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National Information Center on Health Services Research and Health Care Technology (NICHSR)

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Introduction to Health Services Research : A Self-Study Course

Module 2: Brief History of Health Services Research (Page 21 of 40)

Work of the National Center for Health Services Research and Development and Other Agencies

National Center for Health Services Research and Development

In 1968 the National Center for Health Services Research and Development was created with Dr. Paul Sanazaro as Director. Sanazaro had been a member of the NIH Health Services Research Study Section and had succeeded White as chair in 1966.

The Center initially had broad authority to "support research, development, demonstrations, and related training directed to the improvement of the organization, staffing, delivery and financing of health services, including the design and operation of health facilities."

In the 1970s, however, the influence and impact of the NCHSR&D declined following loses in political favor and budget support.

Growth of Health Services Research in Other Agencies

Compensating for this decline was the growth of health services research in old and new federal agencies, such as the Social Security Administration, the Veterans Administration, and the Health Care Financing Administration (created in 1974 to oversee the Medicare and Medicaid programs), and the continued development of health services research in national research centers and universities.

Instruments that Measure Health Status

The Work of Norman Bradburn

Norman M. Bradburn, Ph.D. produced a measure of psychological well-being that was outlined in a book titled The Structure of Psychological Well-Being in 1969. Bradburn is also the author of numerous books dealing with questionnaire design (Bradburn, 1969).

Lester Breslow's Influence on Health Behaviors

Lester Breslow, M.D. provided scales to measure physical, mental, and social well-being to correspond with WHO's definition of health ("a state of complete physical and social well-being..."). His work in chronic disease epidemiology forged the initial link between health behaviors and quality of life.

Lester Breslow's landmark studies in Alameda County in the early 1960s resulted in the promulgation of the “Seven Healthy Habits” which are now and integral part of public health thinking.

His landmark studies in Alameda County, California, in the early 1960s resulted in the promulgation of the "Seven Healthy Habits" which are now an integral part of public health thinking. (Breslow, 1980)

These habits, now considered part of public health thinking include:

  • not smoking
  • moderation in consumption of alcohol
  • regular exercise
  • weight control
  • eating regular meals (especially breakfast)
  • avoiding between-meal snacks, and
  • getting a good night’s sleep

View Key Projects and Milestones in Health Services Research.

Discussion Questions

  1. While governmental agencies come and go, there is an interesting story behind the loss in favor of NCHSR. Find out what happened and discuss it. (Hint: think of the findings of the PORTS, especially as the results pertain to back pain).
  2. Discuss the impact of special interest groups on the work of researchers and agencies.
  3. As NCHSR grew weaker other agencies grew stronger. Discuss the work of the Social Security Administration, the Veterans Administration, and the Health Care Financing Administration. How important was the continued development of health services research in national research centers and universities? What proof do you have of this? Why were these other agencies interested in supporting health services research?
  4. Breslow's work in establishing the “Seven Healthy Habits” is now an essential part of public health lore. How important was this work and where do we see its influences today? Do you follow some or all of these recommended habits?
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