LAUSR

Health services research (HSR) conducted in lowand middle-income countries (LMICs) is not so different than HSR conducted in any other environment. The usual concerns hold: the importance of the research question, appropriateness of research design, sampling and data quality, analytic plan and execution, evidence-based conclusions, balanced reporting, and resources to support rigorous inquiry. But differences lie in the unique cultural, geographic, and financial constraints and extensive unmet need among LMICs, which underscore the importance of advance planning, optimization of resource use, and rigorous periodic assessment. Conducting HSR in LMICs is worthwhile but challenging. Investing in well-designed research in the service of clinical goals1 could conserve effort and time, which could then be reinvested in capacity building. In contrast to surgical studies from wealthy nations, every clinical question tends to be important. However, sampling and data quality issues are more difficult to address. Electronically based networks that could ensure robust sample size are frequently unavailable. Patients rarely return to the hospital for postoperative follow-up visits, thereby curtailing the opportunity to assess even short-term outcomes. Medical record standardization that would enable eligibility screening, risk adjustment, and comparison of outcomes across studies is limited. Although they exist, funding sources are scant. Given these challenges, the Surgical Outcomes Club dedicated a symposium of its 2017 scientific session to the topic of HSR in the global surgery context. Alex B. Haynes, MD, MPH, Catherine J. Juillard, MD, MPH, and Benedict C. Nwomeh, MD, described their research efforts in LMICs, including issues that arose when partnering with local stakeholders to implement quality and safety improvement programs. Here, we summarize the proceedings of that symposium and discuss threats to the quality of research in the global context and emerging strategies for their resolution.