The Integration of Evidence Based Medicine and Health Services Research in the ICU

From the perspective of critical care medicine, health services research has languished in the shadows until recently. Why is this? Health services researchers take as their topic the organizational, cultural, political, and economic structures that undergird health care. They pose system-level questions that may be viewed as abstract and irrelevant at the bedside. Health services research may seem preoccupied with mapping the ‘forest’ without a close view of the ‘trees (i.e., the myriad, complex and immediate clinical decisions facing ICU practitioners daily). Many health services research studies eschew methodological conventions which value controlled experiments to answer specific effectiveness questions; in contrast, health services research draws heavily on observational research designs and often relies on sources such as large administrative databases, surveys, or field observation. Resulting analyses are often complex, and the findings more suggestive than decisive. In summary, clinicians have been slow to recognize and accept the value of health services research, doubting both the relevance of health services research topics to critical care practice and the methodological rigor of health services research studies. These views are now changing.