tions for integrated, skill-based workforce requirements models, and (b) collaborate with the Agency for Healthcare Research and Quality (AHRQ) to provide funding to support the development of analytic approaches to assess skills shortages rather than personnel shortages and for articulating optimal skill-mix configurations to address those skills shortages.

Over the years the federal government has invested considerable resources in analytic efforts to estimate the future supply of and demand for doctors, nurses, and a range of allied health workers. Together the estimates from these activities have been used to estimate the shortfall or surplus in these health occupations. These efforts are flawed in several significant ways that affect their utility for future workforce planning. As discussed earlier the demand-based models are founded on current patterns of demand which we have shown for nurses to poorly conform to evidence-based models for effective nursing use. The supply-based models derive from current patterns of producing nurses that are influenced in part by current demand and by current patterns of education that are not well aligned with the future RN workforce requirements to support delivery system redesign. Finally, these models do not take into account the overlap in the skills and abilities of RNs and other health occupations, e.g., doctors, as well as other nursing personnel categories.

In its 2008 report, Out of Order, Out of Time, the Association of Academic Health Centers (2008) calls for the creation of a national health workforce planning body to provide a coordinated approach to health workforce planning that offers an integrated national strategic vision rather than decentralized multi-stakeholder decision-making. This idea is echoed in provisions in the health reform legislation calling for the creation of a National Health Care Workforce Commission. Our proposed recommendation would support and augment the work of this Commission in two ways: (1) by creating an Advisory Group responsible for developing a range of options for building integrated skill-based workforce requirements models, and (2) by providing funding through AHRQ to explore ways to assess and compare the outcomes of health care services offered under a range of skill-mix configurations derived from these integrated requirements models. These strategies would be founded on a comprehensive review of the literature and related resources illuminating the full range of workforce configurations employed in the delivery of health care services and, where available, associated outcomes.

The reorganization of health care service delivery that will accompany many of the innovations included in health reform has potentially profound implications for RNs, whose broad scope of practice places them at the cross section of virtually all health care settings. Redefining roles and responsibilities of health team members that such innovations will entail could significantly affect the skill mix

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