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HSR - Health Services Research

Impacting Health Practice and Policy Through State-of-the-Art Research and Thinking

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October 2019
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Instructions for Authors and Statement of Editorial Policy

Table of Contents

 The Vision and Mission of HSR
 Specific Areas of Research Targeted by HSR
 Five Types of Peer-Reviewed Manuscripts in Regular Issues
 Publication in Print and Electronically
 Special Issues and Theme Issues
 External Peer Review Process
 Requirement of Original Manuscripts and Disclosure of Prior Dissemination
 Additional Material Published in HSR
 Preparation of Manuscript to Submit to HSR
 Disclosures and Criteria for Determining Authors and Other Contributors
 Disclosures about Potential Conflicts and Funding
 Supplementary Materials
 Copyediting and Publication
Offprints and Reprints
 Permissions to reprint articles from HSR in new collective work

Section 1: The Vision and Mission of HSR  
The primary purpose of Health Services Research is to provide researchers and public and private policymakers with the latest research findings, methods, and concepts regarding the financing, organization, delivery, evaluation, and outcomes of health services, and with analysis of their relationships to clinical practice, management, and policy. Additionally, HSR provides a mechanism for linking the various disciplines engaged in health services research and for disseminating the results to those charged with improving the health of individuals and communities and setting evidence-based policy.
VISION: To be the preferred outlet for:

  • Dissemination of the findings of original investigations that expand knowledge and understanding of the broad field of health care and that help to improve the health of individuals and communities

  • Analysis and discussion of the implications of these findings for clinical practice, management, and policy in both U.S. and global contexts

KEY VALUES: ∞ Scientific Integrity ∞Timeliness ∞ Methodological Rigor ∞ Creativity ∞ Policy and Practice Relevance ∞ Clarity of Thought and Expression ∞ Significance ∞ Originality
MISSION: To further our vision and values by publishing thoughtful, timely, rigorously conducted, state-of-the-art research articles and commentary and that are widely disseminated and meet the highest standards of scientific peer review.

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Section 2: Specific Areas of Research Targeted by HSR  
Areas of specific interest for manuscripts include:

  1. Issues related to the delivery of care—for example, access to and utilization of health services; cost, cost-effectiveness, quality, and outcomes of care; practice variations, technology assessment, and health care workforce issues;

  2. Assessments of the impact of or changes in specific policies and interventions on health care delivery—for example, Medicare and Medicaid, state health policies and regulations, payment policies, personnel licensure and certification, and antitrust enforcement;

  3. Evaluation of national demonstration programs—particularly those focusing on disease prevention, chronic disease management, and community-based efforts to integrate services or promote health;

  4. Examinations of changes in health services organizations, systems of care, managed care, and related developments, including comparisons of systems across nations; and

  5. Examinations of the relative importance of biological, behavioral, social, and political factors, in addition to health care, as determinants of health outcomes.

International Manuscript Submissions: While we welcome manuscripts from outside of the U.S., HSR has a largely US-based audience and so we want our international articles to 1) provide enough context about the health care setting in which the research takes place for our readers to judge its results and implications appropriately and 2) help draw out the implications of the work for health services research as it can be adapted to the US system.

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Section 3: Five Types of Peer-Reviewed Manuscripts in Regular Issues
Authors submitting for a regular issue are asked to indicate which among five types of manuscripts is best for their manuscript. A manuscript based on an empirical study generally will include a statement of the problem, objectives of the research, methodology used, and discussion of the analysis and findings. In addition, the manuscript should include a thoughtful discussion of the relevance of the findings to clinical practice, health services management, or health care policy development.
HSR publishes five basic types of manuscripts in its regular issues. Most issues include full-length research articles, research briefs, and methods articles:

  1. Full-length research articles deal with important empirical issues involving health and health services.

  2. Research briefs involve incremental contributions to the literature such as validation or extensions of previous work, single-setting studies, or case studies. A research brief is also appropriate for articles in which the essential message can be communicated in fewer pages.

  3. Methods articles and briefs focus on contributions involving the development of new methods and tools, the application of current methods in novel ways, and examination of the pros and cons of using different methods and tools in particular study situations and empirical settings. Health Services Research is interested in studies that appropriately apply the full range of research methods, from quantitative to qualitative and from primary data to analytic reviews of the literature. These articles may also serve to introduce methodological approaches understood by one discipline to readers in other disciplines.

    From time to time, issues will include policy/managerial impact articles or debates/commentaries. These are typically invited by the editors:

  4. Policy impact articles are thoughtful essays on the impact of health services research on policy and managerial decision makers, the overall relationship between health services research and the users of research, or articles that examine the impact of specific health services research initiatives on an overall body of work in the field. These include the Chair’s Address and selected Roundtable panel discussions from the AcademyHealth Annual Research Meetings.

  5. Debates/Commentaries feature pro and con views on important, controversial health services or policy issues or commentary on an article in the issue.

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Section 4: Publication in Print and Electronically
HSR publishes in print six issues and two special or theme issues annually. All manuscripts published in print are also published electronically. Electronic versions may include color and are accompanied by any electronic-only appendices and disclosures. HSR now publishes manuscripts OnLine Early usually within less than six months of acceptance. These are fully citable as being published. Articles subsequently appear in a regular printed issue, within a few months of publication Online Early.

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Section 5: Special Issues and Theme Issues

  1. Special issues (usually bound separately) or special sections in regular issues.
    Up to twice a year, HSR publishes special issues or special sections, usually based on papers presented at conferences. These papers are subject to the same external peer review process as other papers submitted to the journal. Thus, there is no guarantee that a paper presented at a conference and subsequently submitted to HSR will be published. All special issues and sections are supported by outside funds, and proposals require editorial approval. 

    Sponsors or guest editors for a special issue should contact the editors via hsr@aha.org and click here for recent special issues and a link to an editorial on the process. A manual for guest editors is available via the business manager for HSR at HRET.

  2. Theme issues are bound separately but are based on a call for papers on a particular theme developed and issued by the editors of HSR and the publisher. These manuscripts undergo the usual peer review process but are published as a set or series. See our Web for an editorial about the theme issue series (see "from the editors" section of www.hsr.org). For current calls for theme issues, see the home page at www.hsr.org.

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Section 6: External Peer Review Process  
Manuscripts submitted to HSR are subject to review by the editorial staff and, if they clear the initial review, by external peer review from at least two reviewers. Authors are encouraged to suggest reviewers for their manuscript who have appropriate expertise but no apparent or real conflicts of interest; we prefer 2 to 4 suggestions but up to 10 (all with e-mail addresses) can be named. However, there is no guarantee that suggested individuals will be used. Authors may also request that specific reviewers not be used.

HSR's electronic peer review system permits each author to monitor the progress of the manuscript through the peer review process via our Web site on Manuscript Central. We generally make an initial decision to reject or send out for external review within two weeks of submission. For more information about our peer review process and times associated with each step, see our “From the Editors” editorials at www.HSR.org.

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Section 7: Requirement of Original Manuscripts and Disclosure of Prior Dissemination
Only original manuscripts will be considered for publication. Articles published, accepted, or submitted for publication elsewhere will not be considered. Articles previously distributed publicly via the Internet or via national meetings may be accepted, subject to the approval of the editors. Prior dissemination of findings does not automatically preclude review and acceptance of an article, but raises the bar with respect to how publication in HSR will benefit the field. Prior dissemination or concurrent submission must be disclosed at the time of submission.  For further detail, see "Policy on Prior Dissemination" located at www.hsr.org.

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Section 8: Additional Material Published in HSR
Additional types of material may be published in HSR, either in print or exclusively in electronic form:

  1. Updates from AcademyHealth and other organizations. HSR publishes a regular update of activities and key news from AcademyHealth, the official sponsor of HSR. The journal will also publish selected 500-word abstracts of key reports from governmental agencies such as the Agency for Healthcare Research and Quality, Centers for Disease Control and Prevention, Congressional Budget Office, Food and Drug Administration, Department of Health and Human Services, and the Office of Management and Budget, as well as reports from private foundations.

  2. Electronic-only appendices and use of color in electronic versions. HSR will publish, at the co-editors’ discretion, electronic-only supplemental materials and color figures that will appear only in the Web-based version of the published journal. These materials should be referenced in the printed article and will be maintained permanently by Blackwell Publications. We will also publish the author and contributor grid as an electronic appendix.

  3. Other electronic-only published material. In addition, HSR will occasionally create electronic-only features designed to improve the peer review process or enhance the field, for example, by illustrating the evolution of an article through the peer review process; encouraging reactions and comments on innovations in the field; providing databases or supplemental appendices for readers to perform additional analyses or examine details of instruments used or analyses performed that are not available in the print version of HSR. We welcome suggestions and nominations for such features.

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Section 9: Preparation of Manuscript to Submit to HSR

  1. General order of presentation of material. In the manuscript as submitted, please use this preferred order: the title and structured abstract (with keywords) are first, followed by the text, generally without embedded tables and figures. After the text, place notes (if any) and references; place tables and figures at the end of the article, following the references. We prefer that all text and notes, references, tables, and figures be included in the same electronic file or in as few separate electronic files as possible.

  2. Text style and manuscript length "word counts and tables/figure maximums." ALL MANUSCRIPTS MUST BE SUBMITTED IN ELECTRONIC FORM via the Web-based peer review system located at http://mc.manuscriptcentral.com/hsr. Authors’ identifying information should appear only in a cover letter or notes to the editors and appropriate author fields, not in the manuscript file, its headers or footers, or in the file name. Manuscripts should preferably be submitted in a single document, including tables and figures, using Word or WordPerfect and double-spaced. Please use U.S. English spellings and be sure to number all pages for easy reference. Only if necessary, include tables or figures in a separate file; PowerPoint or Excel are acceptable. Provide a brief structured abstract (defined below) and up to five key words that reflect the content of the manuscript.

    Full-length research manuscripts and methods articles, including text and any notes, should be no longer than 4800 words (abstract, references, tables and figures are not included in this count). The abstract should be no longer than 200 words. The number of tables and figures should not exceed five.

    Research and methods briefs and commentaries should not exceed 2500 words (text and any notes) with an abstract limited to 125 words.

    Longer manuscripts or manuscripts with more than five tables/figures may be published if there is a compelling justification. Requests to waive the maximums will be handled on a case-by-case basis through discussions between the corresponding author and editors assigned to the manuscript. The editors may ask that certain text and tables/figures be posted on the Web as supplementary material; authors are encouraged to avail themselves of this opportunity whenever appropriate.

  3. Structured abstract. Manuscripts that are submitted as a research article, research brief, or methods article or brief are required to have a structured abstract prepared according to the format described herein. (Manuscripts submitted as a policy impact or commentary/debate may have a more flexible structure for their abstracts that conveys at least the objectives of the piece, the principal findings, and conclusions.) Manuscripts without appropriate abstracts will not be accepted. Each abstract should not exceed the word count and should include information under each of the following headings:

    Objective (or study question). Provide a single partial sentence, beginning with the word ‘‘To,’’ indicating the principal reason for conducting the study. For example: ‘‘To test’’ a specific hypothesis or theory.

    Data sources/study setting. Provide a single partial sentence indicating whether primary or secondary data were collected and the time frame of the data collection. Descriptions of the study setting, with regard to both primary and secondary analyses "in complete sentence(s)", will help to establish the generalizability of the findings.

    Study design. Describe succinctly (with complete sentences) the general structure of the study approach, indicating whether the study involved an intervention, randomization of subjects, or particular diagnostic or therapeutic procedures, and whether measures were taken at multiple points in time. Identify the key variables in the analysis.

    Data collection/extraction methods. Indicate in complete sentence(s) the procedures used in assembling the data for the analyses. 

    Principal findings. Using complete sentences, focus on the most important observations from the data pertinent to the questions or issues identified.

    Conclusions. Using complete sentences, mention only those conclusions directly supported by the data from this particular study. Avoid speculative observations but indicate the extent to which additional research may be required to address the central issues raised in the article.

    Key words (part of abstract). At the end of the abstract, provide no more than five terms or concepts that reflect the essential content and message of the article. These keywords can differ from those required in the pull-down menu on the Web-based system for submitting articles. Please note that the author should also select key words from the pull-down menu of choices on the Web page. The latter are used to categorize the manuscripts and select reviewers; therefore it is very important to select all appropriate pre-determined keywords, in addition to any included in the manuscript.

  4. Mathematics/formulas. Only if absolutely necessary should mathematical equations or expressions be included. Keep mathematical notation as simple as possible. Avoid barred, dotted, or otherwise-accented symbols; use only one superior and one inferior level of superscript and subscript; and use ‘‘slash’’ rather than ‘‘stacked’’ fraction forms in equations, especially where complex terms appear in the fraction.

  5. Endnotes. Endnotes are additional explanatory statements outside the "flow of the text." If used, they should be kept to a minimum. Cite endnotes in the text with a superscript number and list them, double-spaced, at the end of the text and before the references. Do not list notes at the bottom of the page. A note is not a reference but may refer to one.
    Sample endnote: 
    1. Superscript numbers are standard procedure for notes in scholarly papers (Turabian 1963).

  6. References. PLEASE NOTE that HSR has recently changed to the AMA citation style rather than the previous bibliographic citation style. The AMA style uses numerical citations within the text and a Reference List of the citations listed in numerical order, by order of appearance, rather than alphabetical. Please don’t use footnotes, but instead provide a comprehensive list of references at the end of the manuscript. Multiple references should not be combined under a single number. The list of references at the end of the document should be formatted as follows:

    Journal article:

    1. King VM, Armstrong DM, Apps R, Trott JR. Numerical aspects of pontine, lateral reticular, and inferior olivary projections to two paravermal cortical zones of the cat cerebellum. J Comp Neurol 1998;390:537-551.


    2. Voet D, Voet JG. Biochemistry. New York: John Wiley & Sons; 1990. 1223 p.

    For more information about AMA reference style - please see the AMA Manual of Style

  7. Tables/figures. Each table and figure should be on a separate page in the file and must be specifically cited within the text. In preparing tables and figures, please keep in mind the image area of the printed journal: 4.5 inches by 7.0 inches. Keep titles brief but clear and descriptive of the contents. Key the table footnotes to the body of the table with symbols rather than numerals or letters. All illustrative artwork (all figures) must be original and of camera-ready quality resolution. Color may be used, but note that the printed version will appear in black and white only. We encourage authors to avoid excess tabular data. Include no more than five tables or figures unless reasons for additional tabular material are specified in the cover letter accompanying the manuscript.

  8. English as a Second Language. Blackwell Publishing has introduced a service for authors who speak English as a second language, providing some linkages to nonaffiliated services that provide such services. Contacts and any fees should be arranged directly with these services. Blackwell’s Web site with links to the suppliers’ Web pages can be found at www.blackwellpublishing.com/bauthor/english_language.asp

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Section 10. Disclosures and Criteria for Determining Authors and Other Contributors

  1. Definitions. Health services research is increasingly a team effort, but not everyone on the team has necessarily contributed enough and knows enough about the manuscript to take responsibility for it, in exchange for receiving credit as an author.

    To be considered an author, HSR requires that one make a substantial intellectual contribution:

(1) in
    (a) conception and design,
    (b) acquisition of the data, or
    (c) analysis and interpretation of the data 
(2) in
    (a) drafting the manuscript or
    (b) critical revision of the manuscript for important intellectual content
All authors meeting the criteria for authorship must approve the final manuscript (including revisions) and take public responsibility for it. 

  1. Contributorship matrix. Although we use the above explicit criteria for who should receive the credit for (and accept the responsibility of) authorship, we also want to facilitate the formal recognition of those playing other critical roles in the research process. e.g., providing statistical analysis, programming, administrative, technical or material support (including data), supervision, obtaining funding, initiating the study or through other means. Thus, we will publish electronically a contributorship matrix identifying who did what in the research—listing both the authors and other contributors. On the behalf of all the authors, the corresponding author will certify that all who have contributed to the study are appropriately identified in an acknowledgement of contributorship and that all agree to such listing. Over time, analysis of such information may lead to more formal recognition of the “idea people,” “statisticians,” “commentators,” or “graphics experts” who helped create many great manuscripts, yet were listed as the authors of none. A sample contributorship matrix and disclosure form is available at www.hsr.org and at http://mc.manuscriptcentral.com/hsr.

For a more complete discussion of the rationale for our approach to authorship, see New Policy on Disclosures at Health Services Research.

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Section 11. Disclosures about Potential Conflicts of Interest and Funding
Authors will be asked to disclose all financial and material support (including the provision of or access to data) for the research and to disclose to the editors all affiliations and financial involvements with organizations with a financial or policy interest in the subject matter discussed in the manuscript. Authors are also requested to disclose public stands they have taken (in print, media, testimony, or other venues) that are identified with a particular advocacy position relevant to the manuscript and whether their current (or at the time of writing) organization is identified with such an advocacy position.

We also ask whether sponsors and/or supporters of the research (including employers and providers of data) have contractual rights to (a) review and approve or (b) review and comment on the manuscript within a reasonable number of days.

For a more complete discussion of the rationale for our approach to disclosures, see New Policy on Disclosures at Health Services Research in the "From The Editors" section of www.hsr.org.

Disclosure process. At HSR we emphasize disclosure of sponsors and relationships to related advocacy groups to the editors and reasonable publication of such information. With the exception of “review and approve” clauses that raise the possibility of censorship, such information will not enter into our decisions to accept or reject a manuscript. To minimize the burden on both authors on editors, we do not require such disclosure statements until a manuscript has cleared the initial hurdle of external review and revisions are requested. Before submitting a manuscript to HSR, however, all authors should be aware of our requirements for disclosure.

For accepted manuscripts, we will publish electronically and in print a one to three paragraph acknowledgement/disclosure statement recognizing the various forms of support that made the project possible and summarizing all real or potential financial and other conflicts about which readers may be concerned. This statement reflects disclosures with respect to the project supporting the work and the authors, and will be submitted by the corresponding author, with the concurrence of all the authors.

Each author is expected to submit his or her own disclosure statement to the corresponding author, and the corresponding author will be responsible for submitting the disclosure statements and for working with the editors to create a combined disclosure statement for publication. We expect that individual disclosures may go into more detail than needed for publication and anticipate a few “rounds” of revisions to make sure the statements are necessary and sufficient, but not overdone. To prevent manuscript publication from being delayed during this process, we encourage all authors to submit drafts of their disclosures to the corresponding author and encourage the corresponding author to submit a draft of the joint statement as early in the peer review process as possible. We generally expect to see an initial draft submitted with the first invitation to revise and resubmit. Please add it to the manuscript record in our electronic peer review system (http://mc.manuscriptcentral.com/hsr ) in the area ‘for the editors only’ as supplemental files not for review. The editors will review the draft and individual disclosures for consistency and completeness in parallel to the manuscript moving through our normal process.

The disclosure form is available at www.hsr.org and at the authors instructions area when submitting manuscripts at http://mc.manuscriptcentral.com/hsr.

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Section 12: Supplementary Materials

  1. Required materials. Our Manuscript Central process requires authors, at submission, to indicate any prior publication and conflicts of interest. Authors should explain affirmative answers in the section for author’s notes or in an accompanying cover letter. [See Sections 7 and 11 respectively for details.]

    Copyright permission (required if relevant). If an article contains material reproduced from other sources, written permission from the author and publisher to use such material must be received prior to our sending the manuscript for review.

  2. Optional materials. Three types of optional supplementary materials may be submitted:

    1. For the editors’ use only (example: disclosures; suggested reviewers who can give an unbiased review; requests for people who should not be asked to review this manuscript)

    2. For the editors’ and reviewers’ use only (example: a paper that describes the sample in more detail)

    3. For an electronic-only appendix intended for all readers (example: appendices with details on the questions used in a survey or a database)

    Upload separate files to the windows clearly indicated for the type of supplementary material, and describe briefly in the note area.

  3. Acknowledgements and disclosure statements to be published if the manuscript is accepted will not be sent to reviewers; please submit any files related to these in the area indicated for supplementary material that is NOT intended for reviewers. These files will be required only at the time of submitting a revised manuscript. Note: While potential conflicts need to be addressed during the editorial review process, and prior publication may influence the value of a manuscript as submitted, they will usually not jeopardize publication. Failure to disclose these issues initially is a far more serious problem and may rise to the level of being considered scientific misconduct.

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Section 13: Copyediting and Publication
Once a manuscript is accepted for publication in HSR, the author will be asked to provide the accepted version in both a document format (preferably using Microsoft Office Word or Excel) and a PDF. Most modern word processing software can be accommodated; any PowerPoint slides or figures must use high resolution. Edited page proofs are returned electronically to the corresponding author for review. The author-approved copyedited manuscript should be returned (with all additions, changes, and clarifications) within 48 hours of receipt. In the event that the corresponding author does not respond, attempts to communicate with coauthors will be made. Delays may result in postponement of the article or deletion from special issues. Accompanying appendices and databases may be accepted for electronic publication and mounted on the journal’s Web page. See here for the form. Be sure to add title and number and authors’ information as well as signatures. Note that a signed hardcopy of the copyright transfer form should be signed by the corresponding author on behalf of all authors and sent by mail to the managing editor. The Certification and Disclosure form should be completed by the corresponding author and uploaded onto our submission site if and when your manuscript is asked to be revised.

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Section 14: Offprints and Reprints 
After publication, each author will be furnished with one free print copy of the issue containing his or her article. Corresponding authors will be sent a PDF of their article to use under specified circumstances. NOTE: The contents of Health Services Research are protected by copyright and may not be reproduced without permission. The note beneath the table of contents indicates that the copyright owner consents to copy reproduction of the article for personal or internal use by individuals or specific clients. For copying beyond that permitted in Sections 107 and 108 of the U.S. Copyright Law (e.g., for copying for general distribution, large-scale copying for internal distribution, copying for resale), the copier must pay the stated per-copy fee through the Copyright Clearance Center, Inc. (P.O. Box 765, Schenectady, NY 12301).

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Section 15: Permissions to Reprint Articles from HSR in New Collective Work.
Please contact the Journals Rights & Permissions Coordinator, Blackwell Publishing, Osney Mead, Oxford OX2 0EL, UK 
Email: JournalsRights@BlackwellPublishers.co.uk

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