Research

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Many states have certificate of need (CON) laws which restrict providers supply for certain procedures.  A paper presented by Vivan Ho at AcademyHealth claimed that there were 37 states with a CON law for at least one procedure.  Following up earlier research which found that CON laws decreased quality, Dr. Ho found that dropping CON laws also reduced cost.

An important point was made by an audience member, however.  CON law stringency is highly variable across states.  According to the commenter, most providers who make applications to receive a certificate of need receive one in states like Massachusetts.  In other states, however, CON laws are much more stringent.

Thus, in any empirical analysis, using an dummy variable to indicate the presence of CON law indicates the effect of CON on average.  Policymakers may care more about this variable if they feel they cannot pre-determine the level of stringency upon passing a law.  The true causal effect of CON, however, may of course vary depending on how severely States restrict providers supply of services.

This issue provides a valuable teaching point: any research into CON or other regulations must explicitly interpret what their findings do and do not say about the regulation under consideration.

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The National National Institute for Health Care Management (NIHCM) recently selected its five finalists for their Annual Health Care Research Award.  These studies include the following:

 

 

 

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Why research?  

It is for the intellectual challenge?  Is it to make recommendation policymakers?  Or is it to make the world a better place?

Margarita Alegria believes that health services researchers must change their focus “from a science of recommendation to a science of implementation.”  Dr. Alegria’s address can be found in the upcoming HSR.

“The distance between the people who produce the information and the people who use the information—for example, end-users such as a clinician working in a safety net clinic or an immigrant worker who goes to his primary care doctor—is vast. We do not do much to minimize this distance—not even asking if the information we are producing will be valuable to the end-users. We basically produce the evidence and go on to the next research problem.”

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As an academic researcher, using the web has made my life significantly easier.  I can access millions of articles from academic journals in the click of a button.  Sites such as JStor and ScienceDirect have hundreds of journals located in the same place for easy use.  With so much more information online, I am able to access information in the “long tail” of the academic knowledge spectrum.

In an article titled “Digital Libraries,” The Economist magazine, however, reports that “as more journals become available online, fewer articles are being cited in the reference lists of the research papers published within them.”  The findings are from a study by James Evans, a sociologist at the University of Chicago.

“…for every additional year of back-issues of a journal available online, the average age of the articles cited from that journal fell by a month. He also found a fall, once a journal was online, in the number of papers in it that got any citations at all.”

This phenomenon is likely due to the advent of search engines.  Search engines often rank academic article by either the date published or the number of citations the article has received.  Whereas a manual library search in the old days treated each article as near equals regardless of its publication date and number of citations, electronic searchers are more likely to come across the best most popular work.

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The Scientific American magazine has an interesting article (“Science 2.0“) about the web, open-access, blogging and research. Should researchers post their results online? Should scientists blog about their methodology?

Pros

It seems like academic research is the perfect forum for social networking and blogging. The sharing of ideas is a key means towards scientific invention/innovation. Posting raw data is a great way for other researchers to verify results, or utilize the same data for different purposes. One cancer researcher noted:

  • “To me, opening up my lab notebook means giving people a window into what I’m doing every day,” Hooker says. “That’s an immense leap forward in clarity. In a paper, I can see what you’ve done. But I don’t know how many things you tried that didn’t work. It’s those little details that become clear with an open [online] notebook but are obscured by every other communication mechanism we have. It makes science more efficient.”

The site OpenWetWare let’s laboratories share their daily experiences online. Further, researchers who are traveling can access their lab notebooks from anywhere in the world with OpenWetWare.

Further, social networking can allow easier collaboration between colleagues working in different parts of the country or different parts of the world.

It seems like researchers would be some of the first people to utilize Web 2.0, but…

Cons

  • “It’s so antithetical to the way scientists are trained,” Duke University geneticist Huntington F. Willard said at the January 2007 North Carolina Science Blogging Conference, one of the first big gatherings devoted to this topic. The whole point of blogging is getting ideas out there quickly, even at the risk of being wrong or incomplete. “But to a scientist, that’s a tough jump to make,” Willard says. “When we publish things, by and large, we’ve gone through a very long process of drafting a paper and getting it peer-reviewed. Every word is carefully chosen, because it’s going to stay there for all time. No one wants to read, ‘Contrary to the result of Willard and his colleagues….’”

Beside the fact that writing about unfinished results is not the way scientists are usually trained, most individuals worry about having their ideas stolen. Having your idea “stolen” by another individual means you will not get the recognition you deserve for coming up with an idea, and your career path can be adversely affected. Doling out credit for work accomplished is an important component of the “old school” journal system.

Other worries include the fact that when junior faculty post critical comments of the work of senior faculty, they may fear some sort of reprisal. This has lead some individuals to use pseudonyms.

Summing up

There are some serious drawback to Science 2.0, but as Timo Hannay, head of Web publishing at the Nature Publishing Group, states, “Our real mission isn’t to publish journals but to facilitate scientific communication.”

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KBPS reports that Google will begin digitizing tens of thousands of library books at my current school, UC San Diego (UCSD).

Why was UCSD chosen?  Google states that UCSD has an “exceptional collection of social sciences and east asian books.”  Within six months, all UCSD books will be available online.

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