Health-Care Research: Who Has The Healthiest Publication Record?

different things to different people. To the biomedical scientist it could include the crucial basic investigations that lead to a life- and cost-saving vaccine. By contrast, to a hospital's staff ethicist it could entail devising a policy of informed consent for experimental medical treatments. Health-care research, according to many experts, covers the spectrum from fundamental research projects like those in cell biology to such applied questions as how to lower costs yet maintain high-quality service in hospitals. To evaluate the more applied side of health-care research, the newsletter Science Watch, published by the Philadelphia-based Institute for Scientific Information (ISI), analyzed the publication record over the past 13 years of facilities engaged in this area of endeavor. Using ISI's Science Indicators Database, the newsletter ranked the citation impact of research papers produced at universities, government agencies, and other institutions in such fields as public health, epidemiology, economics, and medical ethics. Following is Science Watch's September 1994 report, reprinted with the permission of the newsletter and ISI. "Outcome analysis is all the rage in the delivery of health care," notes a recent editorial in the Lancet ("Proposal quality or product quality?" 344:488-9, 1994). "By comparison, medical research is far simpler to evaluate because there is only one main outcome--published papers. These articles can be evaluated not only in terms of how many and where they are published, but also according to whether they are read and cited." Taking this line of reasoning one step further, Science Watch has elected to use this form of outcome analysis to assess recent studies in health-care research itself by examining such publications and their citation histories over the last 13 years. Which institutions, Science Watch wanted to know, have had the greatest impact in this field? The answer is of more than academic interest. With health-care costs in the United States now topping 14 percent of the gross domestic product and ranging from 8 percent to 12 percent in most other industrialized nations, significant studies in health-care research that reveal successful, efficient, and economical therapies and delivery systems can materially contribute to lowering costs and providing better care to patients. In undertaking such a study, the primary challenge is determining the characteristics and boundaries of the complex patchwork of disciplines that fall under the heading of health-care research. Science Watch began by selecting 99 journals indexed by the Institute for Scientific Information (ISI) pertinent to this area. These journals represent a broad spectrum of topics, including public health, epidemiology, psychology, health-care economics, health administration, health-care policy, and medical ethics. Science Watch examined nearly 90,000 papers published in these journals, along with the institutions that produced them. The institutions were ranked according to their citations-per- paper scores, or citation impact. The listings were grouped in two categories: those institutions that produced 500 papers or more during 1981 to 1993 and those producing fewer than 500 but more than 200 (see accompanying table). Among the big producers, the Centers for Disease Control and Prevention in Atlanta had the highest citations-per-paper impact, followed by the University of California, San Francisco, and the University of California, Los Angeles. For sheer output, none could match Harvard University's total of 1,572 papers. In terms of impact, however, Harvard barely managed to crack the top 10 in the over-500-papers club, finishing ninth. As it turned out, the highest impact scores were recorded by members of the "small producers"--those institutions publishing fewer than 500 papers in the 13-year period. Highest of all was the Institute of Psychiatry in London, with a citations-per-paper score of 11.95. The institute also proved to be one of only two non-U.S. institutions to appear on the list. The other was the University of Toronto, which ranked at No. 20 among the big producers. Besides the Institute of Psychiatry, the only other institution to achieve double-digit impact--despite its relatively low output of 234 papers--was the Rand Corp. of Santa Monica, Calif., which produced an average of 10.37 citations per paper. The National Institute of Mental Health, with 260 papers and an impact score of 9.05, placed third among the small producers. A Range Of Topics In selecting nearly 100 journals from ISI's Science Citation Index and Social Sciences Citation Index, Science Watch cast a wide net in an effort to capture a sense of health-care research over the last 13 years. A look at the most-cited papers from the Institute of Psychiatry demonstrates the breadth and variety of that research. Among the topics treated by these papers are an epidemiological survey of mental disorders in the South London borough of Camberwell; another epidemiological study examining biochemical markers of smoke absorption and self-reports of exposure to passive smoking; an evaluation of tests used to distinguish smokers from nonsmokers; and a study of life events and their relationship to depressive illness. Of course, in many cases the journals selected by Science Watch for this study do not deal exclusively with health-care issues. For example, the presence of such journals as Psychological Medicine, the British Journal of Medical Psychology, and Hospital and Community Psychiatry undoubtedly meant the inclusion of some papers that focused narrowly on topics within the realm of clinical psychology or psychiatry, rather than on larger issues pertaining to health care. In general, however, the aim was to select journals that offered the broadest possible view of the disciplines pertaining to health care. These disciplines included, to name just a few examples and representative journals: policy (Administration and Policy in Mental Health, Health Policy, Health Policy and Planning); public health (Public Health, Public Health Reports, Journal of Public Health Medicine); law (American Journal of Law and Medicine, International Journal of Law and Psychiatry, Issues in Law and Medicine); and ethics (Journal of Medical Ethics, Bioethics, Journal of Clinical Ethics). Also included were journals devoted to broader aspects of social work, family and child welfare, nursing, gerontology, and AIDS. (among those publishing more than 500 papers, 1981-93) Rank Name Papers Citations Impact 1 Centers for Disease Control 693 5,592 8.07 and prevention 2 University of California, S.F. 1,016 7,155 7.04 3 University of California, L.A. 1,246 8,439 6.77 4 Johns Hopkins University 1,168 7,745 6.63 5 University of Michigan 1,150 7,170 6.23 6 University of Washington 1,123 6,837 6.09 7 University of Pittsburgh 502 2,985 5.95 8 Columbia University 746 4,392 5.89 9 Harvard University 1,572 8,368 5.32 10 University of Minnesota 743 3,950 5.32 11 Yale University 703 3,609 5.13 12 Duke University 603 3,031 5.03 13 Stanford University 690 3,352 4.86 14 Cornell University 597 2,864 4.80 15 University of North Carolina 932 4,342 4.66 16 University of Illinois 771 3,579 4.64 17 Boston University 722 2,866 3.97 18 University of Wisconsin 793 3,132 3.95 19 University of Maryland 833 3,161 3.79 20 University of Toronto 517 1,914 3.70 (among those publishing 200 to 500 papers, 1981-93) Rank Name Papers Citations Impact 1 Institute of Psychiatry, London 407 4,864 11.95 2 Rand Corp., Santa Monica, Calif. 234 2,427 10.37 3 National Inst. of Mental Health 260 2,352 9.05 4 Arizona State University 216 1,583 7.33 5 University of Southern Calif. 411 2,888 7.03 6 University of Calif., Berkeley 414 2,718 6.57 7 Ohio State University 304 1,942 6.39 8 Brown University 285 1,772 6.22 9 University of California, Irvine 211 1,256 5.95 10 University of Chicago 372 2,042 5.49 11 Rutgers University 375 2,022 5.39 12 Washington University 287 1,425 4.97 13 Vanderbilt University 264 1,303 4.94 14 University of Calif., San Diego 313 1,484 4.74 15 University of Miami 223 1,033 4.63 16 University of Massachusetts 462 2,066 4.47 17 University of Utah 210 929 4.42 18 Yeshiva University- 251 1,100 4.38 Albert Einstein College of Medicine 19 Case Western Reserve University 421 1,795 4.26 20 University of Colorado 452 1,905 4.21

Health-Care Research: Who Has The Healthiest Publication Record?

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