Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 105
5. HEALTH SERVICES RESEARCH AND NURSING RESEARCH
Since the Committee's last report, little improvement has been made
in the funding of the Committee's recommended programs in the areas of
health services research and nursing research. In the past year, a
hiatus has existed in the Committee's work in these areas. In this
year' s report, the Committee reviews its approach to health services
research (HSR) and presents the results of a 1977 survey of HER trainees
and researchers. In nursing research, the Committee reviews the status
of the federal programs for the support of training in nursing research.
HEALTH SERVICES RESEARCH PERSONNEL
From its inception, the Committee has strongly supported the need
for training in the area of health services research. Early attention by
the Committee led to the recognition of health services as an area to be
specif ically included under the purview of NRSA. However, passage
earlier this year of the Omnibus Budget Reconciliation Act of 1981
(Public Law 97-35) deleted from the NRSA Act the authority for the
National Center for Health Services Researob (NCHSR) to use this
mechanism to support research training. The Committee views with concern
this diminished and unfocused federal role in health services researab
training as limiting the supply and quality of personnel who are trained
to study the many pressing problems in this area. The Committee
continues to believe that the increasing importance of health care and
the implications that the provision of health services has for the
quality of life for all Americans have made health services research an
essential area. The training of competent health services researchers
remains central to this task.
The nature of health services research provides challenges not
present in the other areas under the Committee's purview. Because health
services research is not a traditional discipline, but rather the
selected application of a variety of disc iplines to health services, the
Committee and its Panel on Health Services Research had f irst to def ine
what constitutes this area. The problem was magnified by the fact that
health services research lacks readily identif table boundaries.
Previously used def initions therefore have varied according to the policy
issues being studied at a particular time.
In its 1978 Report, the Committee provided a definition of health
services research that it still believes encompasses the diverse aspects
of this area:
Health services research is theoretical or applied re-
search which examines the organization and performance
of health care delivery systems and makes possible in-
formed health care policy. It is a distinct area of
inquiry in which systematic methods are applied to pro-
blems of the allocation of f inite health resources and the
improvement of personal health care services.
Because health services researab utilizes the perspectives of many
disciplines, it is useful to view it in terms of a matrix of research
disciplines and research problems. Figure 5.1 presents the matrix,
slightly modif fed from its first use in the 1978 Report (p. 115) of
disciplines (e.g., behavioral and social sciences, biomedical sciences,
and other fields) and problem areas (e.g. , health personnel, ambulatory
105
OCR for page 106
-
a~sueJ~ A601ou4oa} 6U!Pnl3U!)
uawdola~aa pue u6!saa sao!'uaS 4~1eaH
aJe ~ 411eaH 10 sloads~ leJ°!6eMaq°!~°S
Uo!leonp3 glleaH
sa!pniS A~!unwwo~
.
S3!~!1°d 4lleaH
aJe~ 4lleaH ~o s~oads~ leBal
sa!~! l!oe j 411eaH
aa aoueJnss~ A~!len~
. . -
aoueJnSUl 411eaH
uamu!eluo~ ~so~ pue uo!;el~ul
i~
~ .
sweJ6oJd U°!lUa~aJd [US!1040O
X sweJ6oJd uo!;ua'`aJd asnq~ 6nJa
ce sao!AJaS 41leaH lelUaW
.o sao!~aS aJe ) 4~1eaH leJn~
sao!~JaS 411eaH palelaB-~oewJeNd
sao!~JaS 411eaH 6U!SJnN
aJe~ wJal-6uo
sao!~JaS 4~1eaH ue!pul
pa6e~ue'\pes!a a4~ ~oi Sa0!~aS 411eaH
sao!~aS 4~1eaH Aoua6Jaw3
sao'~aS 411eaH le~ua~
sao!~aS 411eaH Pl!4~)
a~e ) AJo~einqw~
auuos~ad 411eaH leluDw
aUuosJad 4lleaH
~ , c ~ ~
. ~ ~ r' ° ~ ° ° '~ C.IS ~ = = ~
106
~n
eo
c~
E
o
Q
V)
o
._
C
C~
._
._
4 -
~n
~n
o
._
-
C
o
U)
C
-
._
._
C~
E
._.
IO
LL
OCR for page 107
care, mental health services, health insurance, quality assurance, and
legal stud ies) .
The Committee has also emphasized that health services research is
not simply an applied f ield, but one that involves f undamenta' research
as well. A full range of research methodolog ies may be utilized,
including statistical and computer analysis, case studies, clinical
studies, survey research, evaluation research, technology assessment, and
dec ision and policy analyst s.
Evaluation of the labor market in an interdisciplinary area suab as
this is cliff ~cult. For health services research, measuring the flow
through the training pipeline cannot be done in the usual ways because so
much of the training occurs outside of traditional degree granting
departments. In addition, many health services researchers have received
nontraditional training, coming to the f ield with professional degrees or
academic doctorates in associated disciplines. To obtain such informa-
tion, a survey was undertaken in 1977 of two cohorts of individuals who
could be ident if fed as important segments of the health services research
labor force: 1) approximately 770 individuals who received support f rom
the health services research training programs of the NCHSR and the
Alcohol, Drug Abuse, and Mental Health Administration (ADAMS) between
1970 and 1976, and 2) approximately 600 individuals who were principal
investigators on NCHSR research grants and contracts between 1960 and
1976. The response rate of both cohorts was 80 percent.
The survey results indicate that there are two distinct populations
of health services researchers. One, principal investigators, is older,
almost exclusively men ~ 91 percent) and is comprised of a large number of
medical degree holders {36.8 percent) as well as research doctorate
holders (41.3 percent). The second group, former trainees, is younger,
includes more women (46 percent), and is comprised predominantly of
research doctorate holders (68. 4 percent) with a much smaller portion of
medical doctorates (9.4 percent). The changing pattern of degree holders
conf irms the Committee's earlier judgment that health services research
has been moving f rom an earlier period, where either no formal graduate
training was received or where training was received informally in
midcareer, to a time when formal training is the norm.
As for employment, health services researchers compare favorably
with their biomedical and behavioral science counterparts. Over 90
percent of HSR trainees and principal investigators were employed full-
or part-time, as was the case in these other fields. Furthermore, un-
employment was very low (2 percent or less) in all f ields. Almost 70
percent of HSR trainees and 64 percent of the principal investigators
were employed in educational institutions, slightly lower than for
biomedical scientists and somewhat higher than for behavioral
scientists. Eighty-nine percent of HSR trainees spent some time in
research, with an overall average of 38 percent in research. Once again
biomedical trainees s bonged a higher average time spent in research (56
percent) than HSR trainees, with behavioral trainees somewhat lower (24
percent). Most importantly, approximately 77 percent of trainees and 81
percent of the principal investigators were engaged in health services
research at the time of the survey.
Overall' the results of the survey indicate that federal support for
training in health services research teas generated a cadre of health
services researchers who are fully employed and actively utilizing their
HSR skills. In addition, there has been no significant loss of federally
supported HSR trainees from academic to industrial employment.
107
OCR for page 108
These findings support the Conunittee's previous recommendations that
a broad program of federal support for HSR training is warranted.
Unfortunately, a positive federal response to this call has not been
made. The only current HSR training program is limited to mental health
services research in which ADAMHA supports 174 trainees ~ 87 predoctoral
and 87 postdoctoral) and 2 f allows as of FY 1980. NIH, which had
previously indicated that it did support HSR training, has recently
reviewed its prog rams and cono luded that it does not provide such
support. NCHSR, which supported 440 students in 1972, was forced to
phase out its training prog rams shortly thereat ter because no f unds have
been provided to NCHSR for this purpose.
Recommendation. It is recommended that 330 health services
research trainees and fellows be supported annually through
FY 1985.
NURS ING BESEECH PERSONNEL
Since the inclusion of nursing research by Congress under the
authority of the NRSA Act in 1976, the Committee has examined personnel
requirements in this area and come to recognize it as a distinct and
emerging area of scientific inquiry. Thus, in addition to its numerical
recommendations of modest increases in student support, the Committee has
made several recommendations in earlier reports designed to improve the
research training capability of doctoral nursing programs: ( 1)
increasing use of training grants, (2) utilizing basic science
departments with established relationships with nursing schools, (3)
focusing support on ~well-qualif led" schools of nursing with existing
capability for research training, ~ 4) phasing out fellowship support in
the consciences, (5) provide ng a limited amount of postdoctoral support
for advanced training, and ~ 6) instituting a midcareer training program
for the upgrading of research skills of current nursing school faculty.
Although the HRA Division of Nursing had research training authority
prior to 1977, it initiated awards under NRSA only at that time. Having
made its initial recommendations, the Committee has taken the position
that the programs should be given an opportunity to become established
before an evaluation is attempted. Therefore, while a full evaluation of
these training programs will not be undertaken in this report, a review
of their status will be useful. The Committee wishes to thank the HRA
Division of Nursing for its cooperation in providing relevant information.
The principal observation to be made about the development of the
HRA nursing research training program is that it has not been funded at a
level that would permit reasonable, modest growth. After a start-up
increase from FY 1977 to FY 1978, funding teas remained level at just
under $1 million annually through FY 1980. With high inflation rates,
the number of individuals supported has declined f rom 127 to 109 between
FY 1978 and FY 1980 and is anticipated to fall further in FY 1981. The
number of fellowships, primarily predoctoral, has decreased from 122 to
95 in that period. In FY 1977, 3 institutional training grants,
primarily postdoctoral, were awarded and renewed through FY 1980 ;
however, no new awards have been made since then. The training grants
have been quite small, supporting a total of 30 trainees over the entire
FY 1977-1980 period. Because of the budgetary constraints, the nursing
programs have not reached the level recommended by the Committee, which
was 270 fellows and trainees by FY 1981.
108
OCR for page 109
While recommending that the preponderance of support be directed to
the predoctoral level, the Committee also supported the use of up to 15
percent of the awards as postdoctoral appointments as high-quality
candidates present themselves. To date, 13 postdoctoral fellowships and
20 traineeships have been awarded between FY 1977 and FY 1980, or 7
percent of all new awards.
One of the primary objectives of the Committee's recommendations for
federal support for nursing research training has been to provide seed
money not previously available for nursing schools to develop high-
quality training programs. The Committee believes that the impact of the
limitations on funding thus far provided has been to inhibit this
development. Furthermore, the proliferation of doctoral training
programs in nursing schools in the last few years has also detracted from
efforts to develop quality training. The number of doctoral granting
nursing schools has risen f ram 16 in 1977 to 23 in 1981, an increase of
over 40 percent. The Committee remains concerned, therefore, that the
unevenness in quality of research training programs evident in its 1977
survey and site visits (1978 Report, pp.131-138) has been perpetuated
rather than alleviated. Given the limited resources, both federal and
nonfederal, for nursing research training, the Committee has suggested
that available funds be directed toward improving programs of demon-
strated capability and that an expansion of doctoral programs be avoided
until a core of quality programs teas been developed.
One positive program designed precisely to strengthen nursing
research has been the Nursing Research Emphasis (NRE) grants of HRA. A
onetime opportunity, the NRE grants were awarded in the fall 1980 to 10
schools of nursing with doctoral programs at an average level of support
of $115, 000 per grant per year. The grants are for 3 years, with a
possible renewal to 5 years. The purpose of the
the development of nursing research by providing
program is to stimulate
funds for faculty
research. Applicants were required to demonstrate their research
capacity and specify the projects that would be conducted. Among the 10
grants, there are 47 component studies on children; adolescents;
beginning families and parenting; aged, chronically ill, and terminally
ill; and minorities and other underserved groups. The Committee is
~ ~ . . . . . _ . . . . .
this important
effort to enhance the research capabilities of doctoral nursing programs.
pleased that the Division or Nursing at HRA iS making
Recommendation.
NBSA support for nursing research train-
ing should rise to 300 trainees and fellows annually from
FY 1982 through FY 1985e No more than 15 percent of these
trainees should be at the postdoctoral level.
am.
109 en!
Representative terms from entire chapter:
nursing research
