Personnel Needs and Training for Biomedical and Behavioral Research 1978 Report (1978) / Chapter Skim
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5 Health Services Research Personnel
5 Health Services Research Personnel
Pages 111-127
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From page 111... ...
. Wh at i s not immed i ately apparent to the casual observer i s the fact that attempts to improve health services can g ive ri se to new problems even as the old ones are being corrected.
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From page 112... ...
It is clear that research is needed on the mental he e, th services needs of people who are underserved or inappropriately served at this time (President's Commission on Mental Heal th, rat g 7 ~ ~ ~ Heal th se rv i ce s re se ar ch yi e ~ ~ s in format ion about the organization of the heal th care system so that future attempts to make adjustments in the system wit ~ be based on informed judgments. It draws investigators from a variety of scientific di sciplines who are familiar with the system under invest igation by virtue of training or employment experiences For over 2 years the Committee has identif fed health services research as an emerging area of national need and has attempted to describe the importance of federal support for research training in this area so that more sensible e allocations of our finite heal th resources can be made (NRC, 1975-77: 1977 report ~ .
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From page 113... ...
In expanding earlier definitions for use in this report, the Committee and its Panel on Health Services Research have tried to make a clear statement which is broad enough to encompass the various health systems stud fed by HER personnel . The Committee recogni zes that there is no universally accepted definition of HSR (Myer, 1973; Rein and White, 1977; Mechanic, 1978)
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From page 114... ...
However, this unidimensiona~ display may leave the mi sleading impression that health services research is an "applied" activity distinctly unl Ike the activities that comprise the other, more basic, sciences . In actual fact, heal th services research does inch use fundamental inquiry, often using the experimental methods developed by the social and behavioral sc fences.
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From page 115... ...
. ~ ~ 1 Figure 5.1 primary disciplines of heal~ch services research ~craining and major researct problem areas.
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From page 116... ...
Technology assessment Decision analysis Policy analysis In summary, health services research is a distinct area of scientific inquiry that examines health systems to make information available for future adjustments to the system. Itdraws scientists from a variety of backgrounds who are distinguishable from their colleagues chiefly on the basis of th problem they elect to study -- namely, the health care system.
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From page 117... ...
This system would permit the recognition of any formal health services research training that may be supported by the various institutes, and would permit the development of appropriate recommendations for research training support. ADAMHAe Since the enactment of the NRSA Act in 1974, the research training programs of ADAMHA have included opportunities for mental health services research evaluation training.
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From page 118... ...
, for example, has a program to train HSR personnel for research pertinent to improvement of VA health services.' Twenty individuals presently receive such support through the general education authority of the VA.2 The Stealth Services Research, Health Statistics and Medical Libraries Act of 1974 (PL 93-353~3 authorizes intramural and extramural HSR training authority for the NCHSR, although lack of funding since FY 1973 has virtually eliminated this program of research training even though the training authority continues.4 This review of HSR programs may not be complete if opportunities for HSR training are available in other federal agencies not yet examined by the Committee, such as the Health Care Financi ng Admini stration (HCFA)
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From page 119... ...
Estimating the Number of HSR Personnel Any study that attempts to guide federal policies for research training support on the basis of market descriptions requires such minimum information as the estimated number of investigators in the U.S e labor force in a given year.7 Because of the peculiar way in which health services research personnel are identified, however, the Committee believes that an estimate of the pool of these scientists will not be readily forthcoming, if it can be achieved at all. As a result it will be necessary to develop alternative approaches to labor force discussions in this area.
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From page 120... ...
Earlier in the chapter the Committee identified a number of disciplines that typically represent fields in which HSR may be trained, such as anthropology, biostatistics, or public health. It would beta gross error to use tine' estimated number of doctoral scientists in each discipline tin a particular year as an estimate of the pool of,avaiJab~e HSR personnel, since health services research personnel differ' from their discipline colleagues in their familiarity with the operation of the various health care ' systems.
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From page 121... ...
' In summary, the findings from the Invitational Conference on HSR Personnel convened by the Committee reveal that these investigators are being sought by a variety of employers.' Furthermore, while on-the-job training has been provided in Certain instances, it was not the preferred approach to hiring investigators by the majority of employers who participated in the conference.' Impact of Lost Training Grant Support In A number of conference participants once received institutional training grant support from the National Center for Health Services Research to provide HSR training . Wi thdrawal of support from the academic sector by the federal government in recent years was described as having a profound effect on the research tra, Ring environment .
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From page 122... ...
In contrast to the loss of training grant support for noncategorical HSR training, representatives from mental health services research enjoy a favorable climate for support under the auspices of the MRSA authority. Some noted a proliferation of institutional sites that provide interdisciplinary training in this area as a result of increased funding.~2 In summary, it appears that the availability of NRSA support for training in mental health services research has resulted in expansion of the sites engaged in mental health services research training.
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From page 123... ...
Because the Committee considers the NRSA authority to be appropriate for supporting investigators whose HSR expertise goes beyond mental health services and nursing health services research, the Committee urges that a program of general health services research training be established. Such a program would assure the production of investigators to take up the research and evaluation required by a variety of federal laws, investi123
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From page 124... ...
~4 A o v o A o pi o v to Pi o TO u)
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From page 125... ...
The Commi ttee recommends that a program of general heal th services research training be established uncier the NRSA author i ty . Traineeshi ps/Fellowshi ps The institutional training grant, which permits the development of innovative interdi sc ipl inary research training programs wh ile it strengthens the research setting, i s viewed as the preferred mechan i sm of support i n th i s emerg i ng re sear ch area .
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From page 126... ...
The Committee wi 11 explore possible roles for NRSA support for midcareer research training in health services research in the coming year.
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From page 127... ...
Goldman, San Francisco Community Mental Health Services, NRC Invitational Conference on Health Services Research Personnel, May 17, 1978. 10 e These included representatives from the Rand Corporation and the BI ue Cros s/Bi ue Sh i eld As so c i ation.
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