Development of Public Health Systems and Services Research: A Citation Network Analysis

Background: As the public health system (PHS) has adapted and grown over time, the field of public health systems and services research (PHSSR) has also grown. Over many decades PHSSR has evaluated system structures, functions, and outcomes with the goal of increasing efficiency and effectiveness. The PHS is facing unprecedented challenges including an aging population, an increase in chronic disease, threats of bioterrorism, natural disasters, and pandemic influenza. PHSSR is critical to understanding and meeting these challenges. Methods: Through an analysis of over 150 years of PHSSR research, this study identifies where PHSSR has been, how PHSSR has been defined, and where PHSSR is, and maybe should be, going. Experts in PHSSR identified 15 key articles in the field. Results: Using Web of Science, we collected 6,755 publications linked to the 15 key articles. We used citation network analysis to examine the resulting network, which includes articles, reports, books, and other works dating back to 1850. Each publication was cited an average of 1.25 times (range 0-94) and cited 1.25 publications (range 0-433). We coded articles for topic and approach and identified trends, strengths, and gaps in PHSSR. We identified a number of prominent publications and turning points in PHSSR, including: the 1921 APHA report, outlining the need for data collection related PHS services. Discussion: The strengths, gaps, and turning points paint a picture of a field with the potential to affect change in our struggling system. By drawing on our history, PHSSR can meet the challenge of our future.