Using the Right Tools to Answer the Right Questions

The Importance of Evaluative Research Techniques for Health Services Evaluation Research in the 21st Century

Abstract

The marked changes in health care expenditures in recent years have led to a call for greater accountability in the areas of health education, policy, services, and reform. In recent years, evaluative research has been conducted in health arenas under the rubric of health services research. The research methods employed have evolved not from evaluation research methodology, but from frameworks that often do not lend themselves to deriving appropriate causal inferences in multi-causal environments. Given the complexity of the interrelated political, social, psychological, and economic factors that can affect health services, more complex evaluative techniques are needed. This article describes the epistemology of evaluative research and, through a series of examples from the health services literature, demonstrates the strengths of theory-driven approaches and statistical multivariate techniques compared to traditional black-box methods, as ways to increase validity for causal inference.