Établissement/organisme porteur : Inserm
Nom du chef d’établissement/d’organisme : Gilles Bloch
Mots-clés : Health services, healthcare pathway, health performance, prevention, health professionals
Durée visée : 5 years
Scientific domain : Research on Health Services
Contact : Karine Chevreul ( email@example.com )
Strategy of the host institution:
The COVID-19 emergency has clearly demonstrated the complexity and interconnectedness of national health and care services and shown how difficult it is to introduce change in such rapidly evolving environments. Moreover, the current crisis has also highlighted pre-existing challenges like the need to address social and environmental determinants of health, develop prevention, rethink and redesign services in an effort to best optimise the complementarity of prevention and of inpatient and outpatient care. Improving the working conditions of health professionals has also proved to be pivotal. The goal of creating this Junior chair would be to strengthen the French potential over Health Services Research (HSR), a domain traditionally well developed in English speaking countries which has also strongly emerged in France. Several research teams, included three Inserm’s labelled ones, are concerned and Inserm’s strategy is to use the CPJ’s tool to get the best candidate on one of their thematic. Besides, HSR will greatly benefit in the coming years from a major investment (300 M€) from the European Commission, through the research partnership “Transforming Health and Care Services” (THCS) that has recently been validated and will start up beginning 2023. French Ministry of Health, ANR and Inserm are the three French partners in THCS. It is of primary importance for French HSR research to be able to take advantage of this research investment.
Candidates are invited to choose one of the following research labs for their application :
- RESHAPE lab U1290, research unit that operating under the supervision of INSERM and University Claude Bernard Lyon, in partnership with the Lyon University Hospitals (HCL and CLB).
- ECEVE lab (UMS 1123), research unit operating under the supervision of INSERM and University Paris Cité.
- The RSMS “Health services and management research team” U1309 which belongs to the research laboratory ARENES (UMR 6051), operating under the supervision of Inserm, CNRS, EHESP, University Rennes 1 and Sciences Po Rennes, in partnership with the University Rennes 2
Strategy of the host laboratory :
- RESHAPE: the team’s research strategy focuses on the performance of health services and health professionals based on three major axis: personal and human factors, contextual and organizational factors, professionals and patient interaction factors. To investigate these topics, methodological approaches, combining expertise in health services research and equipment, support the work of the unit’s scientists, including mixed quantitativequalitative methods, large databases analyses, and investigations in high-fidelity simulated environments.
- ECEVE: the lab strategy is to produce results to assist decision makers in developing evidence-based policies that improve vulnerable people’s preventive and curative care pathways. Vulnerable people are in this case people who show low social competencies that impair their capacity and chance to access optimal pathways in health. These can be, for instance, people with mental health impairment, adolescents, socially deprived or migrants. As such resulting social health inequalities in access to, or benefit from, care are of major concern. In this aim, ECEVE develops projects in health services and policy research along two main axes that are the study of people and professional practices in health in order to understand the reality (is there a problem and why?) and research on health interventions (what can be a solution and/or is it efficient?). A third axe focuses on research on methods in order to feed the two first.
- RSMS team (ARENES) aims to estimate the impact of public policy that focuses on health and social care (axis I) and prevention (axis II) services. Research focus on identifying the determinants (linked to individuals, health care providers, territory) of the performance of the health care pathways (access, effectiveness, efficiency), and on estimating the impact of public policy (either regulation, experiment or pilot) notably regarding health outcomes, health care delivery organization, human resources, professional practice and/or payment mechanism. Through mixed methods design, the RSMS team aims to generate overall gains regarding health care pathways and prevention services.
Summary of the scientific project :
The scientific project must align within the conceptual framework of the three major axis of the RESHAPE lab research program, combining the intrinsic and extrinsic determinants of health professionals’ performance in interaction with patients and their entourage. This approach should not be limited to the study of health services but also integrate the development and integration of effective prevention strategies to improve the care and health of the population. The research field can focus on either technical care for acute diseases, specialized care for rare diseases, or primary care for chronic disease.
For those purposes, the employed methodology integrates, as appropriate: 1) observational and interventional investigations using mixed quantitative-qualitative methods, 2) the exploitation of local and national data collected in the context of care (SNDS-PMSI-HCL data warehouses) or from specific cohorts of professionals (physiological sensors, ad hoc surveys, etc.) matched with their patients, 3) and immersive simulations to observe the behavior of professionals and test the potential impact of pilot interventions.
The first objective of the health care system is to improve the health of the population with a particular attention on decreasing inequalities. Performance is thus affected by disparities between individuals and groups in access to optimal preventive and curative care pathway and services.
In line with the ECEVE’s axes of research, the scientific HSR project will therefore aim at understanding how these inequalities in access, utilization or benefit raise (study of current practices, health policy evaluation), what are their impact and what are the efficient changes in the organization that can be made (new interventions, programs or policies) in order to improve the performance of the health care system. It will request a multi/interdisciplinary approach using both quantitative and qualitative methods, using existing data (health data, Insee survey,…) and setting new data collection (observational and experimental studies) in order to help opening the black box of health services organization and identify, for instance, factors of success and failure or unanticipated effects of services and policy.
RSMS team (ARENES)
The scientific project will be principally oriented on the analysis of the links between the organization of health care professionals and the overall performance, for patients, professionals, and the health system. Primary care would be of particular interest, the hypothesis being that coordination and integration in health care delivery, at the practice and/or territorial level, as well as alternative to fee-for-service payment mechanism, could be, under specific circumstances, of greater add value for the society than individual health care providers mainly paid with fee-for-services.
Such research project will request the evaluation of pilots or experiments or programs launched about primary care team or medical homes, skill-mix between GPs and allied health care professionals, alternatives to fee-for-services payment for integrated care, ehealth and e-monitoring, health care pathways. The methodology will be based on public policy evaluation design as well as on mixed method design. If not based upon primary care, the project should align with the research objectives of the team.
Summary of the teaching project :
The candidate is expected to participate to existing courses (Master’s/PhD) and develop specific teaching contents consistently with his/her research topics and methods. Teaching projects will include mentorship and direction of Master and PhD students.
According to the lab choice, specific courses or focuses are expected:
RESHAPE : Specific focus on health services research concepts, analytical skills to exploit large databases, development and evaluation of complex interventions. The candidate will also endorse mentoring activities to oversee fellows’ primary research projects.
ECEVE : Develop teaching units on social health inequalities and determinants and on multidisciplinary methods that can be used to research on these topics. Develop a seminar for PhD students of the doctoral school to which ECEVE is affiliated (ED 393) on how to incorporate social health inequalities matters and consider them in a multidisciplinary perspective in research on health services and policy.
RSMS team (ARENES): Specific focus on public health policy, program or pilot evaluation courses, including management and/or microeconomics, and mixed methods for master degree program develop by EHESP (notably MPH, AMOS, PPASP). Second, the teaching project focus on internship mentoring for master degree students.
Funding : ANR package 200k€
Scientific communication and dissemination :
The recruited researcher is expected to publish regularly as principal author but also as coauthor, in the higher ranked scientific journals of the domain. Articles written in the frame of international collaborations, especially from projects funded by the THCS partnership (see above), will be much appreciated.
Active participation in the development of the French HSR community, within the French Hub of the THCS program, promoted in France by Ministry of Health and IReSP (French Institute for Publoic Health Research), is also expected.
5 Several presentations at international conferences and meetings will be part of the expected contributions.
Open Science :
All the published articles will be on HAL in their integral version. As for the data collected and prepared for research, they will be made available to the community as soon as possible, after a possible embargo period.
Science and society :
The recruited researcher will be expected to actively participate to public dissemination events such as the yearly “la fête de la science” and communicate with the general public on issues of broad interest regarding everyone health care. Depending on his or her current situation, he or she may also be interviewed by journalists from the general or popular science press.
Indicators : Teaching ; Research ; Knowledge transfer
– Ouverture de la campagne : février 2023
– Présélections : printemps 2023
– Auditions : mai/juin 2023
– Les résultats seront affichés sur le site EVA en juin.