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A Dialogue with SHOSHANNA SOFAER
By BRUCE FELTON

More than half the nation's health care providers are nurses, yet little is understood about their impact on patient outcomes, notes Robert P. Luciano Chair of Health Care Policy and Baruch Professor of Public Affairs Shoshanna Sofaer. Widely recognized as an expert in health care policy and related issues, Sofaer has been awarded more than $5 million in funding for research initiatives since joining Baruch in 1998. Now, with a grant from the Robert Wood Johnson Foundation, she is a lead participant in the foundation's Interdisciplinary Nursing Quality Research Initiative (INQRI). Its objective: to identify causal links between nursing and how patients fare.

sofaer

Are nurses underutilized in this country?
No, but they are certainly undervalued. There is a common assumption among health care workers that while nurses make a big difference in patient care it's the doctors who really count. But nurses are the frontline workers in most hospitals and thus have a huge potential to do good—or harm—to patients. Attempting to evaluate hospital care without factoring in their role makes little sense.

Do patients make that same assumption?
From what we've seen from the patient focus groups we've conducted, no. One person's comment was typical. She said, "The doctors breeze in and out of the room, but it's the nurses who tell you what they said." A comment like that really catches my attention.

Tell me something about the methodology of the INQRI.
There are two parts to the study. In the first part, which took place in 2006, we ran focus groups in three cities to elicit patients' views on 15 measures of nursing performance and quality. We are now analyzing the data in preparation for part two: developing meaningful metrics for evaluating the care coordination that nurses provide in a hospital. The hope is that these measures will identify both the contributions nurses make to their patients' health and areas for improvement.

You've been involved in a broad array of major research programs at Baruch as well as George Washington University Medical Center and UCLA School of Public Health, where you taught earlier. Is there a common theme?
Virtually all my research is aimed at making health care systems serve the needs of users, the patients and their families. Too often, health care is geared to accommodate the administration and staff. The focus of the INQRI isn't just to publish our findings but to get those findings used by health care policymakers and practitioners.

Overall, how do you feel about the state of health care in the U.S. today?
It's not nearly where it should be. The problem is that we spend $2 trillion a year on health care and we're not getting value for our money. It isn't that we're spending too much but that we're spending wrong.

Sofaer photo by Jerry Speier