Health Services Research (HSR) Methods
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Hypothetical 1: Shaping the Study

Mary White is a young health services researcher at Top Notch University where she hopes to secure tenure someday. StarHealthPlan asks White to conduct a research project examining spending and health outcomes for a certain medical procedure covered by this plan. StarHealthPlan will pay White as a consultant for her work on the project and allow her to publish the results in a peer reviewed journal.

White prepares her research plan for the project using well-tested and widely used methods. The plan, including specific analytic methods, is approved by StarHealthPlan at the start of the project. As the research project proceeds, the findings show that the medical procedure is associated with unfavorable health outcomes. After StarHeathPlan receives an interim report from White, they begin calling her, asking questions about the project and suggesting alternative methods. White agrees to adjust her methods. The alternative methods, while acceptable, may not generate results that are as definitive as those that could have been generated using White’s original methodology.

As the project proceeds and the results remain unfavorable, the questions and suggestions from StarHealthPlan continue. Eventually, after various adjustments to the project methods, White finds favorable, albeit limited results. StarHealthPlan’s questions and suggestions cease. At the close of the project, StarHealthPlan issues a press release which stretches the findings from cautious and limited to unequivocal and generalizable. White receives a call from a reporter who would like to discuss the study and the press release. White knows that StarHealthPlan has endowed a chair in her department at the University. Supporting their characterization of the project would put her in a positive light, both with the University and the University’s financial supporter, StarHealthPlan.


Did White act appropriately in adjusting her methods during the course of the study? Did she subvert the science for 
        the benefit of the funder? 
B.    What if there are legitimate reasons for using an alternative methodology?           
C.    What obligation does White have to document the shift in methodology and report all  of the results in any publications 
        that are generated from the study?   
D.    White knows that there can be honest differences of opinion relative to the interpretation of research. How does she 
        balance that reality with her desire to preserve her reputation and report the true history of the project, including 
        changes to the methods?
E.    How does White respond to the reporter?
F.    What obligation does White have to correct the record relative to StarHealthPlan’s press release?
G.    Should she continue her consulting arrangement with StarHealthPlan?

For further discussion on these questions, please join the Hypothetical 1: Shaping the Study forum.