have significant payoffs for policymakers, nursing educators, and hospital administrators.

RECOMMENDATION 5-5: The committee recommends that the National Institute of Nursing Research (NINR) and other appropriate agencies fund scientifically sound research on the relationships between quality of care and nurse staffing levels and mix, taking into account organizational variables. The committee further recommends that NINR, along with the Agency for Health Care Policy and Research (AHCPR) and private organizations, develop a research agenda on staffing and quality of care.

Several other agencies of the U.S. Department of Health and Human Services also have a major role in health workforce data collection and research, including the Division of Nursing in the Bureau of Health Professions, the Health Resources and Services Administration; the National Center for Health Statistics (the principal health statistics agency of the federal government) in the Centers for Disease Control and Prevention; and the Health Care Financing Administration. Finally, private organizations could be partners in these research programs, for example, hospital associations (e.g., Hospital Research and Education Trust, the American Hospital Association [AHA]; and state hospital associations, some of which [e.g., in Maryland and New York State] conduct work of this sort already) and private philanthropic and research foundations, particularly those with long-standing interests in health personnel, organization of the health care sector, or quality of care.

A major part of any such research agenda might call for elaboration of the actual variables—in terms of structure, process, and outcome—that warrant high priority attention in studies of the relationship of nursing care, staffing patterns for nursing, to patient outcomes. As discussed below, for example, the American Nurses Association (ANA) has been developing quality indicators that warrant further investigation.

Report Cards

During its work, the committee heard a great deal about the need for more information on hospital quality of care to be made available to policymakers and the public. The reasons are several: to improve the workings of a competitive health care market, to enable the public to make better choices about health care plans, and generally to reflect the nation's expanding interest in generating and using information to help improve the quality and cost-effectiveness of health care. One notable indication of this movement is the growing belief in "report cards"—that is, summary collections of indicators or measures of health care



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