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Introduction to Special Section: Causality in Health Services Research

In 2002, the Agency for Healthcare Research and Quality (AHRQ) defined health services research as “research [that] examines how people get access to health care, how much care costs, and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance, and deliver high quality care; reduce medical errors; and improve patient safety” (http://www.academyhealth.org). AcademyHealth's (AH) definition is parallel but focuses more explicitly on the factors studied. Thus AH defines health services research as “the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations” (http://www.academyhealth.org). Explicit in both definitions is the notion that health services researchers should strive to identify and estimate the causal effects on outcomes of interest of alternative organizational structures, management approaches, financing systems, provider practices, and personal choices regarding lifestyle and behavior. Without a focus on causal effects, it would be impossible to identify the most effective ways to achieve the outcomes we seek through clinical, management, or policy interventions.

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