Patient Outcomes

The goal of health services is to protect and improve the health of individuals and populations. In a landmark 2001 report, Crossing the Quality Chasm: A New Health System for the 21 st Century, 25 the Institute of Medicine (IOM) of the National Academy of Sciences proposed that the goals for health services should include six critical elements:

• Patient Safety: Patients should not be harmed by health care services that are intended to help them. The IOM report, To Err Is Human , 26 found that between 46,000 and 98,000 Americans were dying in hospitals each year due to medical errors. Subsequent research has found medical errors common across all health care settings. The problem is not due to the lack of dedication to quality care by health professionals, but due to the lack of systems that prevent errors from occurring and/or prevent medical errors from reaching the patient.
• Effectiveness: Effective care is based on scientific evidence that treatment will increase the likelihood of desired health outcomes. Evidence comes from laboratory experiments, clinical research (usually randomized controlled trials), epidemiological studies, and outcomes research. The availability and strength of evidence varies by disorder and treatment.
• Timeliness: Seeking and receiving health care is frequently associated with delays in obtaining an appointment and waiting in emergency rooms and doctors’ offices. Failure to provide timely care can deny people critically needed services or allow health conditions to progress and outcomes to worsen. Health care needs to be organized to meet the needs of patients in a timely manner.
• Patient Centered: Patient-centered care recognizes that listening to the patient’s needs, values, and preferences is essential to providing high-quality care. Health care services should be personalized for each patient, care should be coordinated, family and friends on whom the patient relies should be involved, and care should provide physical comfort and emotional support.
• Efficiency: The U.S. health care system is the most expensive in the world, yet there is consistent evidence that the United States does not produce the best health outcomes 27–30 or the highest levels of satisfaction. 31 The goal is to continually identify waste and inefficiency in the provision of health care services and eliminate them.
• Equity: The health care system should benefit all people. The evidence is strong and convincing that the current system fails to accomplish this goal. The IOM report, Unequal Treatment , 32 documented pervasive differences in the care received by racial and ethnic minorities. The findings were that racial and ethnic minorities are receiving poorer quality of care than the majority population, even after accounting for differences in access to health services.

Crossing the Quality Chasm concludes that for the American health care system to attain these goals, transformational changes are needed. 25 The field of HSR provides the measurement tools by which progress toward these goals is assessed, as seen in the National Healthcare Quality Report. 11 Equally important, health services researchers are developing and evaluating innovative approaches to improve quality of care, involving innovations in organization, financing, use of technology, and roles of health professionals.

• Evaluating the Quality of Health Care

HSR evaluation of quality of care has proven to be an inexact science and complex, even though its definition is relatively simple: “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” 1 This definition draws attention to the importance of the application of current professional knowledge in the diagnostic and treatment processes of health care. The goal of quality care is to increase the likelihood of achieving desired health outcomes, as expressed by the patient.

The complexity in measuring quality comes from gaps in our knowledge regarding which services, for which patients, will actually improve the likelihood of desired health outcomes. Also, patients need not have the same desired health outcomes and therefore might not receive the same care for an identical health problem, further complicating the measurement of quality of care. Quality measurement has advanced substantially, but it remains early in its development.

The conceptual framework widely applied in evaluating quality comes from years of research and the insightful analysis of Avedis Donabedian. 33 He formalized the conceptual model for describing, analyzing, and evaluating the quality of care using three dimensions: (1) structure, (2) process, and (3) outcome. This model is applied in the evaluation of health services and the accreditation of health care providers and organizations.

Seminal research about variation in the quality of care patients received brought to focus the need to monitor and improve the quality of health care. Wennberg and Gittelsohn 34 , 35 found wide variation in practice patterns among community physicians, surgical procedures, and hospitals. Brook and colleagues 36 found that a small number of physicians were responsible for a large number of improperly administered injections. This was the precursor to research on the appropriateness of procedures and services under specific circumstances 36 , 37 as well as the development of practice guidelines and standards for quality care. 38 Yet the challenge of research on variations in care is the implication of the inappropriateness of care. The challenge is determining whether there is a direct relationship between rates of utilization, variations in appropriateness, and quality of care.

One of the challenges in understanding quality, how to measure it, and how to improve it is the influence of physical, socioeconomic, and work environments. Income, race, and gender—as well as individuals within society and organizations—influence health and risks to health. 40 Researchers have found that differences in internal factors, such as collaborative relationships with physicians, decentralized clinical decisionmaking, and positive administrative support, impact nurse and patient outcomes 41 , 42 and the quality and safety of care. 43 Differences in external factors, such as insurance and geographic location, can influence access to available health care professionals and resources, what type of care is afforded patients, and the impact of care on patients. The structure, process, and outcome dimensions of quality are influenced by both internal and external factors.

Structure of Health Care

The structure of health care broadly includes the facilities (e.g., hospitals and clinics), personnel (e.g., number of nurses and physicians), and technology that create the capacity to provide health services. Structural characteristics are expected to influence the quality of health care services. One component in the accreditation of health care facilities (e.g., hospitals, nursing homes) is the review of the adequacy of structural characteristics, including staffing, on-call resources, technology, and support services (laboratory, pharmacy, radiology). The structural resources of health care facilities and organizations are the foundation upon which quality health care services are provided.

Process of Care

The interactions between the health care providers and patients over time comprise the process of health care. The process of care may be examined from multiple perspectives: the sequence of services received over time, the relationship of health services to a specific patient complaint or diagnosis, and the numbers and types of services received over time or for a specific health problem. Examining the time sequence of health care services provides insights into the timeliness of care, organizational responsiveness, and efficiency. Linking services to a specific patient complaint or diagnosis provides insights into the natural history of problem presentation and the subsequent processes of care, including diagnosis, treatment, management, and recovery. Examining the natural history of a presenting health complaint across patients will reveal variations in patterns of care. For example, presenting complaints for some patients never resolve into a specific diagnosis. An initial diagnosis may change as more information is obtained. Patients may suffer complications in the treatment process. Also, the process of care may provide insights into outcomes of care (e.g., return visit for complications). Generally it is not possible to examine the process of care and determine how fully the patient has recovered prior health status by the end of the episode of treatment. For this reason, special investigations are needed to assess outcomes of care.

Evaluation of the process of care can be done by applying the six goals for health care quality. 25 Was the patient’s safety protected (i.e., were there adverse events due to medical errors or errors of omission)? Was care timely and not delayed or denied? Were the diagnosis and treatments provided consistent with scientific evidence and best professional practice? Was the care patient centered? Were services provided efficiently? Was the care provided equitable? Answers to these questions can help us understand if the process of care needs improvement and where quality improvement efforts should be directed.

Outcomes of Care

The value of health care services lies in their capacity to improve health outcomes for individuals and populations. Health outcomes are broadly conceptualized to include clinical measures of disease progression, patient-reported health status or functional status, satisfaction with health status or quality of life, satisfaction with services, and the costs of health services. Historically, quality assessment has emphasized clinical outcomes, for example, disease-specific measures. However, disease-specific measures may not tell us much about how well the patient is able to function and whether or not desired health outcomes have been achieved. To understand the patients’ outcomes, it is necessary to ask patients about their outcomes, including health status, quality of life, and satisfaction with services. HSR has developed valid and robust standardized questionnaires to obtain patient-reported information on these dimensions of health outcomes. As these are more widely applied, we are learning about the extent to which health care services are improving health.

Public Health Perspective on Health Services

Another perspective on health care services comes from the field of public health in which preventive health services are conceptualized at three levels: primary, secondary, and tertiary prevention. 44 Primary prevention includes immunizations, healthy lifestyles, and working and living in risk-free environments. Primary prevention seeks to prevent disease or delay its onset. Examples of primary prevention include immunizations against infectious disease; smoking prevention or cessation; and promotion of regular exercise, weight control, and a balanced diet. Secondary prevention includes the range of interventions that can reduce the impact of disease morbidity once it occurs and slow its progression. With the increasing burden of chronic diseases, much of the health care provided is directed at secondary prevention. Tertiary prevention is directed at rehabilitation for disabilities resulting from disease and injury. The goal of tertiary prevention is to return individuals to the highest state of functioning (physical, mental, and social) possible. The public health framework expands the structure, process, and outcome conceptual model by identifying the role and value of health services at three stages: prior to onset of disease, disease management, and disease recovery and rehabilitation.

• Methodologies and Data Sources Used in Health Services Research

The interdisciplinary character of HSR draws on methods and data sources common to the many disciplines that form the intellectual underpinnings of the field. This section discusses the measurement of effectiveness and efficacy of health services and some of the methods and data sources used to understand effectiveness. Effectiveness is one of the six goals of health services. Effectiveness is interrelated with the other five goals, and some of these interrelationships are discussed.

Efficacy and Effectiveness

An important distinction is made between efficacy and effectiveness of health services. Efficacy is generally established using randomized controlled trial (RCT) methods to test whether or not clinical interventions make a difference in clinical outcomes. A good example is the series of studies required for Food and Drug Administration approval of a new drug before it is certified as safe and efficacious and allowed to be used in the United States. Efficacy research is generally done with highly select groups of patients where the impact of the drug can be validly measured and results are not confounded by the presence of comorbid conditions and their treatments. The efficacy question is: What impact does a clinical intervention have under ideal conditions?

In contrast, effectiveness research is undertaken in community settings and generally includes the full range of individuals who would be prescribed the clinical intervention. Many of these individuals will have multiple health problems and be taking multiple medications, unlike those who were recruited to the RCT. Effectiveness research is seeking to answer the question: Who will benefit from the clinical intervention among all those people in the community who have a specific health problem(s)?

Both efficacy and effectiveness questions are important. Logically, effectiveness research would be conducted after finding the clinical intervention to be efficacious. However, there are many treatments for which no efficacy information exists; the treatments are accepted as common practice, and it would not be ethical to withhold treatments from a control group in an RCT. As a result, effectiveness research may not have the benefit of efficacy findings.

The routine use of an RCT to evaluate efficacy began in the 1960s and is the accepted procedure for evaluating new medications. However, this standard is not applied across all health care services and treatments. Most surgical procedures are not evaluated using an RCT. Intensive care units have never been evaluated using an RCT, nor are nurse staffing decisions in hospitals or the evaluation of many medical devices. We currently accept different standards of evidence depending on the treatment technology. As a result, the level of evidence guiding clinical and public health decisionmaking varies.

Methods for Effectiveness Research

A variety of methods are used to examine effectiveness of health services. RCT methods are not usually applied in effectiveness research because the intervention being studied has demonstrated efficacy or is acknowledged as accepted clinical practice. When this is true, it would be unethical to randomly assign individuals who would be expected to benefit from the intervention to a control group not receiving an efficacious treatment. We will discuss when RCT methods can be used to test effectiveness and provide several examples. More commonly, effectiveness research uses statistical methods for comparing treatments across nonequivalent groups.

RCT and Policy Research

RCT study methods can be used to compare the effectiveness and costs of services across randomly assigned representative population groups. In an RCT, study participants are randomly assigned to two or more groups to ensure comparability and avoid any selection bias. At least one group receives an intervention (clinical, organizational, and/or financial), and usually one group serves as a control group, receiving a current standard of care, sometimes referred to as “usual care.” Two examples of effectiveness research using an RCT methodology to answer policy questions are described.

Health insurance experiment

Probably the first application of RCT methods in effectiveness research was undertaken in the 1970s as a health insurance experiment. The experiment was designed to test the impact on cost and health outcomes of different levels of insurance deductibles and copayment rates. A total of 3,958 people, ages 14–61, were randomized to a set of insurance plans and followed over 3 to 5 years. 45

The economic impact of receiving free care in one plan versus being in a plan requiring payment out-of-pocket of deductibles and co-insurance had the expected impact on utilization. Those paying a share of their medical bills utilized approximately one-third fewer doctor visits and were hospitalized one-third less frequently.

The impact on 10 health measures of free health insurance versus paying a portion of medical care costs out of pocket was evaluated. The findings were that there was largely no effect on health as measured by physical functioning, role functioning, mental health, social contacts, health perceptions, smoking, weight, serum cholesterol, diastolic blood pressure, vision, and risk of dying. 46 The exceptions were that individuals with poor vision improved under free care, as did low-income persons with high blood pressure.

Medicare preventive services experiment

A more recent example of RCT methods applied in HSR is the Baltimore Medicare Preventive Services Demonstration. The study evaluated the impact on cost and outcomes of offering a defined preventive services package to Medicare beneficiaries. This was compared to usual Medicare coverage, which paid for few preventive services. The preventive services coverage being evaluated included an annual preventive visit with screening tests and health counseling. The physician could request a preventive followup visit during the year, which would also be covered. Medicare beneficiaries (n = 4,195) were randomized to preventive services (the intervention group) or usual care (the control group). Sixty-three percent of those in the intervention group had at least one preventive visit. Significant differences were found in health outcomes between intervention and control groups. Among the 45 percent with declining health status, as measured by the Quality of Well-Being scale, 47 the decline was significantly less in the group offered preventive services. Mortality was also significantly lower in the intervention group. There was no significant impact of preventive services on utilization and cost. 48

Comparative Clinical Effectiveness and RCTs

The passage of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) included provisions for the funding of comparative effectiveness studies. AHRQs’ Effective Health Care Program (authorized under MMA Section 1013) informs comparative clinical effectiveness efforts by conducting and supporting research and evidence syntheses on priority topics to CMS.

Comparative effectiveness studies ask the question: Which of the alternative treatments available is best and for whom? Interest in this question reflects how advances in science have provided multiple treatment options for many conditions. Currently, there is no systematic process by which treatment options are compared and matched to the needs of different types of patients. Frequently, patients are started on one treatment and then may be prescribed alternative treatments if they cannot tolerate the treatment or if it is not as effective as expected. RCT methods can be used to evaluate comparative effectiveness of an intervention in treatment and control populations. This is ethical to do when there is no evidence that the treatments are not equivalent.

An example of a comparative effectiveness study using RCT methods is the CATIE study, testing alternative antipsychotic medications in the treatment of schizophrenia. A study of 1,493 persons with schizophrenia compared five of the newer antipsychotic medications (second generation) and also compared them against one of the first-generation antipsychotic medications. 49 , 50 The findings were surprising to many. The second-generation antipsychotics were no more effective in controlling psychotic symptoms than the first-generation drug. There was one exception, the drug Clozapine. 51 Furthermore, second-generation medications showed significant side effects that can affect health outcomes. These included weight gain, metabolic changes, extrapyramidal symptoms, and sedation effects. Each medication showed a somewhat different side-effect risk profile. From a positive perspective, the findings indicated that the clinician and patient can choose any of these medications as first-line treatment except Clozapine, which is generally used for treatment-resistant cases due to more intensive clinical monitoring requirements. The ultimate choice of treatment will depend on the patient’s ability to tolerate side effects that vary by drug.

The conduct of any RCT is resource intensive, requiring the recruitment of participants, and participants must give informed consent to be randomized. The rationale for making this investment may depend on the importance of the policy or practice issue. As shown, RCT methods can be applied to address policy and clinical care concerns with effectiveness. To the extent that the RCT includes a broad cross-section of people who would be affected by a policy or receive a clinical treatment, this methodology provides robust effectiveness findings.

Comparing Effectiveness and Costs Across Nonequivalent Groups

A range of statistical methods can be used to compare nonequivalent groups (i.e., groups receiving different treatments or exposures when there has been no random assignment to ensure comparability of group membership). It is not practical to review all the specific statistical approaches that can be applied. In general, the statistical methods seek to adjust for nonequivalent characteristics between groups that are expected to influence the outcome of interest (i.e., make the comparisons fair). Statistical adjustment for nonequivalent characteristics is referred to as “risk adjustment.” The foundations for risk adjustment come from multiple disciplines. Epidemiologic methods are routinely used to identify and estimate disease and outcomes risk factors. These methods are applicable in comparative effectiveness evaluations. 52

Operations research uses methods for creating homogeneous groups predictive of cost or disease outcomes. These methods are used to make fair comparisons across provider practices and health plans and to control the cost of health care. They also have been used in designing payment systems, including diagnostically related groups used in Medicare’s Prospective Payment System to reimburse hospitals for care rendered to Medicare beneficiaries, and resource-based relative value scales used in Medicare’s physician payment system. Diagnostically related groups are used to standardize and rationalize patient care in hospitals—provided largely by nurses and other health professionals—and resource-based relative value scales are used to standardize and rationalize patient care in outpatient settings—care provided largely by physicians and nurse practitioners. Other disciplines also contribute to our understanding of risk factors for the range of health outcomes, including mortality, health and functional status, quality of life, and rehabilitation and return to work

The basic form of a nonequivalent group comparison includes adjusting the outcomes of each group for the risk factors that are known to affect the occurrence and/or severity of the outcomes being evaluated. 53 For many disease outcomes, risk factors include demographic characteristics (age, gender), disease-specific risk factors (e.g., health behaviors, environmental exposures, and clinical indicators of risk), and indicators of health status (e.g., presence of comorbid conditions). After adjustment for risks factors, variations in access to care and quality of care (e.g., choice of treatment and adherence to treatment) would be expected to explain the remaining observed variation in outcomes. Ideally, the nonequivalent group comparison makes it possible to compare the effectiveness of alternative treatments and assess the impact of poor access to care. One limitation of this methodology is the limit of current knowledge regarding all relevant disease risk factors. Even when risk factors are known, limits on data availability and accuracy of risk factor measurement have to be considered.

Risk adjustment methods are also used to make cost comparisons across health care providers to determine which providers are more efficient. Instead of adjusting for disease risk factors, adjustments are made for the costliness of the patient mix (case mix) and differences in costs of labor, space, and services in the local area. Comparisons may be made to assess efficiency of providing specific services (e.g., hospitalization, office visit, or laboratory test). These comparisons would use case-mix measures that adjust for the costliness of different mixes of hospital episodes. 18 Comparisons of the total cost of care for insured populations would apply case-mix measures that adjust for disease and health factors that affect total cost of care. 54

Data Sources for Effectiveness Research

A range of data sources is used in effectiveness research, including administrative and billing data, chart reviews and electronic health records, and survey questionnaires. The following discussion identifies major attributes of each category of data source.

Medical records

Medical records document the patient’s presenting problem or condition, tests and physical exam findings, treatment, and followup care. The medical record is generally the most complete source of clinical information on the patient’s care. However, medical records are generally not structured to ensure the physician or other provider records all relevant information. The completeness of medical record information can vary considerably. If the patient does not return for followup care, the medical record may provide no information on outcomes of care. If a patient sees multiple providers during the course of treatment, each with its own separate medical record, complete information on treatment requires access to all the records. Lack of standardization of medical records also can make abstracting records for research very resource intensive.

Administrative and billing data

Health care providers generally have administrative and billing data systems that capture a limited and consistent set of data on every patient and service provided. These systems uniquely identify the patient and link information on insurance coverage and billing. Each service received by the patient is linked to the patient using a unique patient identifier. Services are identified using accepted codes (e.g., ICD9-CM, CPT), together with date of service, provider identifier, and other relevant information for billing or management reporting. Administrative data make it possible to identify all individual patients seen by a provider and produce a profile of all services received by each patient over any defined time period. Administrative data are comprehensive and the data are generally complete (i.e., no problems with missing data). The primary limitation is the data set collected by administrative systems is very limited and lacks the detail of the medical record.

Administrative data systems can provide some insights into quality and outcomes of care. AHRQ has developed software that provides quality indicators and patient safety measures using one administrative data set, hospital discharge abstracts. 55 , 56 Utilization-based indicators of outcome include rehospitalization, return to surgery during a hospitalization, and incidence of complications; some systems include information on death. Administrative data can efficiently provide quality and outcomes indicators for defined populations and for health systems. Other applications of administrative data include assessing efficiency, timeliness, and equity. The limitation is that there are many health conditions and health outcomes that cannot currently be measured using administrative data.

Survey questionnaires

Neither the medical record nor the administrative data capture information on the patient’s experience in health or patient-reported outcomes of care. Survey questionnaires are routinely used to obtain information on patient satisfaction in health plans. A widely used example is the Consumer Assessment of Healthcare Providers and Systems or CAHPS. 57

Information on the impact of health conditions on health and functional status has to come from the patient. This may be obtained at the time of a visit or hospitalization. However, to assess patient outcomes of care, systematic followup of patients after the completion of treatment is generally required. This can be done using mail questionnaires, telephone interviews, or in-person interviews. The HSR field has developed health-status and quality-of-life measures that can be used no matter what health conditions the patient has. 47 , 58–60 Numerous condition-specific measures of outcome are also used. 53

Effectiveness research relies on a range of data sources. Some are routinely collected in the process of medical care and patient billing. Others may require special data collection, including medical record abstracts to obtain detailed clinical data and survey questionnaires to gain information on the patient’s perspective on treatment and outcomes. Efficient strategies for examining effectiveness may use administrative data to examine a limited set of data on all patients, and a statistically representative sample of patients for in-depth analysis using data from chart abstracts and survey questionnaires.

Using HSR Methods To Improve Clinical Practice

HSR research tools can be applied in clinical settings to improve clinical practice and patient outcomes. These tools are used as part of quality improvement programs in hospitals, clinics, and health plans. Two examples illustrate applications to improve quality-of-care performance.

Evidence-based treatment

For many chronic medical conditions, clinical research has evaluated the efficacy of diagnostic methods and treatment interventions. As a result, evidence-based reviews of research literature can provide a basis for establishing quality-of-care criteria against which to judge current practice. In a national study of quality of medical care, it was found that only 55 percent of patients received evidence-based treatments for common disorders and preventive care. 61 The researchers examined treatment for a range of health conditions, using a national sample of medical records abstracts. For each quality criterion, a classification was applied to determine if the quality-of-care deficiency was one of underuse, overuse, or misuse. Greater problems were found with underuse (46 percent) than with overuse (11 percent). Quality of care varied by condition: senile cataracts scored highest, 78 percent of recommended care received, and alcohol dependence scored lowest, 10 percent of recommended care received. Overall, only about half of recommended care was received, frequently due to underuse of services.

Researchers have sought to identify why rates of conformance with evidence-based treatments are low. Frequently cited barriers to evidence-based practice include physician disagreement with the evidence, perception that patients will not accept treatment, low ratings of self-efficacy as a provider of the treatment, and difficulty of integrating the evidence-based treatment into existing practice. 62 More needs to be learned how to assist health care providers to overcome barriers to the adoption of evidence-based practices.

The described data sources and methods can be applied in clinical settings to assess conformance to evidence-based quality criteria and provide feedback to clinicians. If electronic health records are available, the feedback and reminders may be directly incorporated into the medical record and seen by the clinician at the time of a visit. Intermountain Health Care utilizes its electronic health records to monitor adherence to evidence-based quality standards and to provide decision support to clinicians when seeing patients. This strategy has contributed to substantial improvements in their quality performance. 63

Outcomes management system

In 1988, Paul Ellwood proposed the adoption of outcomes management system (OMS) as a method to build clinical intelligence on “what treatments work, for whom, and under what circumstances.” 64 OMS would require linking information on the patient’s experience with outcomes of care and information on diagnosis and treatment that would usually come from the medical record.

In 1991, the Managed Health Care Association, an employer organization, brought together a group of employers and their health plan partners who were interested in testing the OMS concept in health plans. 65 To do so would require a set of methods that could be widely applied across health plans with differing information systems. The methodology chosen was for each of 16 health plans to identify all adult enrollees with at least two diagnoses of asthma over the previous 2 years. A stratified sample was chosen with half of the enrollees having more severe asthma (e.g., hospitalization or emergency room visit in the past 2 years) and the other enrollees having less severe asthma (outpatient visits only). Each adult received a questionnaire asking about their asthma treatment and health status. Followup surveys were done in each of 2 successive years to track changes over time.

The findings were compared to national treatment recommendations for adult asthma. 66 Across the health plans, 26 percent of severe asthmatics did not have a corticosteroid inhaler, and 42 percent used it daily, as recommended. 67 Only 5 percent of patients reported monitoring their asthma using a home peak flow meter. Approximately half of adults with asthma reported having the information they needed to avoid asthma attacks, to take appropriate actions when an asthma flare-up occurs, and to adjust medications when their asthma gets worse. Health plans used the baseline findings to develop quality-improvement interventions, which varied across health plans. Followup surveys of the patient cohort provided feedback to health plans on their success in improving asthma treatment and outcomes over time.

This chapter has provided a definition and history of the field of health services research and discussed how this field is examining quality-of-care issues and seeking to improve quality of care. Comparisons of current practice to evidence-based standards with feedback to clinicians and the integration of patient-reported outcomes are two examples of how HSR tools can be used to provide quality-improvement information for health care organizations. These examples utilize multiple data sources, including medical records, patient surveys, and administrative data. The opportunities for nurse researchers to provide invaluable contributions to the growing field of health services research are innumerable.

• Cite this Page Steinwachs DM, Hughes RG. Health Services Research: Scope and Significance. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 8.
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What are the trending topics in Public Health and related disciplines?

You can identify some of the most discussed and influential topics with the help of Altmetric attention scores, which take into account several outlets including social media, news articles, and policy documents.

Drawing from a selection of Public Health and Medicine journals, we have compiled a list of the articles that have been mentioned the most over the past few months.

Discover the articles that are trending right now, and catch up on current topics in Public Health and related disciplines. We will update our collection every few weeks; come back to this page to be on top of the latest conversations in Public Health and Medicine. Previously featured articles are listed here .

You can also sign up for e-alerts to make sure you never miss the latest research from our journals.

*Last updated October 2021*

Age and Ageing

Alcohol and alcoholism, american journal of epidemiology, annals of work exposures and health, epidemiologic reviews, european journal of public health, family practice, health education research, health policy and planning, health promotion international, international health, international journal of epidemiology, international journal for quality in health care, journal of public health, journal of travel medicine, journal of tropical pediatrics, nicotine & tobacco research, transactions of the royal society of tropical medicine & hygiene, behaviour change interventions to increase physical activity in hospitalised patients: a systematic review, meta-analysis and meta-regression.

There is moderate-certainty evidence that behaviour change interventions are associated with increased physical activity levels among older hospitalised patients.

Attention-Deficit/Hyperactivity Disorder and Alcohol and Other Substance Use Disorders in Young Adulthood: Findings from a Canadian Nationally Representative Survey

This study from Canada found that one in three young adults with ADHD had a lifetime alcohol use disorder, and that young adults with ADHD were also three times more likely to develop a substance use disorder. Targeted outreach and interventions for this extremely vulnerable population are warranted.

Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality

According to this study, resuming evictions in summer 2020 was associated with increased COVID-19 incidence and mortality in US states, with an estimated 433,700 excess cases and 10,700 excess deaths. Explore more research on COVID-19 in a curated collection from the AJE: https://academic.oup.com/aje/pages/covid-19

The Development of a Covid-19 Control Measures Risk Matrix for Occupational Hygiene Protective Measures

The British Occupational Hygiene Society (BOHS) developed a control banding matrix for employers and others to help assess the risks of COVID-19 infection, and calls for further work to validate the reliability of the tool. Browse the Annals' collection on occupational hygiene for virus protection: https://academic.oup.com/annweh/pages/covid-19 

Immunization to Protect the US Armed Forces: Heritage, Current Practice, and Prospects

In 1777, George Washington ordered a mandatory inoculation program for his troops, in what would become the first mass immunization mandate in the US. This archival article discussess and contextualizes immunization practices for US Armed Forces.

Does face mask use elicit risk-compensation? Quasi-experimental evidence from Denmark during the SARS-CoV-2 pandemic

Responding to concerns that that face mask use could elicit a false sense of security and lead to riskier behaviours, this study from Denmark found that mask use overall correlated positively with protective behaviours.

Evidence reversals in primary care research: a study of randomized controlled trials

While medical practice is often undermined by subsequent investigation, randomized trials relevant to primary care generally hold up over time.

Social media influencers can be used to deliver positive information about the flu vaccine: findings from a multi-year study

This study shows the potential for using social media influencers to inspire positive engagements on pro-vaccine health messaging. For more content on accurate information's importance for public health, browse the latest article collection from HER: https://academic.oup.com/her/pages/covid-19

COVID-19 Preparedness and Response Plans from 106 countries: a review from a health systems resilience perspective

Current emergency response planning does not have adequate coverage to maintain health systems functionality for essential health service delivery alongside emergency-specific interventions and healthcare. The findings from this study can help align health emergency planning with broader population health needs.

Rise and demise: a case study of public health nutrition in Queensland, Australia, over three decades

This case study shows that that ongoing efforts are needed to improve sustainability of nutrition policy and programmes to address all diet-related diseases.

Institutional and behaviour-change interventions to support COVID-19 public health measures: a review by the Lancet Commission Task Force on public health measures to suppress the pandemic

This review article outlines evidence for a range of institutional measures and behaviour-change measures, and highlights research and knowledge gaps.

Quantifying impacts of the COVID-19 pandemic through life-expectancy losses: a population-level study of 29 countries 

The COVID-19 pandemic triggered significant mortality increases in 2020 of a magnitude not witnessed since World War II in Western Europe or the breakup of the Soviet Union in Eastern Europe.

Gender in the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist

The authors propose an update to the Equator’s Consolidated criteria for reporting qualitative research (COREQ) checklist, with the aim of enhancing inclusivity.

Rate of reinfections after SARS-CoV-2 primary infection in the population of an Italian province: a cohort study

This study confirms previous findings on a low risk of SARS-CoV-2 reinfection. If confirmed, these findings suggest that more targeted restriction policies can be applied to the subjects that recovered after a first infection. Read highly cited papers on COVID-19 from the Journal of Public Health: https://academic.oup.com/jpubhealth/pages/covid-19

The reproductive number of the Delta variant of SARS-CoV-2 is far higher compared to the ancestral SARS-CoV-2 virus

Given the Delta variant's high reproductive number associated with higher transmissibility, in a context of globally still low vaccine coverage rates and lower vaccine effectiveness, public health and social measures will need to be substantially strengthened. A high reproductive number also means that much higher vaccine coverage rates need to be achieved compared to the originally assumed.

Neurological Complications of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis

Neurological complications are rare in children suffering from COVID-19. Still, these children are at risk of developing seizures and encephalopathy, more in those suffering from severe illness.

Reactions to Sales Restrictions on Flavored Vape Products or All Vape Products Among Young Adults in the United States

The researchers examined support for and perceived impact of e-cigarette sales restrictions. Findings suggest that bans on flavored vape products could have a positive impact on lower-risk users, but that other young adult user subgroups may not experience benefit.

Covid-19 and Health at Work 

An editorial from the earlier stages of the pandemic highlights the importance of properly fitted respirators for worker safety and outlines occupational hygiene measures.

Lessons from the field: delivering trachoma mass drug administration safely in a COVID-19 context

Guidelines for safe mass drug administration for neglected tropical diseases were developed in a COVID-19 context; training and implementation were assessed through an observation checklist.

For more research on the impact of COVID-19 on NTDs, explore the March 2021 special issue: https://academic.oup.com/trstmh/issue/115/3

Previously featured

Age and frailty are independently associated with increased COVID-19 mortality and increased care needs in survivors: results of an international multi-centre study

Trajectories of Alcohol Use and Related Harms for Managed Alcohol Program Participants over 12 Months Compared with Local Controls: A Quasi-Experimental Study

Estimating the Effect of Social Distancing Interventions on COVID-19 in the United States

Selecting Controls for Minimizing SARS-CoV-2 Aerosol Transmission in Workplaces and Conserving Respiratory Protective Equipment Supplies

What Do We Know About the Association Between Firearm Legislation and Firearm-Related Injuries?

Denialism: what is it and how should scientists respond?

Acute cooling of the feet and the onset of common cold symptoms

The effect of falsely balanced reporting of the autism–vaccine controversy on vaccine safety perceptions and behavioral intentions

Climate change: an urgent priority for health policy and systems research

Power, control, communities and health inequalities I: theories, concepts and analytical frameworks

Research ethics in context: understanding the vulnerabilities, agency and resourcefulness of research participants living along the Thai–Myanmar border

Tobacco smoking and mortality among Aboriginal and Torres Strait Islander adults in Australia

Quality and safety in the time of Coronavirus: design better, learn faster

Years of life lost associated with COVID-19 deaths in the United States

In-flight transmission of SARS-CoV-2: a review of the attack rates and available data on the efficacy of face masks

Stability of the Initial Diagnosis of Autism Spectrum Disorder by DSM-5 in Children: A Short-Term Follow-Up Study

Impact of Tobacco Smoking on the Risk of COVID-19: A Large Scale Retrospective Cohort Study

Mental health of staff working in intensive care during COVID-19

The benefits and costs of social distancing in high- and low-income countries

A classification tree to assist with routine scoring of the Clinical Frailty Scale

Recent Advances in the Potential of Positive Allosteric Modulators of the GABAB Receptor to Treat Alcohol Use Disorder

The recent oubreak of smallpox in Meschede, West Germany

Your Hair or Your Service: An Issue of Faith for Sikh Healthcare Professionals During the COVID-19 Pandemic

Emerging Infections: Pandemic Influenza

Identifying the views of adolescents in five European countries on the drivers of obesity using group model building 

Novel multi-virus rapid respiratory microbiological point-of-care testing in primary care: a mixed-methods feasibility evaluation

Public health crisis in the refugee community: little change in social determinants of health preserve health disparities

In search of ‘community’: a critical review of community mental health services for women in African settings

COVID-19, a tale of two pandemics: novel coronavirus and fake news messaging 

Disrupting vaccine logistics

Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations

Measurement and monitoring patient safety in prehospital care: a systematic review

Black Lives Matter protests and COVID-19 cases: relationship in two databases

The positive impact of lockdown in Wuhan on containing the COVID-19 outbreak in China

Severe Malnutrition and Anemia Are Associated with Severe COVID in Infants

A Single-Arm, Open-Label, Pilot, and Feasibility Study of a High Nicotine Strength E-Cigarette Intervention for Smoking Cessation or Reduction for People With Schizophrenia Spectrum Disorders Who Smoke Cigarettes

Healthcare workers and protection against inhalable SARS-CoV-2 aerosols

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Health Policy

Pursuing policies that improve the public health, including health economics, health services, advocacy, and preparedness

Health Policy Headlines

 Explore the latest public health research and insights about health policy.

A Brief History of Traffic Deaths in the U.S. 

More and faster cars, wider highways, and unsafe driver behaviors contribute to tens of thousands of deaths every year—but researchers see a safer road ahead.  

5 Fixes for Aging in America

Shifts in attitudes and policies can pave the way to thriving in later life.

Rewriting the Story of Life’s Later Years

Advances in three key areas will help us ensure people everywhere enjoy longer, healthier lives.

The Hunger Gap

Food programs tend to target adults and younger kids. What about adolescents?

Cooking Skills: The Missing Ingredient in Nutrition Efforts

If we want to help people eat better, we need to teach them how to cook. 

OB-GYN Training and Practice in Dobbs’ Shadow

Abortion bans are changing where prospective doctors study and work—and stand to exacerbate health care shortages and disparities.

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 Looking for prominent public health experts in the field of health policy? They’re here at the Bloomberg School of Public Health.

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Rajiv N. Rimal, PhD, MA, works globally on social and behavior change interventions with a focus on women and children’s nutrition and well-being. He adopts a social norms-based approach to address health inequities in low- and middle-income countries.

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Gerard Anderson, PhD, works with policymakers to control health care spending.

Albert Wu, MD, MPH, studies the impact of safety problems on patients and health care workers.

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Hope challenge hands that rock the cradle: expanding policies to protect black maternal and infant health.

151+ Public Health Research Topics [Updated 2024]

The important area of public health research is essential to forming laws, influencing medical procedures, and eventually enhancing community well-being. As we delve into the vast landscape of public health research topics, it’s essential to understand the profound impact they have on society.

This blog aims to provide a comprehensive guide to selecting and understanding the diverse array of public health research topics.

Overview of Public Health Research Topics

Table of Contents

Public health research encompasses a wide range of subjects, reflecting the interdisciplinary nature of the field. From epidemiology and health policy to environmental health and infectious diseases, researchers navigate through various dimensions to address complex health challenges.

Each category holds its own significance, contributing to the overall understanding of public health dynamics.

Key Considerations in Selecting Public Health Research Topics

• Current Relevance: Assess the timeliness of potential topics by considering recent health trends, emerging issues, and societal concerns.
• Impact on Public Health: Evaluate the potential impact of the research on improving health outcomes, addressing disparities, or influencing policy and interventions.
• Feasibility and Resources: Gauge the practicality of conducting research on a particular topic, considering available resources, data accessibility, and research infrastructure.
• Ethical Considerations: Scrutinize the ethical implications of the research, ensuring it aligns with ethical standards and guidelines, especially when dealing with vulnerable populations or sensitive topics.

Top 151+ Public Health Research Topics

Epidemiology.

• The Impact of Social Determinants on Disease Outcomes
• Patterns and Trends in Emerging Infectious Diseases
• Investigating Health Disparities among Different Ethnic Groups
• Childhood Obesity and its Long-Term Health Consequences
• Assessing the Effectiveness of Contact Tracing in Disease Control

Health Policy

• Universal Healthcare: Comparative Analysis of Global Models
• The Role of Telemedicine in Improving Healthcare Access
• Evaluating Mental Health Policies and Their Impact on Communities
• Assessing the Impact of Affordable Care Act on Public Health
• Vaccine Policies and Public Perception: A Comprehensive Study

Environmental Health

• Climate Change and Health: Adapting to the Challenges
• Air Quality and Respiratory Health in Urban Environments
• Waterborne Diseases and Strategies for Safe Water Supply
• Occupational Health Hazards: A Comprehensive Workplace Analysis
• The Impact of Green Spaces on Mental Health in Urban Areas

Infectious Diseases

• Antimicrobial Resistance: Strategies for Mitigation
• Vaccination Strategies and Herd Immunity
• Global Health Security: Preparedness for Pandemics
• The Impact of Vector-Borne Diseases on Public Health
• Emerging Trends in Antibiotic-Resistant Infections

Chronic Diseases

• Lifestyle Interventions for Preventing Cardiovascular Diseases
• Genetic Factors in the Development of Cancer: A Comprehensive Study
• Aging and Health: Addressing the Healthcare Needs of the Elderly
• Diabetes Prevention Programs: Efficacy and Implementation
• Mental Health in Chronic Disease Patients: Bridging the Gap

Maternal and Child Health

• Maternal Mortality: Understanding Causes and Prevention
• The Impact of Breastfeeding on Infant Health and Development
• Childhood Immunization: Barriers and Strategies for Improvement
• Teenage Pregnancy and Its Long-Term Health Consequences
• Mental Health Support for Postpartum Women: Current Gaps and Solutions

Health Behavior and Promotion

• Smoking Cessation Programs: Effectiveness and Challenges
• Physical Activity Promotion in Schools: Strategies for Success
• Nutrition Education and Its Impact on Healthy Eating Habits
• Mental Health Awareness Campaigns: Assessing Public Perceptions
• The Role of Social Media in Health Promotion

Global Health

• Assessing the Impact of International Aid on Global Health
• Water, Sanitation, and Hygiene (WASH) Programs in Developing Countries
• The Role of Non-Governmental Organizations in Global Health
• Communicable Disease Control in Refugee Populations
• Global Access to Essential Medicines: Challenges and Solutions

Community Health

• Community-Based Participatory Research: Best Practices and Challenges
• The Impact of Community Health Workers on Health Outcomes
• Health Literacy and its Relationship to Health Disparities
• Assessing the Effectiveness of Mobile Health (mHealth) Interventions
• Community Resilience in the Face of Public Health Crises

Healthcare Quality and Patient Safety

• Hospital-Acquired Infections: Strategies for Prevention
• Patient Safety Culture in Healthcare Organizations
• Quality Improvement Initiatives in Primary Care Settings
• Healthcare Accreditation: Impact on Patient Outcomes
• Implementing Electronic Health Records: Challenges and Benefits

Mental Health

• Stigma Reduction Programs for Mental Health Disorders
• Integrating Mental Health into Primary Care Settings
• The Impact of COVID-19 on Mental Health: Long-Term Implications
• Mental Health in the Workplace: Strategies for Employee Well-being
• Suicide Prevention Programs: Effectiveness and Outreach

Health Disparities

• Racial Disparities in Healthcare: Addressing Systemic Inequities
• LGBTQ+ Health Disparities and Inclusive Healthcare Practices
• Socioeconomic Status and Access to Healthcare Services
• Geographical Disparities in Health: Rural vs. Urban
• The Impact of Gender on Health Outcomes and Access to Care

Public Health Education

• Evaluation of Public Health Education Programs
• Innovative Approaches to Teaching Public Health Concepts
• Online Health Education Platforms: Opportunities and Challenges
• Interdisciplinary Training in Public Health: Bridging Gaps
• Continuing Education for Public Health Professionals: Current Landscape

Digital Health

• The Role of Wearable Devices in Health Monitoring
• Telehealth Adoption: Barriers and Opportunities
• Health Apps for Chronic Disease Management: User Perspectives
• Blockchain Technology in Healthcare: Privacy and Security Implications
• Artificial Intelligence in Disease Diagnosis and Prediction

Health Economics

• Cost-Effectiveness of Preventive Health Interventions
• The Impact of Healthcare Financing Models on Access to Care
• Pharmaceutical Pricing and Access to Essential Medicines
• Economic Evaluation of Health Promotion Programs
• Health Insurance Coverage and Health Outcomes: A Global Perspective

Innovations in Public Health

• 3D Printing in Healthcare: Applications and Future Prospects
• Gene Editing Technologies and their Ethical Implications
• Smart Cities and Public Health: Integrating Technology for Well-being
• Nanotechnology in Medicine: Potential for Disease Treatment
• The Role of Drones in Public Health: Surveillance and Intervention

Food Safety and Nutrition

• Foodborne Illness Outbreaks: Investigating Causes and Prevention
• Sustainable Food Systems: Implications for Public Health
• Nutritional Interventions for Malnutrition in Developing Countries
• Food Labeling and Consumer Understanding: A Critical Review
• The Impact of Fast Food Consumption on Public Health

Substance Abuse

• Opioid Epidemic: Strategies for Prevention and Treatment
• Harm Reduction Approaches in Substance Abuse Programs
• Alcohol Consumption Patterns and Public Health Outcomes
• Smoking and Mental Health: Exploring the Connection
• Novel Psychoactive Substances: Emerging Threats and Strategies

Occupational Health

• Workplace Stress and Mental Health: Intervention Strategies
• Occupational Hazards in Healthcare Professions: A Comparative Analysis
• Ergonomics in the Workplace: Improving Worker Health and Productivity
• Night Shift Work and Health Consequences: Addressing Challenges
• Occupational Health and Safety Regulations: A Global Overview

Disaster Preparedness and Response

• Pandemic Preparedness and Lessons from COVID-19
• Natural Disasters and Mental Health: Post-Traumatic Stress
• Emergency Response Systems: Improving Timeliness and Efficiency
• Communicating Health Risks During Emergencies: Public Perception
• Collaborative Approaches to Disaster Response in Global Health

Cancer Research

• Precision Medicine in Cancer Treatment: Current Advancements
• Cancer Screening Programs: Efficacy and Challenges
• Environmental Factors and Cancer Risk: Exploring Connections
• Survivorship Care Plans: Enhancing Quality of Life after Cancer
• Integrative Therapies in Cancer Care: Complementary Approaches

Sexual and Reproductive Health

• Access to Contraception in Developing Countries: Challenges and Solutions
• Comprehensive Sex Education Programs: Impact on Teen Pregnancy
• Reproductive Health Rights: Global Perspectives and Challenges
• Infertility Treatment: Ethical Considerations and Societal Impact
• Maternal and Child Health in Conflict Zones: Addressing Challenges

Cardiovascular Health

• Hypertension Prevention Programs: Strategies and Effectiveness
• Cardiovascular Disease in Women: Gender-Specific Risk Factors
• Innovations in Cardiac Rehabilitation Programs
• Artificial Heart Technology: Advancements and Ethical Implications
• Impact of Air Pollution on Cardiovascular Health: A Global Concern

Social Determinants of Health

• Educational Attainment and Health Outcomes: Exploring Links
• Income Inequality and its Impact on Population Health
• Social Support Networks and Mental Health: A Comprehensive Study
• Neighborhood Environments and Health Disparities
• Employment and Health: The Interplay of Work and Well-being

Genomics and Public Health

• Population Genomics and its Implications for Public Health
• Genetic Counseling and Education: Empowering Individuals and Families
• Ethical Issues in Genetic Research: Privacy and Informed Consent
• Pharmacogenomics: Tailoring Drug Therapies to Individual Genotypes
• Gene-Environment Interactions in Disease Risk: Unraveling Complexities

Public Health Ethics

• Informed Consent in Public Health Research: Current Practices
• Ethical Challenges in Global Health Research: Balancing Priorities
• Confidentiality in Public Health Reporting: Striking the Right Balance
• Research with Vulnerable Populations: Ethical Considerations
• Ethical Implications of Emerging Technologies in Healthcare

Health Communication

• The Role of Media in Shaping Public Health Perceptions
• Health Literacy Interventions: Improving Understanding of Health Information
• Social Media Campaigns for Public Health Promotion: Best Practices
• Tailoring Health Messages for Diverse Audiences: Cultural Competency
• Risk Communication in Public Health Emergencies: Lessons Learned

Nutrigenomics

• Personalized Nutrition Plans based on Genetic Makeup
• Impact of Nutrigenomics on Chronic Disease Prevention
• Ethical Considerations in Nutrigenomics Research
• Public Perceptions of Nutrigenomic Testing: A Qualitative Study
• Integrating Nutrigenomics into Public Health Policies

Public Health and Artificial Intelligence

• Predictive Analytics in Disease Surveillance: Harnessing AI for Early Detection
• Ethical Considerations in AI-Driven Health Decision Support Systems
• Machine Learning in Epidemiology: Predicting Disease Outbreaks
• Natural Language Processing in Public Health: Text Mining for Insights
• Bias in AI Algorithms: Implications for Health Equity

Health Disparities in Aging

• Geriatric Health Disparities: Bridging the Gap in Elderly Care
• Ageism in Healthcare: Addressing Stereotypes and Discrimination
• Social Isolation and Health Consequences in Aging Populations
• Access to Palliative Care for Older Adults: A Global Perspective
• Alzheimer’s Disease and Ethnic Disparities in Diagnosis and Treatment
• Loneliness and Mental Health in the Elderly: Interventions and Support

Research Methodologies in Public Health

Public health research employs various methodologies, including quantitative, qualitative, and mixed-methods approaches. Each method brings its own strengths to the research process, allowing researchers to gain a comprehensive understanding of the complex issues they investigate. 

Community-based participatory research is another valuable approach, emphasizing collaboration with communities to address their specific health concerns.

Challenges and Opportunities in Public Health Research

While public health research is immensely rewarding, it comes with its own set of challenges. Funding constraints, ethical dilemmas, the need for interdisciplinary collaboration, and the integration of technology pose both obstacles and opportunities. 

Researchers must navigate these challenges to ensure their work has a meaningful impact on public health.

In conclusion, public health research topics are diverse and dynamic, reflecting the complex nature of the field. As researchers embark on their journeys, they must carefully consider the relevance, impact, and ethical implications of their chosen topics. 

The collaborative and interdisciplinary nature of public health research positions it as a powerful tool in addressing the health challenges of our time. By exploring the depths of these topics, researchers contribute to the collective effort to build healthier and more equitable communities. 

As we move forward, a continued exploration of relevant public health research topics is essential for shaping the future of healthcare and improving the well-being of populations worldwide.

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Health Services Research

• © 2020
• Latest edition
• Justin B. Dimick 0 ,
• Carrie C. Lubitz 1

Department of Surgery, University of Michigan Health System, Ann Arbor, USA

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Department of Surgery, Massachusetts General Hospital, Boston, USA

• Partnered with the Association of Academic Surgery (AAS) and the book accompanies their Fundamentals of Surgical Research course
• Covers career development and gives medical professionals insight from leading experts in the field
• Provides a practical guide to health services research that can be easily implemented

Part of the book series: Success in Academic Surgery (SIAS)

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Table of contents (31 chapters)

Front matter, main research areas, an introduction to health services research.

• Justin B. Dimick, Carrie C. Lubitz

Comparative Effectiveness Research

• Nader N. Massarweh, George J. Chang

Understanding Variations in the Use of Surgery

• Jesse A. Columbo, Philip P. Goodney

Health Policy Research in Surgery

• Karan R. Chhabra, Justin B. Dimick

Surgical Disparities: Beyond Non-Modifiable Patient Factors

• Numa P. Perez, Claire A. Pernat, David C. Chang

Measuring Surgical Quality

• Ryan P. Merkow, Karl Y. Bilimoria

Using Data for Local Quality Improvement

• Caroline E. Reinke, Rachel R. Kelz

Emerging Areas of Research

Dissemination and implementation science.

• Lesly A. Dossett, Dana A. Telem

Studying Organizational Culture in Surgery

• Nikhil Panda, Alex B. Haynes

Patient Reported Outcomes in Surgical Research

• Larissa K. F. Temple, Arden M. Morris

Studying What Happens in the Operating Room

• Yue-Yung Hu, Caprice C. Greenberg

Evaluating Non-Technical Skills in Surgery

• Jason C. Pradarelli, Steven Yule, Douglas S. Smink

Collaborative Quality Improvement

• Margaret E. Smith, Jonathan F. Finks

Machine Learning and Artificial Intelligence

• David F. Schneider

Tools of the Trade

Large databases used for outcomes research.

• Kyle H. Sheetz, Terry Shih, Justin B. Dimick

Methods for Enhancing Causal Inference in Observational Studies

• Kyle H. Sheetz, Hari Nathan
• Medical Research
• Implementation science
• Qualitative research in surgery
• Evaluating healthcare policy
• Measuring surgical quality
• Patient-centered outcomes
• Observational studies
• Meta-analysis

About this book

This updated volume provides insight into health services research, as well as the emerging areas of research and the tools required to perform scientific work. The book covers topics related to performance assessment, quality improvement, health care policy, and career development. New chapters on the evaluation of non-technical skills in surgery, methods of enhancing causal inference in observational studies, and writing scientific manuscripts are also included.

Health Services Research aims to give advice on how to obtain National Institutes of Health funding and other grants, as well as breaking through the barriers to developing a career in academic surgery. This book is relevant to surgical residents and young surgical faculty, as well as anyone undertaking a career in academic surgery.

Editors and Affiliations

Justin B. Dimick

Carrie C. Lubitz

About the editors

Justin Dimick, MD, MPH is a Past President of the Association for Academic Surgery (AAS). Dr. Dimick is the Frederick A. Coller Distinguished Professor and Chair of the Department of Surgery at the University of Michigan. He completed surgical residency at the University of Michigan and a fellowship in health services research at the Dartmouth Institute for Health Policy and Clinical Practice. Dr. Dimick has an active externally funded health services research program and, prior to becoming a department chair, served as Director of the Center for Healthcare Outcomes & Policy at the University of Michigan. His research program is supported by R01 grants from the Agency for Healthcare Research and Quality and National Institutes of Health. The goals of his research are to evaluate the effectiveness of different strategies for improving outcomes and reducing costs of surgical care. He has more than 300 peer-reviewed publications, including papers in The New England Journal of Medicine, Journal of the American Medical Association, Health Affairs, and Health Services Research.

Carrie C. Lubitz, MD, MPH is the Recorder of the Association for Academic Surgery (AAS)  She received her undergraduate and medical degrees at the University of Michigan. She completed general surgery training at New York Presbyterian Hospital/Weill-Cornell Medical College. She then completed her clinical endocrine surgery fellowship in 2010 at the Massachusetts General Hospital, obtained a Master of Public Health through the Harvard School of Public Health and completed a two-research fellowship in the Dana-Farber/Harvard Cancer Center Program in Cancer Outcomes Research Training. She is now an Associate Professor of Surgery at the Harvard Medical School and a senior scientist at the MGH Institute for Technology Assessment. In addition to her endocrine surgery practice, Dr. Lubitz has clinical and translational research interests including comparative-effectiveness research aimed to improve the quality of care of patients with thyroid cancer and other endocrine-related disorders. She is currently supported by the NIH/NCI for her research. 

Bibliographic Information

Book Title : Health Services Research

Editors : Justin B. Dimick, Carrie C. Lubitz

Series Title : Success in Academic Surgery

DOI : https://doi.org/10.1007/978-3-030-28357-5

Publisher : Springer Cham

eBook Packages : Medicine , Medicine (R0)

Copyright Information : Springer Nature Switzerland AG 2020

Softcover ISBN : 978-3-030-28356-8 Published: 02 January 2020

eBook ISBN : 978-3-030-28357-5 Published: 01 January 2020

Series ISSN : 2194-7481

Series E-ISSN : 2194-749X

Edition Number : 2

Number of Pages : VII, 376

Number of Illustrations : 17 b/w illustrations, 38 illustrations in colour

Topics : Surgery , Medical Education

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Trust, human-centered AI and collaboration the focus of inaugural RAISE Health symposium

Artificial intelligence experts discuss how to integrate trustworthy AI into health care, why multi-disciplinary collaboration is crucial and the potential for generative AI in research.

May 17, 2024 - By Hanae Armitage

Fei-Fei Li and Lloyd Minor give opening remarks at Stanford Medicine's first RAISE Health Symposium on May 14.  Steve Fisch

Most people captured by artificial intelligence have all had something of an “aha” moment that opens their minds to a world of opportunities. During the inaugural RAISE Health symposium on May 14, Lloyd Minor , MD, dean of the Stanford School of Medicine and vice president for medical affairs at Stanford University, shared his.

Asked to summarize a discovery he’d made related to the inner ear, a curious Minor turned to generative AI. “I asked, ‘What is superior canal dehiscence syndrome?’” Minor told a group of nearly 4,000 symposium attendees. In seconds, a few paragraphs appeared.

“They were good — really good,” he said. “The information was brought together into a concise and, by and large, accurate and well-prioritized description of the disorder. It was quite remarkable.”

Minor’s excitement was shared by many at the half-day event, which was born of the RAISE Health initiative, a project launched by Stanford Medicine and the Stanford Institute for Human-Centered Artificial Intelligence (HAI) to guide the responsible use of AI in biomedical research, education and patient care. Speakers explored what it means to bring AI into the folds of medicine in a way that’s not just helpful for physicians and scientists, but transparent, fair and equitable for patients.

“We believe this is a technology to augment and enhance humanity,” said Fei-Fei Li , a professor of computer science at the Stanford School of Engineering who leads RAISE Health with Minor and is the co-director of HAI. From generating new molecular sequences that could give rise to new antibiotics, to mapping biodiversity, to uncovering hidden bits of basic biology, AI is accelerating scientific discovery, she said. But it’s not all beneficial. “All of these applications can have unintended consequences, and we need computer scientists to work with multiple stakeholders — from doctors and ethicists…to security experts and more — to develop and deploy [AI] responsibly,” she said. “Initiatives like RAISE Health show that we’re committed to this.”

The alignment of Stanford Medicine’s three entities — the School of Medicine, Stanford Health Care and Stanford Medicine Children’s Health — and its connection to the rest of Stanford University puts it in a unique position as experts grapple with AI development, governance and integration in health and medicine, Minor said.

“We’re ideally suited to be a pioneer in advancing and deploying AI in responsible ways, covering the gamut from fundamental biological discovery, enhancing drug development, making clinical trial processes more efficient, all the way through the actual delivery of health care and the way we run our health care delivery system,” he said.

What ethical integration looks like

Some speakers underscored a simple concept: Focus on the user — in this case, the patient or the physician — and all else will follow. “It’s putting patients at the center of everything that we do,” said Lisa Lehmann, MD, PhD, director of bioethics at Brigham and Women’s Hospital. “We need to be thinking about their needs and priorities.”

From left: Moderator Mohana Ravindranath of STAT News; Jessica Mega; Peter Lee of Microsoft Research; and Sylvia Plevritis, professor of biomedical data science, discuss the role of AI in medical research.  Steve Fisch

Speakers on one panel — which included Lehmann, Stanford Medicine bioethicist Mildred Cho , PhD, and Michael Howell, MD, chief clinical officer at Google — pointed to the complex nature of a hospital system, highlighting the need to understand the purpose of any intervention before implementing it and to ensure that all systems developed are inclusive, with input from the populations it’s meant to help.

One key to that is transparency — being explicit about where the data used to train the algorithm came from, what the algorithm was originally intended for and whether future patient data will continue to help the algorithm learn, among other factors.

“Trying to predict ethical problems before they become consequential [means] finding a perfect sweet spot of knowing enough about the technology that you can make some ascertainment of it, but getting to it before [an issue] spreads further,” said Danton Char , MD, associate professor of pediatric anesthesiology, perioperative and pain medicine. One of the key steps, he said, is to identify all the stakeholders who could be impacted by a technology and take note of how they would want those questions answered for themselves.

Jesse Ehrenfeld, MD, president of the American Medical Association, discussed four drivers of adoption for any digital health tool, including those powered by AI. Does it work? Does it work in my institution? Who pays for it? Who is liable?

Michael Pfeffer , MD, chief information officer for Stanford Health Care, highlighted a recent example in which many of those questions were tested with care providers at Stanford Hospital. Clinicians were offered assistance from a large language model that drafts initial notes to patient inbox messages. While the drafts weren’t perfect, the clinicians who helped develop the technology reported that the model lightened their workload.

“There are three big things that we’ve been focusing on: safety, efficacy and inclusion. We’re physicians. We take this oath to ‘do no harm,’” said  Nina Vasan , MD, clinical assistant professor of psychiatry and behavioral sciences, who joined a panel with Char and Pfeffer. “That needs to be the first way that we’re assessing any of these tools.”

Nigam Shah , MBBS, PhD, professor of medicine and of biomedical data sciences, kicked off a discussion with a jarring statistic, although he gave the audience fair warning. “I speak in bullet points and numbers, and sometimes they tend to be very direct,” he said.

To Shah, the success of AI hinges on our ability to scale it. “Doing the science right for one model takes about 10 years, and if every one of the 123 fellowship and residency programs wanted to test and deploy one model at that level of rigor, with our current ways of organizing work and [testing] it at every one of our sites to make sure it works properly, it would be $138 billion,” Shah said. “We can’t afford it. So, we have to find a way to scale, and we have to scale doing good science. The skills for rigor reside in one place, and the skills for scale reside in another, and hence, we’re going to need these kinds of partnerships.”

Associate dean Euan Ashley and Mildred Cho (at front table) attend the RAISE Health Symposium. Steve Fisch

The way to get there, according to a number of speakers at the symposium, is public-private partnership, such as that being modeled through the recent White House Executive Order on the Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence and the Coalition for Health AI , or CHAI.

“The public-private partnerships [with] the most potential are [between] academia, the private sector and the public sector,” said Laura Adams, a senior advisor at the National Academy of Medicine. The government can bring public credibility, academic medical centers can bring legitimacy, and the technical expertise and compute time can come from the private sector, she noted. “All of us are better than any one of us, and we’re recognizing…that we don’t have a prayer of reaching the potential of [AI] unless we understand how to interact with each other.”

Innovating in AI, filling gaps

AI is also making an impact in research, whether scientists are using it to probe the dogma of biology, predict new synthetic molecular sequences and structures to underpin emerging therapeutics, or even to help them summarize or write scientific papers, several speakers said.

“There’s an opportunity to see the unknown,” said Jessica Mega , MD, a cardiologist at Stanford Medicine and co-founder of Alphabet’s Verily. Mega pointed to hyperspectral imaging, which captures features of an image that are invisible to the human eye. The idea is to use AI to detect patterns, for example, in pathology slides, unseen by humans that are indicative of disease. “I encourage people to push for the unknown. I think everyone here knows someone who is suffering from a health condition that needs something beyond what we can offer today,” Mega said.

There was also a consensus among panelists that AI systems will provide new means of identifying and combating biased decision making, whether it’s made by humans or AI, and opportunities to figure out where that bias is coming from.

“Health is more than health care,” was a statement echoed by multiple panelists. The speakers stressed that researchers often overlook social determinants of health — such as socioeconomic status, ZIP codes, education level, and race and ethnicity — when they are collecting inclusive data and enrolling participants for studies. “AI is only going to be as good as the data that the models are trained on,” said Michelle Williams , ScD, a professor of epidemiology at Harvard University and a visiting professor of epidemiology and population health at Stanford Medicine. “If we are looking for improving health [and] decreasing disparities, we’re going to have to make sure that we are collecting high-quality data on human behaviors, as well as the social and physical environment.”

Natalie Pageler , MD, clinical professor of pediatrics and of medicine, shared that cancer data aggregates often exclude data from pregnant people, creating inherent biases in models and exacerbating an existing gap in health care.

As with any emerging technology, there are ways that AI can make things better and ways it can make things worse, said David Magnus , PhD, professor of pediatrics and of medicine. The risk, Magnus said, is that AI systems learn about inequitable health outcomes driven by social determinants of health and reinforce them through their outputs. “AI is a mirror that reflects the society that we’re in,” he said. “I’m hopeful that every time we get an opportunity to shine a light on a problem — hold up that mirror to ourselves — it will be a spur for things to get better.”

If you weren’t able to attend the RAISE Health symposium, recordings of the sessions can be found here .

About Stanford Medicine

Stanford Medicine is an integrated academic health system comprising the Stanford School of Medicine and adult and pediatric health care delivery systems. Together, they harness the full potential of biomedicine through collaborative research, education and clinical care for patients. For more information, please visit med.stanford.edu .

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May 14, 2024

Understanding how exercise affects the body

At a glance.

• A study of endurance training in rats found molecular changes throughout the body that could help explain the beneficial effects of exercise on health.
• Large differences were seen between male and female rats, highlighting the need to include both women and men in exercise studies.

Exercise is one of the most beneficial activities that people can engage in. Regular exercise reduces the risk of heart disease, diabetes, cancer, and other health problems. It can even help people with many mental health conditions feel better.

But exactly how exercise exerts its positive effects hasn’t been well understood. And different people’s bodies can respond very differently to certain types of exercise, such as aerobic exercise or strength training.

Understanding how exercise impacts different organs at the molecular level could help health care providers better personalize exercise recommendations. It might also lead to drug therapies that could stimulate some of the beneficial effects of a workout for people who are physically unable to exercise.

To this end, researchers in the large, NIH-funded Molecular Transducers of Physical Activity Consortium (MoTrPAC) have been studying how endurance exercise and strength training affect both people and animals. The team is examining gene activity, protein alterations, immune cell function, metabolite levels, and numerous other measures of cell and tissue function. The first results, from rat studies of endurance exercise, were published on May 2, 2024, in Nature and several related journals.

Both male and female rats underwent progressive exercise training on a treadmill over an 8-week period. By the end of training, male rats had increased their aerobic capacity by 18%, and females by 16%. Tissue samples were collected from 18 different organs, plus the blood, during the training period and two days after the final bout of exercise. This let the researchers study the longer-term adaptations of the body to exercise.

Changes in gene activity, immune cell function, metabolism, and other cellular processes were seen in all the tissues studied, including those not previously known to be affected by exercise. The types of changes differed from tissue to tissue.

Many of the observed changes hinted at how exercise might protect certain organs against disease. For example, in the small intestines, exercise decreased the activity of certain genes associated with inflammatory bowel disease and reduced signs of inflammation in the gut. In the liver, exercise boosted molecular changes associated with improved tissue health and regeneration.

Some of the effects differed substantially between male and female rats. For example, in male rats, the eight weeks of endurance training reduced the amount of a type of body fat called subcutaneous white adipose tissue (scWAT). The same amount of exercise didn’t reduce the amount of scWAT in female rats. Instead, endurance exercise caused scWAT in female rats to alter its energy usage in ways that are beneficial to health. These and other results highlight the importance of including both women and men in exercise studies.

The researchers also compared gene activity changes in the rat studies with those from human samples taken from previous studies and found substantial overlap. They identified thousands of genes tied to human disease that were affected by endurance exercise. These analyses show how the MoTrPAC results from rats can be used to help guide future research in people.

“This is the first whole-organism map looking at the effects of training in multiple different organs,” says Dr. Steve Carr, a MoTrPAC investigator from the Broad Institute. “The resource produced will be enormously valuable, and has already produced many potentially novel biological insights for further exploration.”

Human trials are expected in the next few years. Information on participating can be found here .

—by Sharon Reynolds

Related Links

• Gut Microbes May Affect Motivation to Exercise
• Exercise-Induced Molecule Reduces Obesity in Mice
• Testing Ways to Encourage Exercise
• Hormone Links Exercise with Cognitive Benefits
• Exercise-Induced Protein May Reverse Age-Related Cognitive Decline
• Getting Active Later in Life Brings Benefits
• Get Active Together: Social Support Can Help Keep You Moving
• Personalized Exercise? How Biology Influences Fitness
• Maintain Your Muscle: Strength Training at Any Age
• Molecular Transducers of Physical Activity Consortium (MoTrPAC)
• Participating in MoTrPAC

References:  Temporal dynamics of the multi-omic response to endurance exercise training. MoTrPAC Study Group; Lead Analysts; MoTrPAC Study Group. Nature . 2024 May;629(8010):174-183. doi: 10.1038/s41586-023-06877-w. Epub 2024 May 1. PMID: 38693412. Sexual dimorphism and the multi-omic response to exercise training in rat subcutaneous white adipose tissue. Many GM, Sanford JA, Sagendorf TJ, Hou Z, Nigro P, Whytock KL, Amar D, Caputo T, Gay NR, Gaul DA, Hirshman MF, Jimenez-Morales D, Lindholm ME, Muehlbauer MJ, Vamvini M, Bergman BC, Fernández FM, Goodyear LJ, Hevener AL, Ortlund EA, Sparks LM, Xia A, Adkins JN, Bodine SC, Newgard CB, Schenk S; MoTrPAC Study Group. Nat Metab . 2024 May 1. doi: 10.1038/s42255-023-00959-9. Online ahead of print. PMID: 38693320. The impact of exercise on gene regulation in association with complex trait genetics. Vetr NG, Gay NR; MoTrPAC Study Group; Montgomery SB. Nat Commun . 2024 May 1;15(1):3346. doi: 10.1038/s41467-024-45966-w. PMID: 38693125.

Funding:  NIH’s Office of the Director (OD), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institute on Aging (NIA), National Human Genome Research Institute (NHGRI), National Heart, Lung, and Blood Institute (NHLBI), and National Library of Medicine (NLM); Knut and Alice Wallenberg Foundation; National Science Foundation (NSF).

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May 24, 2024

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Research finds connection between risk factors for periodontitis and general health

by Kari Øverby, University of Oslo

Periodontitis is a disease that affects the supporting tissues of the teeth and is associated with other types of diseases. A study conducted at the faculty of dentistry shows that patients with severe periodontitis also have a higher prevalence of cardiovascular disease, diabetes, and COPD.

The study is published in the journal BMC Oral Health with related previous research published in Journal of Clinical Periodontology .

Ida Haukåen Stødle is a specialist in periodontology and has just completed her doctorate at the faculty.

She shares the following:

The overall purpose of my thesis was to investigate the prevalence of periodontitis and to examine whether we could identify conditions that may be associated with periodontitis. Since periodontitis affects many people, these associations may also be relevant for many, and therefore we have a responsibility to address these potential associations with our patients, says Ida.

Oral health is important for overall health. Maybe we should not consider oral health as something separate but consider health in general. To highlight oral health on its own entails an artificial focus. Interaction between different diseases indicates that we must consider general health as part of periodontal treatment. We should inform patients and encourage them to speak to their general practitioner if they have severe periodontitis and other health challenges, Ida continues.

Periodontitis is an inflammatory condition that can lead to tooth loss and is caused by bacteria that naturally occur in the oral flora. The disease can develop if there is an overgrowth of these bacteria, but not for everyone. The susceptibility varies among individuals.

A new classification of periodontitis

Part of the task was to look at the prevalence of periodontitis in the surveyed population. In 2018, a new globally accepted classification of periodontal diseases was published, which forms the basis for the initial investigations, says Stødle.

We reported the overall prevalence and further prevalence of different severity levels of periodontitis. Once we had identified the participants with periodontitis, we further examined them for any other concurrent diseases, such as cardiovascular disease and diabetes.

We know that several conditions are associated with periodontitis. We selected some to see how they were expressed using the new classification. The findings largely corresponded to previous observations. We also found that those with severe periodontitis, those with significant periodontal bone loss, also have a higher prevalence of other diseases compared to those with little or no periodontitis.

We also included rheumatic conditions in this research but found no association with periodontitis for individuals with rheumatism. This was somewhat surprising because we already know about this association, and since rheumatoid arthritis is also an inflammatory condition, one would expect these diseases to occur together, Ida explains.

There may be several reasons why we did not observe any association. How we included rheumatic conditions in the material, whether we have thoroughly differentiated between healthy and sick individuals, and whether the dataset is large enough, for example. We did not attempt to distinguish between the various forms of rheumatoid arthritis. These factors contribute to the findings in our studies.

Uncertain findings for celiac disease and associations with periodontitis

We also looked at celiac disease. It was a separate study; it was exciting because there is little research on these two diseases. We had no expectations that there would be any difference in periodontal bone loss in individuals with and without celiac disease.

Nevertheless, we found that those with celiac disease have less frequent bone loss as if celiac disease protected against periodontitis. We do not know what lies behind this observation or how the relationship can be explained, and due to this uncertainty, it is hard to draw any conclusions. It would be exciting if further research could be done on this, says Ida.

Extensive and comprehensive material

The studies are based on a vast material, in which almost 5,000 adults from Nord-Trøndelag have participated. The transferability is good for small towns and rural areas. The population from larger cities, where the demography may differ, is not included. Therefore, the findings cannot necessarily represent all population groups in Norway. Population studies (the HUNT studies) have been conducted in this population in Nord-Trøndelag several times, precisely because it is particularly suitable due to stability.

The public dental service (DOT) in Trøndelag, in collaboration with the Oral Health Competence Center, TkMidt carried out the clinical oral and dental health examinations used in the doctoral work. The dentists and dental hygienists who collected this large amount of data did extensive work.

There were periodontal examinations, but also caries examinations and examinations of mucous membranes, in addition to X-rays of all the nearly 5000 participants. The X-rays consisted of a panoramic X-ray image and four smaller images from each participant.

X-rays and further work were analyzed in collaboration with my supervisors, Odd Carsten Koldsland and Anders Verket. The results of the X-ray analysis were compared with data from the clinical examinations. Statistical calculations also made up a significant part of the analyses. Several employees from TkMidt contributed to this. The work has resulted in three articles, Ida explains.

Self-reported disease

The method is partly based on self-reported illness and not exclusively on medical examinations. Self-reported data is weaker than if we had confirmed medical diagnoses and it must be considered when interpreting findings. Blood samples have been obtained from all participants, including blood sugar measurements.

This strengthens the material, and studies have shown that when the disease is well-defined, such as diabetes, there is a good correlation between self-reported illness and an actual diagnosis. Self-reporting is a limitation in our data, but not to such an extensive extent that we do not believe the results.

Medical personnel also obtained many other variables, such as weight, height, and blood pressure. We had a vast amount of data on inflammatory mediators or cells. We did not use it because some choices had to be made. But the data from HUNT are extensive and good and are well-suited for a hypothesis-generating study like this, says Ida.

Preventing periodontitis and diseases associated with periodontitis

We know that the treatment of periodontitis reduces inflammation and can improve blood sugar control in some cases for diabetics. These are connections we need to keep a high focus on. We need to communicate information so patients and health care professionals can benefit from this knowledge—for treatment and to prevent disease.

Risk factors are often the same for several diseases and conditions, including periodontitis, such as smoking. By reducing smoking, the risk for multiple conditions is also reduced. We can discuss this with patients and refer them further if needed.

We should specifically pay attention to the part of the population that goes to the dentist but may not easily seek other health care services. Collaboration across health care professions and having good information flow should be central in preventing periodontitis and diseases associated with periodontitis, concludes Ida.

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A simmering issue —

New research shows gas stove emissions contribute to 19,000 deaths annually, california is considering a law that would require warning labels on gas stoves..

Victoria St. Martin, Inside Climate News - May 19, 2024 11:31 am UTC

Ruth Ann Norton used to look forward to seeing the blue flame that danced on the burners of her gas stove. At one time, she says, she would have sworn that preparing meals with the appliance actually made her a better cook.

But then she started learning about the toxic gases, including carbon monoxide, formaldehyde, and other harmful pollutants that are emitted by stoves into the air, even when they’re turned off .

“I’m a person who grew up cooking, and love that blue flame,” said Norton, who leads the environmental advocacy group known as the Green & Healthy Homes Initiative . “But people fear what they don’t know. And what people need to understand really strongly is the subtle and profound impact that this is having—on neurological health, on respiratory health, on reproductive health.”

In recent years, gas stoves have been an unlikely front in the nation’s culture wars , occupying space at the center of a debate over public health, consumer protection, and the commercial interests of manufacturers. Now, Norton is among the environmental advocates who wonder if a pair of recent developments around the public’s understanding of the harms of gas stoves might be the start of a broader shift to expand the use of electrical ranges.

On Monday, lawmakers in the California Assembly advanced a bill that would require any gas stoves sold in the state to bear a warning label indicating that stoves and ovens in use “can release nitrogen dioxide, carbon monoxide, and benzene inside homes at rates that lead to concentrations exceeding the standards of the Office of Environmental Health Hazard Assessment and the United States Environmental Protection Agency for outdoor air quality.”

The label would also note that breathing those pollutants “can exacerbate preexisting respiratory illnesses and increase the risk of developing leukemia and asthma, especially in children. To help reduce the risk of breathing harmful gases, allow ventilation in the area and turn on a vent hood when gas-powered stoves and ranges are in use.”

The measure, which moved to the state Senate, could be considered for passage later this year.

“Just running a stove for a few minutes with poor ventilation can lead to indoor concentrations of nitrogen dioxide that exceed the EPA’s air standard for outdoors,” Gail Pellerin , the California assembly member who introduced the bill, said in an interview Wednesday. “You’re sitting there in the house drinking a glass of wine, making dinner, and you’re just inhaling a toxic level of these gases. So, we need a label to make sure people are informed.”

Pellerin’s proposal moved forward in the legislature just days after a group of Stanford researchers announced the findings of a peer-reviewed study that builds on earlier examinations of the public health toll of exposure to nitrogen dioxide pollution from gas and propane stoves.

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