title: System impact research - increasing public health and health care system performance.
abstract: BACKGROUND
  Interventions directed to system features of public health and health care should increase health and welfare of patients and population.
  
  
  OBJECTIVE
  To build a new framework for studies aiming to assess the impact of public health or health care system, and to consider the role of Randomized Controlled Trials (RCTs) and of Benchmarking Controlled Trials (BCTs).
  
  
  METHODS
  The new concept is partly based on the author's previous paper on the Benchmarking Controlled Trial. The validity and generalizability considerations were based on previous methodological studies on RCTs and BCTs.
  
  
  RESULTS
  The new concept System Impact Research (SIR) covers all the studies which aim to assess the impact of the public health system or of the health care system on patients or on population. There are two kinds of studies in System Impact Research: Benchmarking Controlled Trials (observational) and Randomized Controlled Trials (experimental). The term impact covers in particular accessibility, quality, effectiveness, safety, efficiency, and equality.
  
  
  CONCLUSIONS
  System Impact Research - creating the scientific basis for policy decision making - should be given a high priority in medical, public health and health economic research, and should also be used for improving performance. Leaders at all levels of health and social care can use the evidence from System Impact Research for the benefit of patients and population. Key messages The new concept of SIR is defined as a research field aiming at assessing the impacts on patients and on populations of features of public health and health and social care systems or of interventions trying to change these features. SIR covers all features of public health and health and social care system, and actions upon these features. The term impact refers to all effects caused by the public health and health and social care system or parts of it, with particular emphasis on accessibility, quality, effectiveness, adverse effects, efficiency, and equality of services. SIR creates the scientific basis for policy decisions. Leaders at all levels of health and social care can use the evidence from SIR for the benefit of the patients and the population.
authors.affiliation: a Centre for Health and Social Economics , National Institute for Health and Welfare , Helsinki , Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Malmivaara
mesh_terms: D019985:Benchmarking / Q000379:methods; D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D011050:Policy Making; D011634:Public Health / Q000379:methods* / Q000592:standards; D016032:Randomized Controlled Trials as Topic / Q000379:methods
keywords: Health care; benchmarking controlled trial; effectiveness; efficiency; equality; health economics; public health; randomized controlled trial; safety; system impact research