Report of the

Implementation Task Force

of the 

National Commission on Allied Health

Building the Future

of Allied Health
Building the Future

of Allied Health

Report of the

Implementation Task Force

of the 

National Commission on Allied Health
Suggested Citation

U.S. Department of Health and Human Services. Building the Future of Allied Health: Report of the

Implementation Task Force of the National Commission on Allied Health . Rockville, Maryland: U.S.

Department of Health and Human Services, Public Health Service, Health Resources and Services

Administration, Bureau of Health Professions, Division of Associated, Dental, and Public Health

Professions, 1999.
iii

Foreword

The National Commission on Allied Health was established by Title VII, Section

302 of the Health Professions Education Extension Amendments of 1992 (P.L. 

102-408). The Commission’s congressional mandate was to provide advice to the

Committee on Labor and Human Resources of the U.S. Senate, the Committee on

Energy and Commerce of the U.S. House of Representatives, and the Secretary of

the U.S. Department of Health and Human Services. Pursuant to its mandate, the

National Commission addressed questions related to allied health and the future

role of the allied health professions in the emerging health care delivery system. 

The National Commission’s final report made 12 recommendations specifically

directing the future of allied health, and 4 recommendations related to allied

health education, workforce, research, and data.

The Implementation Task Force consists of eight experts on allied health

education, the allied health workforce, and employer purchasers. The Task Force

conducted a comprehensive review of the Commission’s recommendations on

education reform, outcomes research, and collaboration. Based on the results of

this review, the Task Force developed implementation plans. Three of those 

plans form the basis for three contracts to be issued by the Bureau of Health

Professions for the purpose of implementing the National Commission’s

recommendations. The remaining implementation plans are not currently 

funded. The Implementation Task Force hopes that the National Commission’s

recommendations plus the potential impact of these unfunded strategies will

stimulate their adoption by the major stakeholders in the allied health 

community. The Task Force believes that stakeholders should pursue selected

strategies based on their tie-in with stakeholder values rather than wait for

Federal funding.
v

Contents

Foreword ............................................................................ iii

Executive Summary .................................................................... 1

Chapter 1. Introduction ................................................................ 7

Purpose ............................................................................... 7

Allied Health in Today’s Health Care Environment .......................................... 8

Managed Care ...................................................................... 8

Utilization Control .................................................................. 9

Reengineering ...................................................................... 9

Use of Substitutes ................................................................... 9

Patient Education ................................................................... 9

Educational Preparation, Research, and Collaboration ...................................... 10

Education Reform .................................................................. 10

Outcomes Research ................................................................ 10

Interprofessional Collaboration ...................................................... 11

Funding Change ................................................................... 11

Critical Issues and Selected Strategies ................................................. 12

Chapter 2. Education .................................................................. 15

Purpose .............................................................................. 15

Addressing Diversity and Minority Health and Cultural Issues ........................... 15

Cost Containment .................................................................. 16

Training in Diverse Care Settings ..................................................... 16

Core Curriculum ................................................................... 17

Education and Training for New Skills ................................................ 17

Disease State Management .......................................................... 17

Educating Patients and Families ...................................................... 18

Recruiting Students ................................................................ 18

Linking 2- and 4-Year Institutions .................................................... 19

Increasing Diversity ................................................................ 20

Collaborating on Education Reform ................................................... 20

Implementation Plans for Education ..................................................... 21

Increase Access to Appropriate Clinical Education Sites by Developing Means of

 Identifying the Cost and Other Benefits of Serving as a Site ............................. 21

Develop and Promote Models for Increasing Diversity in Allied Health Education

 Programs ........................................................................ 23

Define Appropriate Scopes of Practice for Allied Health Professions ....................... 25

Establish Core Competencies of Allied Health .......................................... 27

Chapter 3. Outcomes Research ......................................................... 29

Purpose .............................................................................. 29

Type of Research Needed ........................................................... 30

Allied Health Effectiveness .......................................................... 30
vi

Outcomes Researchers .............................................................. 32

Allied Health Research Agenda ...................................................... 32

Funding Outcomes Research ......................................................... 34

Implementation Plans for Outcomes Research ............................................. 34

Develop Clinical Outcomes Measures for Allied Health Treatment across Multiple

 Patient Care Settings for Disease States ............................................... 34

Create a Data Base of State Licensure Requirements for Allied Health Professionals

 and Promote Outcomes-Based Criteria ............................................... 36

Establish Contracts or RFPs to Examine the Clinical and Cost Effectiveness of Allied

 Health Practitioners ............................................................... 37

Establish an Institute for Outcomes Measurement Training of Allied Health

 Professionals That Is Treatment/Patient Focused ...................................... 38

Chapter 4. Collaboration .............................................................. 41

Purpose .............................................................................. 41

Collaborating on Research ........................................................... 42

Collaborating on Education .......................................................... 42

Cost Reduction .................................................................... 43

Care in Alternative Settings .......................................................... 43

Scope-of-Practice Issues ............................................................. 44

Allied Health Representation ......................................................... 44

Implementation Plans for Collaboration ................................................... 45

Convene an Allied Health Collaborative Steering Committee and Conduct a

 Conference to Plan Collaboration Initiatives and Promote an Action Agenda .............. 45

Develop Practical Mechanisms to Increase Representation of Allied Health

 Professionals on Policy and Advisory Boards and Key Deliberative Bodies ................ 49

References ........................................................................... 51

Postscript ............................................................................ 53

Appendixes

Appendix A. Implementation Task Force ................................................. 55

Appendix B. Survey Mailing List ........................................................ 56

Appendix C. Survey Respondents ....................................................... 57

Appendix D. Survey ................................................................... 58

Appendix E. Glossary ................................................................. 68
Report of the NCAH Implementation Task Force

Executive Summary 1

Executive Summary

Role of the Implementation Issues Driving Change in

Task Force Allied Health

The National Commission on Allied Health Today’s dynamic evolution of the health care

was established to examine the role of allied process and system in this country necessitates an

health in our current and future health care evaluation of the role, current and future, of the

system. In 1992, Congress authorized the allied health practitioner. This role is critical and

Secretary of Health and Human Services to meaningful because allied health practitioners

establish the National Commission to study eight make up an estimated 50 to 60 percent of the

areas of concern for allied health. These areas health care workforce. Therefore, by virtue of the

relate primarily to the supply of allied health large numbers of these health care workers,

personnel, appropriate education of these studying and effectively changing allied health

professionals, and research needed on the allied education and practice models will have a

health professions. The National Commission monumental impact on implementing effective

delivered its final report in 1995. care management programs, controlling

Subsequently, the Implementation Task Force

of the National Commission on Allied Health was

formed to ensure that the recommendations of the

Commission were not forgotten, but were acted

upon and embraced by the allied health community and the following stakeholders:

• Professional associations

• Educational institutions

• Government agencies (State, Federal, 

and local)

• Foundations

• Health care delivery systems

• Employers and employee groups or purchasers

• The public

This report presents the implementation plans

recommended by the Implementation Task Force

and reviews the purpose, goals, and impact of

each. In developing the plans, the Task Force

dealt with only those recommendations of the

National Commission on Allied Health related to

three key areas:

1. Education reform

2. Outcomes research

3. Collaboration

utilization patterns, and reducing consumption of

health care resources. Although the allied health

professions represent a multitude of therapeutic,

diagnostic, and preventive areas of health care,

their practices and education have common

elements, and they share a commonality of

purpose and mutual concerns about the health

care delivery system.

As a basis for developing the most effective

plans for implementing the Commission’s

recommendations, the Implementation Task Force

reviewed the issues that are currently driving

change in health care, including change in allied

health practice. The Task Force report includes an

overview of the following issues:

Managed Care—Managed care can offer new

opportunities for allied health professionals, who

can deliver cost-effective specialized services that

reduce total consumption of health care services. 

Conversely, managed care’s emphasis on cost

containment, which lacks sufficient data on the

effectiveness of allied health and other services,

exerts a negative influence on human resource

needs.
Building the Future of Allied Health

2 Executive Summary

Utilization Control—Emerging evidence

demonstrates that allied health professionals

employing utilization control methods (such as

protocols or standards of care) can decrease costs

without compromising the quality of care or

clinical outcomes. Furthermore, evidence is

mounting that utilization control programs

implemented by allied health professionals

actually increase quality and positive clinical

outcomes.

Reengineering—Downsizing efforts may not

be saving money, since those who are

reengineered out of a job sometimes include

personnel who have the expertise necessary to

avoid misallocation and overuse of clinical

services. The focus has been on staff reduction,

not on system inefficiencies, more effective

utilization of staff skills, or safety and error

reduction.

Use of Substitutes—Workers who receive

limited training on the job but do not receive a full

range of educational opportunities, and lack

documented competence, may not be prepared to

provide optimum patient care. Thus, their

services can lead to higher costs and negative

outcomes.

Patient Education—Allied health professionals

are well positioned to provide patient education,

which is indispensable in today’s health care

environment, given the emphasis on self-care and

health promotion. Furthermore, allied health

professionals can encourage behavior modification, which is key in promoting a healthy

lifestyle.

Preparing Allied Health for the

Future

The job of the Implementation Task Force was

to develop a series of implementation plans for

the recommendations of the National 

Commission on Allied Health that relate to

education, collaboration, and research.

Education Reform

The purpose of addressing the educational

system of allied health providers is to ensure that

the educational preparation of allied health

professionals evolves with the health care 

delivery systems. The National Commission

stated that allied health professions have the

expertise to provide the highest quality of care,

but now they must expand their educational

preparation to include consumer education,

wellness programs, and disease state

management, with an eye on appropriate

utilization of services. The Implementation Task

Force kept that goal in mind as it developed the

following implementation plans:

Increase Access to Clinical Education Sites

1. Review the literature for previous studies on

the cost of clinical education to the site and use

that information to develop models for

measurement that include the constraints to

educational programs and health care facilities

today.

2. Identify and consult with representatives of

health care employers, including managed,

long-term, rehabilitation, hospice, and acutecare facilities as well as community health

centers and home health agencies, to address

the issue of the skill mix needed for allied

health students prior to entering the clinical

setting.

3. Identify and consult with a representative

group of at least eight individuals from

educational institutions and allied health

professions, including certificate, 2-year, 4-

year, and graduate programs, to discover the

most prevalent benefits of student internships.

4. Contact a representative sample of allied 

health professional organizations to determine

if information is available concerning the value

to the clinical site of collaborating with an

educational program.

5. Develop a model for use by educational

programs to document the cost benefit of
Report of the NCAH Implementation Task Force

Executive Summary 3

serving as a clinical education site, and assess

the appropriateness of the model by seeking

input from the professional community and

employer consultants.

Increase Diversity

1. Bring together representatives from the 2- and

4-year college programs to work in concert to

address the issue of diversity as it relates to the

allied health programs within the constraints 

of those institutions. Diversity in this context

refers to the effort to match more closely the

cultural and ethnic characteristics of students/ 3. Recommend skill expansions where approproviders with those of the populations served. priate to further enhance the value of the allied

2. Collect existing models and use them to

develop models that are part of a coordinated

approach for use by 2- and 4-year institutions 4. Make recommendations to allied health

in the allied health educational arena in the educators, legislators, and State regulatory

effort to increase diversity among entering bodies concerning the need to educate and

students. retrain allied health professionals so that 

3. Incorporate recruitment, admission,

matriculation, graduation, and placement of

minority group students as the models are

developed.

4. Utilize ongoing needs assessment projects for

allied health professions—such as those being

conducted in South Carolina, Texas, and

Maine—to address the entire country in terms

of needs and diversity. The outcomes of these

projects were to include restructuring of health

professions programs as necessary to (a)

produce graduates with a mix of needed skills

and competencies, (b) define a funding

mechanism to move toward an academic

program mix that will produce graduates with

an appropriate mix of competencies and skills,

(c) promote development of a workforce more

reflective of the ethnic and cultural mix of the

population, and (d) establish a lasting

consortium to link academic programs with

communities to produce health in the State.

Define Scopes of Practice

1. Collect the scopes of practice for all allied

health disciplines, physician assistants, nursing

(including specialists), and pharmacy, and

examine those along with the skills typically

considered to be those of the physician or

dentist.

2. Develop a model to compare and contrast

various skill mixes of allied health professionals. A representative group of payers,

employers, educators, professions, and

accreditors must be involved with the process.

health worker and provide higher quality and

lower cost health care.

health care provision will be as efficient and

efficacious as possible.

Establish Core Competencies

1. Collect information from the professional

organizations on the scopes of practice.

2. Review and integrate the materials, along with

the materials developed through the Far West

Laboratories and Pew Commission, into a

single plan of core education for the 2-year and

4-year programs.

3. Conduct a roundtable of stakeholders to

review the document and recommend

appropriate action.

4. Encourage the Health Care Financing

Administration to incorporate the skill mix

information into the reimbursement programs

they coordinate.

5. Publicize the document to the education,

accreditation, credentialing, and employment

bodies for their use.
Building the Future of Allied Health

4 Executive Summary

Outcomes Research

As with nearly all health professions, there are

few data to document the benefits that allied

health personnel contribute in terms of quality,

cost-effectiveness, and access to health care. This

deficiency is due, in part, to the lack of outcomes

assessment data and the lack of training for allied

health professionals to perform outcomes

research. The following implementation

strategies were developed by the Task Force to

advance the National Commission’s research

recommendations:

1. The Bureau of Health Professions, Agency for

Health Care Policy and Research, payers, and

professional associations should develop

competitive research grants and partnerships

for the development of outcomes research in

allied health. These funding and partnership

opportunities should include measurement of

the clinical outcomes effectiveness of allied

health service delivery in high-cost, highvolume, and high-risk patient populations. 

Disease states such as asthma, diabetes, stroke,

and cancer should be included in multiple

settings such as inpatient, outpatient, home

health, and long-term care.

2. A task force of allied health professional

associations and networks should be convened

to plan the development of a data base of State

licensure guidelines for allied health professionals. The task force should develop a

plan to compare State guidelines and adopt or

develop outcomes-based criteria for licensure

and professional regulatory boards that reduce

State-to-State variations in practice.

3. The Bureau of Health Professions, the Health

Care Financing Administration, or the Agency

for Health Care Policy and Research should

initiate contracts that give priority funding to

applicants who partner with an allied health

profession, health care provider, and a payer to

examine the clinical and cost effectiveness of

allied health practitioners and to develop

models of allied health practices that are as 

 

effective as, and more efficient than, traditional

health-care delivery patterns.

4. Establish an institute for outcomes measurement training that would provide ongoing

support and infrastructure for the training of

allied health professionals as researchers

supported by technology, information systems,

and adequate funding. A Request for

Proposals to conduct a training conference has

been developed and will be open to bid in

1999.

Collaboration

Collaboration is a hallmark of health care, as

separate disciplines work cooperatively together. 

But the challenge identified by the National

Commission is to ensure that each allied health

profession’s unique expertise is leveraged and

used to its best advantage, while a core of

educational concepts (such as practice guidelines,

health promotion, disease management, and

patient education) is embraced by all professions.

The Implementation Task Force recommends

the following strategies to implement the 

National Commission’s recommendations on

collaboration:

1. Support the formation of an Allied Health

Collaborative Steering Committee to promote

collaboration and cohesiveness among the

allied health communities and between allied

health and other key stakeholders, such as

public and private-sector purchasers, employee

and employer groups, foundations,

professional associations, State and Federal

Government agencies, educational institutions,

and the public. The Steering Committee will do

the following:

a. Plan an agenda for action and coordinate,

among the allied health communities and

between allied health and key stakeholders,

the implementation of strategies to address

critical issues and the National Commission

on Allied Health’s recommendations.
Report of the NCAH Implementation Task Force

Executive Summary 5

b. Plan a conference, consistent with the 3. Adapt the Citizen Advocacy Center’s strategies

above, to initiate the interface between for identifying effective public members for

allied health and key stakeholders, to regulatory boards as a template for identifying

promote collaboration to seek positive allied health professionals to serve on policy

solutions, and, where possible, to highlight and advisory boards. This will reduce the

successful statewide initiatives that have barriers to allied health representation.

effectively addressed issues and needs

within a State.

c. Review possible marketing strategies to recommendations by implementing these

effectively promote the collaborative strategies will help the allied health professions to

agenda. take their appropriate place in, and contribute

2. With the allied health leadership from the

Association of Schools of Allied Health

Professions, the National Network of Health

Career Programs in Two-Year Colleges, and

the Health Professions Network, the Bureau of

Health Professions is the agency that should

develop a template to initiate dialogue with

Federal Government and other entities,

including policy and advisory boards and key

deliberative bodies, to assess their mission and

requirements for service and to promote a

consistent message about the benefits of

including allied health professionals as

appointees to those entities.

The Implementation Task Force believes that

advancing the National Commission’s

fully to, the emerging health care delivery

systems. The strategies will advance this goal by

helping to ensure the most productive and costefficient training to meet future needs, developing

tools to document the effectiveness and cost

benefit of allied health services, using data

developed to increase the efficiency of allied

health services, and communicating effectively

with other stakeholders the major contribution

allied health professionals can make to goals

shared by all.
Report of the NCAH Implementation Task Force

Introduction 7

Chapter 1. Introduction

Purpose

This chapter introduces the National

Commission on Allied Health and the

Implementation Task Force. It also provides an

overview of the role of allied health in today’s

health care environment and how that role relates

to the Commission’s and the Task Force’s goals of

fostering education reform, outcomes research,

and collaboration.

The National Commission on Allied Health

was established as concerns grew about mounting

evidence that the number, mix, and education of

allied health professionals may be insufficient or

inappropriate to meet the current and future

demands of the Nation’s evolving health care

system. Congress, in the Health Professions

Education Extension Amendments of 1992

(PL102-408), authorized the Secretary of Health

and Human Services to establish the National

Commission to examine the following issues:

• The supply and distribution of allied health

professionals throughout the United States.

• Current and future shortages or excesses of

allied health professionals, particularly in

medically underserved or rural communities.

• Priority research needs within the allied health

professions.

• Appropriate Federal policies relating to these

matters, including policies concerning changes

in the financing of undergraduate and 

graduate allied health programs, changes in

the types of allied health education, and the

appropriate Federal role in the development of

a research base in the allied health professions.

• Appropriate efforts to be carried out by health

care facilities, schools, programs of allied

health, and professional associations with

respect to these matters, as well as efforts to

change undergraduate and graduate allied

health education programs and to gain private

support for research initiatives.

• Deficiencies and needs for improvement in

existing data bases concerning the supply and

distribution of training programs for allied

health in the United States, and steps that

should be taken to eliminate such deficiencies.

• Problems and recommendations for a

resolution of such problems relating to the

roles and function of professionals within the

allied health fields and other fields such as

medicine and dentistry.

• Encouragement of entities providing allied

health education to conduct activities to

voluntarily achieve the recommendations of

the Commission.

The National Commission on Allied Health

examined these issues and published its report,

including recommendations, in 1995. To move

these recommendations toward action and ensure

that they were not simply read and forgotten, the

U.S. Department of Health and Human Services,

Public Health Service, Health Resources and

Services Administration (HRSA), established an

Implementation Task Force (see Appendix A for a

member list). The Task Force was charged with

conducting a comprehensive review of the

Commission’s recommendations and developing

implementation strategies in three areas:

1. Education reform

2. Outcomes research

3. Collaboration

After completing its assignment, the Task 

Force forwarded the recommended

implementation strategies to HRSA for

consideration by its Division of Associated,

Dental, and Public Health Professions as the basis

for letting three contracts to implement some of

the Commission’s recommendations.

 

 
Building the Future of Allied Health

8 Introduction

During the 3 years since the Commission’s partnering with the allied health community in

report was published, limited efforts have been efforts to decrease health care consumption by

made by all stakeholders, including the allied promoting healthy behaviors, offering access to

health community, to act on the Commission’s clinical services in diverse care settings that are

recommendations on a broad front. Unfor- less-expensive alternatives to hospitals, and

tunately, there has been no comprehensive and providing opportunities for qualified allied health

unified effort that included all stakeholders. Not professionals to promote appropriate utilization

surprisingly, the needs of the allied health of services through the application of practice

community, and of the Nation’s health care guidelines and protocols.

delivery system as a whole, remain unmet. The

Task Force understands how imperative it is for

the allied health community to make significant,

timely progress toward addressing the needs

described in the Commission’s report.

Allied Health in Today’s 

Health Care Environment

Allied health personnel are expert in a

multitude of therapeutic, diagnostic, and

preventive interventions. According to the

Commission, these professionals are leaders in 

the degree and blend of clinical and technical

expertise they bring to their specialty areas. 

Allied health occupations represent approximately 50 to 60 percent of the health care

workforce (O’Neil 1993). Yet this large workforce

is underrecognized in terms of its ability to assist

in the management of health care and the

constraint of costs.

Managed Care

The managed care movement has exerted and

continues to exert a profound influence on our

Nation’s health care system. Managed care is a

term used to embrace several delivery modes, but

the health maintenance organization (HMO)

probably comes most readily to mind.

HMOs generally recognize the impact on

health care costs of the level of utilization or

consumption of health care, both in care settings

and in clinical services. In today’s health care

environment, it seems obvious that these

managed care plans would benefit from

HMOs and other managed care plans have

evolved rapidly over the past decade. In their

earlier stages, HMOs promoted prevention and

wellness as a critical difference between their

structure for health care and that of the fee-forservice indemnity programs usually in place. Due

to their newness and this emphasis on wellness,

HMOs appeared to attract a population that was

younger and had fewer medical conditions than

the population as a whole. Also, chronic medical

conditions had not yet garnered the increased

attention that came with the advent of disease

management programs. These factors 

contributed to the limited use of allied health

professionals by HMOs.

With the maturation of HMOs and managed

care as an industry, the beneficiary profile has

changed. HMO populations are now more

representative of the general population; and the

profile of HMO subscribers—as of consumers

nationally—has changed to include a larger

number with chronic illnesses. At the same time,

health care costs are rising again and are

predicted to reach $2 trillion by 2006 (Smith et al.

1998); and the general increase in chronic 

illness—and overconsumption of services by 

those with chronic illnesses—certainly are

contributing factors. This overconsumption of

services is due largely to a lack of the kind of

expertise and patient education that allied health

professionals can effectively provide.

This health care context plus the current

emphasis on cost containment create an 

important opportunity for managed care plans to

capitalize on the assets of allied health

professionals. HMOs’ scale of operation and

integrated delivery systems permit the cost- 

 
Report of the NCAH Implementation Task Force

Introduction 9

effective use of allied health clinical specialists. eliminated in favor of substitutes performing the

The current focus on disease management, motor skills involved with a particular clinical

encouraged in part by the introduction of quality intervention. Although personnel budgets were

measures through the Health Plan Employer Data cut, these efforts have failed, by and large, to

and Information Set (HEDIS), supports such use, deliver on their promise to constrain costs. 

as does increased public understanding of the Eliminating professionals with the expertise

importance of treating chronic conditions. necessary to avoid misallocation does not save

Utilization Control

Emerging evidence demonstrates that when

allied health professionals are allowed to use

critical thinking skills in the application of Workers who receive limited training on the

algorithms, these providers can decrease costs job without being provided a full educational

without compromising quality of care or clinical background—including indications,

outcomes. Many of the allied health professions contraindications, physiologic effect, etc.—are

have developed practice guidelines that are being simply not prepared to assist physicians or

used on a national level both to guide physician dentists in modifying orders and care plans

ordering behavior and to minimize misallocation commensurate with the patient’s condition. 

of procedures. Misallocation of medical care Opting for a less-skilled provider receiving lower

consists of both over-ordering and under- compensation may appear attractive initially. 

ordering the delivery of services. Effective and Any savings derived from lowering costs per

efficient delivery of care is also impacted by procedure, however, may be quickly negated by a

appropriate sequencing of diagnostic and higher utilization rate that increases total cost. 

treatment procedures. Sequencing has a direct Misallocation must be targeted.

effect on the cost of goods and services provided

and affects length of stay, patient outcomes, and

patient satisfaction (Stoller 1996, 1998).

Reengineering

Since the early 1990s, many attempts have 

been made to constrain health care spending

without compromising the quality of or access to

care. Much time, effort, and money has been

spent to improve efficiency at the bedside through

multiskilling and de-skilling. These tactics have

met limited success at best, due in part to a

miscalculation of the educational resources

required to qualify personnel to provide safe,

clinically effective, and medically necessary 

health care that is accessible and satisfactory to

consumers.

Many personnel reengineering efforts involved

allied health professionals—in some instances,

through downsizing. These experts were simply

money because utilization of services is not

controlled.

Use of Substitutes

Patient Education

The education and motivation of the consumer

are indispensable components of controlling the

use and costs of health care services without

degrading the quality of care. Patient education is

a cognitive process that also requires affective

skills. It is the key to creating a more thoughtful,

health conscious, participative health care

consumer. It is widely accepted that consumers,

especially those with chronic conditions, can

positively influence health care resource

consumption if they are motivated and are

receiving the education necessary to understand

their disease, its acute exacerbation triggers, and

how to monitor their health status. Additionally,

the promotion of wellness and disease prevention

to keep people healthy is probably the most

effective means of cost containment. In many

instances, allied health professionals are well 

 
Building the Future of Allied Health

10 Introduction

positioned to provide this indispensable edu- appropriate utilization of services. The education

cation and to encourage appropriate behavior system must now encompass efforts to impart the

modification as well as ongoing disease knowledge necessary to enable allied health

management followup. professionals to contribute in the new roles of

Educational Preparation,

Research, and Collaboration

Education Reform

The educational preparation of allied health

professionals must evolve consistent with the

emerging health care delivery system. Just as

allied health professionals are expected to expand

their role to include consumer education, disease

state management, and health promotion, so must

allied health educators expand their collaboration

and partnering with all stakeholders. Although

most allied health schools and programs have

mechanisms for feedback from the communities

they serve, the current system has tended to be

more effective in a stable environment than a

dynamic one; allied health educators now face the

challenge to be proactive in pursuing changes that

serve their constituencies well in a rapidly

evolving health care environment. The paradigm

has shifted from “wait and treat” to disease state

management and health promotion. The new

paradigm is to treat and educate community

members so as to “anticipate and avoid” the need

for more costly health care resource consumption.

Has our education system made this paradigm

shift? All health care providers must be prepared

to provide expanded services in a variety of

environments to consumers who range from the

technology-dependent to those with chronic

conditions who self-treat but may require periodic

assessment and consultation. The National

Commission has stated that allied health professionals already own the expertise necessary to

provide the highest quality treatment, but they

must expand education preparation to include

consumer education, wellness programs, and

disease state management, all with an eye on 

 

demand engineer, patient/consumer educator,

disease state manager, and care consultant. The

dramatic changes in demographics, technological

advances, changes in the occurrence and patterns

of disease, and the social context of care must be

addressed by educational reformers.

Outcomes Research

Outcomes assessment data on the clinical and

cost effectiveness of specific health care practices

are urgently needed to guide decision making in

today’s dynamic, changing health care context. 

Few data are available, however, on the most

effective skill mixes and delivery models for allied

health practices—or, indeed, for most other

professional practices. If the goal of quality,

accessible health care at a reasonable cost is to be

realized, credible data on effectiveness must 

guide future change.

The need for such data is particularly acute in

the allied health professions because their

contributions—in promoting wellness, educating

patients and their families in prevention

measures, functioning as disease managers,

delivering quality care, and reducing utilization 

of services—are not widely understood and

appreciated. As a result, they may not be

integrated most effectively into the new health

care delivery models. Given the fact that allied

health professionals represent at least half and as

much as 60 percent of the health care workforce,

failing to use them efficiently could have a

significant and detrimental effect on total health

care cost as well as on clinical effectiveness.

The Implementation Task Force, pursuant to

research recommendations of the National

Commission, proposes in this report strategies to

overcome obstacles to developing the needed

data. These obstacles include a lack of allied

health researchers trained in outcomes research; 

such researchers will be able to provide the data 

 
Report of the NCAH Implementation Task Force

Introduction 11

needed both to increase the efficiency of allied said that the allied health community, when

health practices and to validate the effectiveness broken down into its components, operates 

of those practices for other stakeholders. To within each component’s respective “silo” of

develop the requisite research infrastructure and education and expertise. While it is true that for

move forward, components of allied health must the most part each allied health profession is

collaborate to achieve the following: unique, it is also true that the allied health

1. Establish postgraduate training programs in

outcomes research.

2. Develop a prioritized research agenda.

3. Develop patient-centered clinical outcomes

measures.

4. Promote greater uniformity and outcomesbased criteria in State licensure requirements

for allied health professionals.

5. Support studies of the clinical and cost

effectiveness of allied health practices.

The Task Force believes that moving forward

in these areas will create momentum in the

research area and help allied health professions

improve their clinical and cost effectiveness,

document their value, and make a major

contribution to the goal of all stakeholders:

improving the efficiency and effectiveness of

health care.

Interprofessional Collaboration

The important goals shared by allied health

professionals in this era of rapid change in the

health care system speak powerfully of the need

for interprofessional collaboration. Joint

development and action in many areas, not least

communication with other health care

professions, can help ensure that the cost and

quality benefits of appropriate allied health care

are key elements of the emerging health care mix.

Many allied health professionals work

successfully with physicians, dentists, nurses,

payers, and each other. Efforts continue within

the allied health community to overcome

discipline-specific differences and focus on the

many issues common to all of allied health. A

major challenge facing efforts to expand

collaboration is that the allied health professions

are notable for their unique expertise. It has been 

 

community has a great deal in common. In terms

of depth of knowledge, use of practice guidelines,

and the utilization gatekeeper role, each allied

health profession is generally recognized as the

nonphysician expert within its respective domain. 

These three areas, when combined, can be

leveraged to add a fourth: consumer empowerment through education.

Much information continues to emerge about

the value of disease state management, health

promotion, and consumer empowerment. 

Interprofessional collaboration is essential if allied

health professionals are to influence the shape of

the new health care models, assuming appropriate roles and making a maximum contribution

to future health care.

Funding Change

Several of the National Commission on Allied

Health’s 16 recommendations identified the

Federal Government as a source for funding to

implement these recommendations. In the

intervening 3 years, it has become apparent that if

the recommendations are to be acted upon, the

required funding must come from other sources. 

These sources should include all stakeholders, not

the least of which is the allied health community

itself. Other partners are essential, however; the

funding necessary to succeed cannot be provided

by the allied health community alone. Through

the establishment of strategic partnerships, we 

can undertake the collaborative research and

education reform efforts necessary to identify

models of service delivery that capitalize fully on

the assets of the allied health community. All

stakeholders want unrestricted access to quality

health care at a reasonable cost. Simply put, we

all share the same values. Logic should compel 

us to develop the partnerships necessary to 

 
Building the Future of Allied Health

12 Introduction

realize those values—not just on a short-term, 14. Reverse the negative trend at work

anecdotal basis, but by hardwiring change in the regarding the quantity and type of clinical

roles and utilization of allied health professionals affiliates for allied health education

to assure delivery of optimum services. programs.

Critical Issues and Selected Strategies

The Implementation Task Force undertook a

survey by mail of 45 agencies and institutions

representing all major stakeholders (identified in

Appendix B; respondents listed in Appendix C). 

The survey instrument (Appendix D) addressed

the principal issues identified by the National

Commission on Allied Health to determine the

current validity of those issues. Nineteen critical

issues were identified by survey respondents:

1. Document the value of allied health

professionals.

2. Foster efforts to improve the quality and

quantity of outcomes research initiatives

within the context of allied health.

3. Utilize allied health professionals to their

full potential.

4. Recognize allied health professionals for

reimbursement in all care settings.

5. Protect the public from incompetent

providers.

6. Educate the allied health community

about the changes in the health care

delivery system.

7. Position the allied health community so it

can anticipate changes in the health care

delivery system and be better able to

influence trends.

8. Increase the involvement of consumers.

9. Position consumers to be more effective in

representing the public.

10. Assure quality health care.

11. Document initial and ongoing

competency.

12. Increase communication with the health

care provider community.

13. Increase public awareness of the value of

allied health professionals.

15. Address the challenges manifest with

shrinking education resources.

16. Reposition academic programs to meet 

the needs of the emerging health care

delivery system.

17. Identify appropriate groups with which to

partner.

18. Support Pell Grant funding.

19. Reauthorize the Higher Education Act.

The foregoing critical issues do not vary

substantially from those contained in the National

Commission’s final report. These issues were

considered extensively by the Task Force as it

developed its recommended implementation

strategies.

The Task Force considered all Commission

recommendations related to education reform,

outcomes research, and collaboration and

developed several implementation plans. The

Health Resources Services Administration

selected three strategies for funding. HRSA will

let three contracts in fiscal year (FY) 1999. After

contracts have been awarded, the Task Force and

the project officer will monitor the progress of

each implementation effort. The strategies

selected for funding will address the following

needs:

• Collaboration among allied health professions,

as well as ongoing collaboration among the

allied health community and all major

stakeholders.

• Outcomes research workshops for allied health

researchers.

• Tools to assist educators in developing costbenefit analyses for clinical affiliates.

Subsequent chapters of this report present all

of the implementation plans developed by the

Task Force related to education, research, and

collaboration. Detail on each plan’s purpose,

goals, strategies, and impact is included in the

appropriate chapter. Although, as indicated, 

 
Report of the NCAH Implementation Task Force

Introduction 13

some start-up funding is available for three plans, The Task Force recognizes that there are

the lion’s share of the implementation effort tensions within the evolving health care delivery

remains unfunded. system, caused in part by two contrary trends: 

The Task Force hopes that the clearly outlined

need and projected impact of action will stimulate

efforts to embrace these implementation plans. 

Without movement to act on the National

Commission’s recommendations, it is not

unreasonable to believe that the allied health

community and the health care system in general

will continue to be frustrated in their efforts to

balance the three central health care issues: 

quality, access, and cost. While we may not know The challenges of the emerging system include

the answer to every question—given the upheaval not only the need for allied health to improve

in the health care delivery system of the past collaboration both outside and inside the allied

decade—this much is very clear: It is time to health community; we must also involve allied

partner, to pool resources, and to seek objective health in efforts to study new approaches to

evidence regarding education and care provision balancing health care access, quality, cost, and

models that capitalize on the assets of the allied diversity. Finally, we must revise education

health professional while contributing to high policy to promote more sensitivity to the issue of

quality, accessible health care at an acceptable tying services into provider employer needs in a

cost to a diverse population. Without such a timely fashion.

concerted effort, we should expect continued

hand-wringing on the part of all stakeholders. 

Until we are ready to face the hard questions, and

to seek objective answers to those questions, we

can expect continued erosion of the public’s trust

in our health care delivery system and an

unprecedented cynicism on the part of health care

professionals, who are trained to do the best for

their patients but are frustrated because of cost

reduction imperatives.

Because allied health professionals comprise of work on the part of the Implementation Task

more than half of the total health care workforce, Force. In addition, the Task Force received

they represent a critical mass that can have a assistance in preparing the report from

profound impact on health care access, quality, consultants, professional organizations, and

cost, and diversity. We must fully and associations. Members of the Task Force

appropriately utilize this enormous workforce. acknowledge with gratitude all contributions

Through collaborative research, we can identify made by the many individuals and organizations

optimum use of this national resource; and that provided input.

through education reform, we can assure that all

changes aimed at optimum use of the allied 

health occupations will continue into the future.

the move to “upscale” to include critical thinking,

disease management, etc., on the one hand, 

versus “de-skilling,” on the other. These tensions

can be resolved only if all stakeholders agree to

begin implementation of the Commission’s

recommendations. Inaction equates with

acceptance and perpetuation of the absence of

meaningful collaboration between the allied

health community and all other stakeholders. 

This report is organized into three main subject

chapters, entitled “Education,” “Outcomes

Research,” and “Collaboration,” in addition to the

executive summary, this introductory chapter,

and five appendixes. Also included is a postscript

to bring the reader up to date on three projects

related to the National Commission’s

recommendations that have been undertaken

since the Task Force began its work in December

1996. This report represents an enormous amount
Report of the NCAH Implementation Task Force

Education 15

Allied health professionals can

contribute to more effective use of

their services by exploring new roles

and influencing changes in the

delivery system for health care

services.

Chapter 2. Education

Purpose

The allied health education system is made up

of more than 5,000 programs. These programs

graduate over 79,000 students each year

(American Medical Association 1998). Due to the

large variance in the depth and breadth of various

allied health education programs, the

Implementation Task Force finds that there is no

one education setting that is suitable for all allied

health professions. The existing 5,000 programs

are based at universities, 2- and 4-year colleges,

proprietary schools, and hospitals. This 

education system represents a tremendous

resource to the health care delivery system by

providing a skilled health provider workforce.

Few will argue with the premise that the future

of allied health care will differ greatly from the

present; but the specific future roles, delivery

models, and other aspects of allied health services

and professionals require study before

conclusions can be drawn about the most

appropriate profile. It is clear, however, that

major system forces currently at work will

profoundly influence the allied health

professional, and therefore the allied health

education system. Also clear are certain basic

educational needs.

This chapter is divided into two main sections: 

“Purpose” provides an overview of the forces

shaping change in allied health education and of

the issues that need to be addressed by

educational reform; “Implementation Plans for

Education” presents the strategies selected by the

Implementation Task Force to advance education

recommendations of the National Commission on

Allied Health.

The need for high-quality, low-cost allied

health services is well established. Patient care

outcomes and cost accountability will continue to

grow in value. Based on these criteria, allied

health professionals can contribute significantly to

more effective use of their services by exploring

new roles and influencing changes in the delivery

system for health care services. Health services

will be based on patient and community needs

and must address cultural differences. State

regulatory systems will, over time, allow

certification of new skills, new competencies, and

expanded practice. Indeed, due partly to the

advent of telemedicine and telehealth, we are

beginning to see much more serious discussion

about restructuring the regulatory system for the

health care workforce. The current system will

give way to a system with greater interstate

recognition of competency and credentialing for

all health care providers, including allied health

professionals.

Addressing Diversity and Minority

Health and Cultural Issues

Diversity has been discussed for several years;

all agree that it is important to have a health care

workforce that is culturally diverse and, in effect,

provides a mirror image of the populations

served. A more diverse allied health workforce

will enhance recent efforts in such areas as 

disease state management, health promotion, and

patient/consumer education. The benefits to be

gained from diversity are impeded, however, by

barriers that hinder recruitment and retention of

minority, disadvantaged, and disabled

individuals. Private and public initiatives must 

be developed to prepare diverse allied health
Building the Future of Allied Health

16 Education

Provider employers are demanding

qualified health care personnel who

understand the different corporate

cultures of a variety of care settings.

professionals to address minority health and who are equipped to work primarily in hospitals. 

cultural issues in the delivery of health care. While there are exceptions, relatively few in the

Cost Containment

Changes in the health care delivery system are

slowly driving change in educational programs. 

In some instances, however, the changes brought

about by the new system are working at cross

purposes to the institutions seeking to better

prepare their graduates to contribute optimal

ability and utility. For example, substituting lessskilled personnel and downsizing—early

reactions to the need to reduce costs—can prove

counterproductive.

The emphasis on cost containment is one of the

most profound changes in the emerging health

care delivery system. Educational institutions

have been slow to react to this concept, while

providers and payers have zealously embraced it. 

It is essential that all parties work in concert to

address the educational and other changes 

needed to make effective, cost-efficient use of the

allied health workforce. One strategy that has

been widely adopted to constrain costs is 

increased use of care settings other than hospitals.

It is generally accepted that acute-care facilities

are the most expensive care setting in our system. 

Skilled nursing, subacute, home care, and clinic

settings have experienced a dramatic increase in

utilization in recent years. Provider employers

are demanding qualified health care personnel

who understand the different corporate cultures

of a variety of care settings.

Training in Diverse Care Settings

The allied health education system is generally

organized to provide highly skilled professionals 

skilled provider workforce (physicians, nurses,

allied health professionals) were prepared, as

undergraduates, to work in care settings that

provide an alternative to hospitals. If allied

health professionals are to be utilized effectively,

they must have opportunities to receive clinical

training in these “new” care settings. Unfortunately, many alternative care settings fail to

appreciate the value of establishing clinical

affiliations with allied health education programs. 

It has not been well understood or recognized 

that costs associated with clinical affiliation, or the

lack thereof, take different forms. Many alternative care settings look at the initial costs of

clinical affiliation and consider them prohibitive. 

We are then left with an unmet need. We want

the allied health workforce to be as efficient and

effective as possible in all care settings. To

achieve this goal, the education system must have

access to more diverse clinical affiliations than at

any time in its history. Yet, given the current era

of fiscal belt-tightening, it is extremely difficult for

many allied health programs to maintain hospital

clinical affiliations, let alone expand those

affiliations to home care, skilled nursing, and

other settings.

The Task Force believes there is measurable

value associated with the partnering of an allied

health education program and a clinical affiliate. 

Some of that value may be represented in direct

cost, while other values are more subtle. The 

Task Force believes, therefore, that a strategy to

create an instrument to assist allied health

educators in demonstrating the cost benefit of

clinical affiliations will prove useful. The Task

Force understands the need for cost containment;

rather than fight that trend, it proposes to give

allied health educators a tool for rationally

demonstrating the benefits of clinical affiliations,

to support and encourage them in their efforts to

establish such affiliations in a variety of settings. 

The bases for the formation of those partnerships

must be the values of the provider institutions.
Report of the NCAH Implementation Task Force

Education 17

The Task Force believes there is a

measurable value associated with the

partnering of an allied health

education program and a clinical

affiliate.

Core Curriculum

In recommendations made over the years for

change in educational preparation for the allied

health professions, a core curriculum has been

suggested and demonstrated as a strategy for

change and integration ( Institute of Medicine

1988; O’Neil 1993; Finocchio and Johnson 1995). 

Finocchio and Johnson define core curriculum as

“a set of interdisciplinary courses, clinical training

and other educational exposures designed to

provide allied health students at each level with

the common knowledge, skills and values

necessary to perform effectively in the evolving

health care workplace.” A core curriculum is

urged as a means of promoting a generalist

practitioner who is prepared to be a member of an

interdisciplinary team. A core curriculum would

also promote articulation among institutions of

higher learning as well as foster career mobility. 

Ultimately, the outcome would be a multiskilled

and more efficient workforce. The National

Health Care Skill Standards Project (NHCSSP) 

can be used as a basis for developing a core

curriculum or core curricula for allied health

programs. Founded on a solid research base, the

standards suggest natural groupings for

combining programs or parts of programs (Far

West Laboratory for Educational Research and

Development 1995).

Education and Training for New Skills

Educational programs for students in the

health professions must also change by

introducing new subjects and innovative ways to

prepare the students to function as members of

the health care team. The National Commission 

reported that curricula need revamping to

emphasize prevention, rural and urban health,

geriatric health, maternal and child health, and

interdisciplinary care delivery. The allied health

graduates of the future must possess criticalthinking, decision-making, interpersonal, and

information-technology skills at entry level. 

Beyond entry level, allied health professionals

must have increased management skills,

communication skills, and advanced clinical

competencies, which may include patient-driven

protocol implementation, care planning, and

disease state management expertise. In order to

provide all of this instruction in already-crowded

curricula, innovative methods must be employed. 

Service-learning, cooperative learning, and

problem-based learning are all methods that can

meet some of these needs (Hallowell 1997).

Disease State Management

Health care should be provided based on the

needs of those requiring the care, not on cost or

reimbursement considerations. Ultimately, we

must empower consumers to take more

responsibility for their health. To do this, allied

health professionals, including educators, must

gain an appreciation of patients’ various lifestyles

and cultural backgrounds. If we are to succeed in

efforts to balance access, quality, the cost of health

care, and diversity, we must do better at

anticipating and preventing costly clinical events. 

The entire health care workforce, including allied

health, must follow the paradigm shift from “wait

and treat” to “anticipate and avoid.” Disease 

state management initiatives have shown

promise; while more comprehensive research

needs to be undertaken, early results of various

disease state management programs are encouraging. Costs have been avoided because the

need for treatment has been avoided. Treatment

was avoided because a trained health care

professional was empowered through education

to, among other things, assess a patient’s

condition, monitor compliance with physician’s 

or dentist’s orders, and make recommendations 
Building the Future of Allied Health

18 Education

We must do better at anticipating and

preventing costly clinical events; we

must follow the paradigm shift from

“wait and treat” to “anticipate and

avoid.”

either to the patient (if within the parameters of a nurses. In many instances the allied health

given protocol) or to the physician. Some of these professional has more time to devote to this

efforts have avoided expensive hospital activity and has more frequent contact with the

admissions (McFadden et al. 1995). Success in patient, making patient and family understanding

this endeavor cannot be achieved, however, of the medical situation more likely.

without the requisite critical thinking and

communication skills on the part of the health

care professional and alignment with

reimbursement incentives. Success will also be

elusive without an understanding of the 

culturally diverse patient (Fuller 1994).

Educating Patients and Families

One of the best strategies at work today to

contain the cost of health care is patient

empowerment. Patients with chronic diseases 

can be taught about their disease and their

treatment regimen. Family caregivers can also be

instructed to monitor compliance when practical

to do so. Patients who avoid unhealthy behaviors

can decrease consumption of health care

resources. It is also generally understood that

patients who comply with physician orders tend

to make fewer physician office visits and

emergency department visits and are admitted to

the hospital at a lower rate (Rich 1995).

Allied health professionals need to be prepared

to fulfill the role of patient educator. To succeed

in this endeavor, we must modify current

curricula to include behavior modification,

communication, skills building, and patient and

family education. Many in allied health are

currently contributing to patient education; but

adding these skills to upwards of a million allied

health professionals would create far greater

access to these needed services, adding

substantially to the efforts of physicians and 

Recruiting Students

To ensure a constant supply of qualified allied

health professionals, a mechanism to establish 

and maintain a cohesive recruiting system must

be established. Recruitment of students into 

allied health professions should begin at a young

age, perhaps even before high school. Tours,

buddy systems, school demonstrations, and 

career days are examples of activities that can

introduce students to allied health programs

(Mishoe et al. 1993). A 1992 survey conducted in

New Jersey and involving 140 allied health

program directors affirms the potential value of

such activities. Survey respondents indicated that

early exposure to allied health fields can be

effective in identifying elementary, junior high

school, and high school students who are strong

academically and who may be interested in allied

health careers (Maillet and Anesetti 1993). 

Another New Jersey survey asked high school

seniors about factors governing their choice of

careers. Most indicated that personal satisfaction,

employment opportunities, and income were the

most important factors. Although more than 75

percent of the respondents had a favorable

impression of allied health, only 15 percent

indicated that they were very familiar with the

allied health professions. One could conclude,

therefore, that it is not a lack of interest in allied

health that causes enrollment vacancies, but 

rather a lack of knowledge about the allied health

professions.

We sometimes pay for this lack of knowledge

by experiencing shortages of certain allied health

professionals. Given the fact that human

resources comprise one of the major cost

components associated with health care, cost

containment efforts can be adversely affected by

the periodic scarcity (and consequent higher cost)
Report of the NCAH Implementation Task Force

Education 19

Recruitment of students into allied

health professions should begin at a

young age, perhaps even before high

school.

of human resources. Such shortages work against for allied health education. One of the reasons 2-

all other efforts to provide access to quality health and 4-year colleges have difficulty collaborating is

care at an acceptable cost. To conduct the that the research orientation of 4-year colleges

educational work necessary to inform and recruit may conflict with the pedagogical interests of 2-

students, linkages are needed between allied year colleges. Four-year colleges have a select set

health professions, elementary and high schools, of courses required for graduation and may 

and colleges. refuse to offer credit for essentially the same

In a relevant undertaking, the National

Consortium on Health Science and Technology

Education (NCHSTE) has proposed the

establishment of a Health Science Building

Linkages Career Path Project to help students at

every level understand the connections between

what they learn in school and what they will do 

in the workforce. A principal purpose of the

project is to help students understand all of the

opportunities available to them in health care as

they begin to consider various careers. Each

activity of the project is based on national

standards in science, mathematics, language arts, Finally, it must be noted that when graduates

health science, social science, physical education, of health career programs of 2-year colleges

and health care. The project requires the pursue baccalaureate degrees, they frequently

establishment of partnerships across the school find that their technical course work does not

setting and beyond: among the K–12 system, transfer—even though the technical course work

higher education, and the health care industry is often as demanding as upper division graduate

(NCHSTE 1998). work at 4-year colleges (Rensch 1994; Council for

In 1989, the Institute of Medicine (IOM)

published a study stating that linkages between

colleges and high schools are playing an

increasingly important role in encouraging the

educational preparation of allied health

professionals. Linkages appear to work well

when there is mutual benefit and shared

commitment, regardless of whether the

arrangement is formal or informal (IOM 1989).

Linking 2- and 4-Year Institutions

Linkages between community colleges and 4-

year institutions have presented some difficulties

course provided by a 2-year college. University

faculty contend that many courses offered by 2-

year colleges are less thorough than comparable

courses taught in the first 2 years of a

baccalaureate program. Two-year colleges 

believe their exclusive teaching mission allows

them to thoroughly prepare students for upper

division work. Conversely, university faculty

believe that, because of 2-year colleges’ open-door

policies and remedial programs, some courses are

simplified or watered down (Barry and Barry

1993).

Allied Health in North Carolina 1994). This

situation creates problems in designing career

ladders for the allied health professions, which 

are further compounded by the lack of

interdisciplinary course work at either level.

Several initiatives are under way to assist in

solving the articulation problem. They include

program-specific 2+2 agreements, systemwide

consortium agreements, and dual admissions. 

The 2+2 program agreements usually refer to a

standard set of mutually agreed upon courses that

are completed at the 2-year college and then

transferred as a group to the 4-year college. 

Consortium agreements require specific, welldefined goals, strong support from high-level

administrators, adequate funding, and an overall

program director who must communicate

effectively with each institution. Dual-admission

articulation arrangements protect the integrity of

the associate degree yet ensure that the 2-year 

 
Building the Future of Allied Health

20 Education

Racial and cultural minorities, as well

as the disadvantaged and the

disabled, should achieve

representation in allied health

education, practice, and leadership

that reflects the demographics of our

society.

college transfer student will receive predictable, they must be prepared to furnish. Kaiser

consistent, and equitable treatment from the 4- Permanente in northern California was one of the

year institution. The student who applies to a 2- first managed care plans to focus on pediatric

year college and agrees to take a specific set of asthma. Cost was an overriding consideration

courses can be simultaneously admitted to a 4- when employers noted that employees were

year institution (Rensch 1994). missing work to take their children to the hospital

Increasing Diversity

African Americans, Hispanics, Native

Americans, Alaska Natives, Asian and Pacific

Islanders, and other racial and cultural minorities,

as well as the disadvantaged and the disabled,

should achieve representation in allied health

education, practice, and leadership that reflects

the demographics of our society. In order to 

make this possible, educational institutions must

undertake collaborative efforts to gain support to

establish elementary and secondary programs 

that provide early exposure for minorities, the

disadvantaged, and disabled Americans. The

allied health education community must work

with foundations and other organizations to

develop an education and practice agenda for

achieving increased representation in allied health

for minorities, the disadvantaged, and the

disabled.

Collaborating on Education Reform

Clearly, the allied health education system

must change if it is to produce allied health

professionals who can work across all care

settings; provide treatment, education, and

consultation; and assist in controlling the demand

for services, thus containing costs. Asthma

provides a good example of the kinds of services 

 

for care or admission. Student grades suffered as 

a result of absenteeism due to illness. By

establishing interdisciplinary teams that focused

on teaching the child and the family how to

manage the disease, hospital admissions were

reduced and absenteeism from school and work

was substantially curtailed (England 1997).

Despite such evidence, it is still very difficult to

bring about change. The barriers identified in the

National Commission’s report include inflexible

curricula, accreditation standards, licensure

requirements, degree requirements, and

disciplinary boundaries. These barriers must be

removed through collaboration with employers,

insurance companies, State licensing agencies, 

accrediting bodies, professional associations, the

public, and other consumers.

The current state of practice is a reflection of

the old health care delivery system, partly 

because of the slow pace of educational reform,

and partly because allied health professionals

have not been involved in the decision-making

process for health care reform. As the health care

delivery system evolves, so should the roles of

allied health professionals. The allied health

education system must enable these professionals

to expand beyond the “wait and treat” paradigm. 

The system must prepare students to work in a

multitude of settings, where they will encounter

patients at every stop across the continuum of

care. Education reform must be undertaken,

therefore, not just by educators and the allied

health professions, but by a group representing all

major stakeholders. The overarching goal uniting

all stakeholders must be to prepare allied health

professionals to provide a wide range of services

in such a way as to optimize access to needed

services, provide positive clinical outcomes, and

maintain cost-effectiveness.
Report of the NCAH Implementation Task Force

Education 21

The benefits and cost-effectiveness of

serving as a clinical education center

must be identified and

communicated.

Implementation Plans for

Education

Plan: Increase access to appropriate clinical

education sites by developing means of

identifying the cost and other benefits of

serving as a site.

NCAH recommendation addressed:

Recommendation 11. Allied Health educational

programs at all levels and in all settings should

collaborate with each other and with other health

professions to create a broader and more effective

educational system. The development of

partnerships within educational institutions and

with the health services industry should prepare

practitioners to meet workforce demands and

maximize resources.

Purpose of Plan

The access to appropriate clinical education

sites must be addressed to assure the continued

quality of education for allied health professionals. Now that the health care system has

evolved from primarily an acute-care focus to

include the community-based care settings

(ambulatory care, home health care, long-term

care facilities), clinical education sites must be

expanded to include such facilities. Major reports

on health care reform call for clinical education in

these settings (Pew Health Professions

Commission 1995). However, these partnerships

have been slow in developing. In fact, a number

of constraints have resulted in a decrease in

available clinical education sites. These

constraints include the following:

• Concern about the financial impact of

providing educational training in the health

care setting has resulted in fewer education

sites. Reasons for the reduction are not only

that delivery of care is the primary mission of

the sites, but also that the benefits—to the 

 

health care delivery system as well as to allied

health professionals—of education in the

clinical sites have not been delineated.

• Reduction of funding to institutions for health

care training has decreased incentives to accept

students.

• Reengineering and downsizing have decreased

clinical staff flexibility to participate in the

educational process. A process must be

developed to make clinical education needs

and new staffing models compatible.

• State boards or accrediting bodies mandate the

amount and type of clinical experiences

required for a sanctioned level of competence. 

These mandates have not been modified to

reflect the changes in health care delivery

settings. For many professional areas, the

curriculum still includes only components

offered in limited health care settings,

primarily hospitals. A decrease in specialized

clinical settings for education has led to an

increased demand for educational programs at

these limited settings.

The benefits and cost-effectiveness of serving 

as a clinical education center—not only to the

provider, but also to the educational system—

must be identified and communicated. 

Partnerships should be developed within the

allied health community to address this need. 

The partnerships should include multiple

disciplines, payers, providers, and accrediting

bodies. Such collaborative action, as proposed in

this plan, will produce a document that will

identify the need for and support the use of all

types of health care providers for clinical

education.

Since a variety of clinical experiences are

required by licensing boards and accrediting

agencies, the educational programs are required
Building the Future of Allied Health

22 Education

to utilize these resources. The tangible benefits to organization under study, and a member of the

the clinical agencies who provide the clinical Task Force. The model they create will be

practice experiences need to be highlighted. In considered a pilot, with input from the

addition, there are intangible benefits that must employers and the respective professions, and

be enumerated. The contract to be let based on will serve as a model for further study. It is

this implementation plan will identify those anticipated that this project will require two

benefits and develop a model for assessing their meetings of the focus group and at least two

validity in specific cases. This model could be conference calls.

used by all allied health disciplines or schools as

they conduct studies in their community to

document benefits.

Other reports have identified the importance of patient satisfaction, reduced employee

strengthening the tie between community-based frustration during the first year of 

practice and education. For health care education employment, and less need for employee

to be most effective, the skills taught and training programs. Models that have been

practiced must more closely emulate the desired used in the past have addressed these issues,

work-skill set. This can only be accomplished if but none are available that reflect the

the employers and educators collaborate to multidisciplinary approach needed to address

enhance clinical education opportunities. the issues facing the system today. The focus

Program standards, accreditation issues, and group must collect those models used in the

clinical access must all be reviewed to support an past and adapt them to address the constraints

effective, appropriate clinical education system in today’s environment.

that meets current and projected education needs. 

The current emphasis on cost requires that a tool

to validate the benefits of serving as a clinical

education site be developed and provided to 

potential partners in clinical education.

Goals of Plan

1. Identify or develop models of prototypes that

have been used and can be used in the future 

to develop collaboration efforts between

employers, professional organizations (at least

two disciplines), health care industry partners

(e.g., health systems or plans), and educational

program representatives.

2. Establish a focus group representing all

principal stakeholders to collect information

for and create a representative model that can

be used by educators and employers to

consider the cost and benefits of the use of

various clinical sites by education programs. 

The focus group shall include one

representative from employers, one from each

accrediting agency, one from each professional 

 

3. Include in the model measures to assess such

values as decreased cost of recruitment,

reduced turnover of employees, increased

4. Recommend other mechanisms for attaining

the clinical practice skills necessary in the work

environment today.

5. Identify methods to measure the direct and

indirect costs of student education.

6. Summarize the information collected in a final

report. Identify the following in the report:

• Benefits of serving as a clinical education

site.

• Variable overhead costs for different types

of clinical sites (e.g., acute care, long-term

care, home health), substitute experiences

(simulations), or modifications to didactic

and laboratory training necessary to

facilitate entry into the clinical setting.

• Level of student skills desired for access to

the clinical sites.

Implementation Plan

1. Review the literature for previous studies on

the cost of clinical education; use that 

 
Report of the NCAH Implementation Task Force

Education 23

information to develop models for end product of this plan (and of the contract that

measurement that include the constraints to resulted from it) will be a document that includes

educational programs and health care facilities a list of benefits associated with serving as a

today. clinical education center and a mechanism for

2. Identify and consult with a representative

group of employers—including managed care

organizations, long-term acute care facilities,

community health centers, and home health

agencies—to address the issue of the skills mix

needed by allied health students when they

enter the workforce.

3. Identify and consult with a representative

group of at least eight individuals from

educational institutions and allied health Plan: Develop and promote models for

professions, representing certificate, 2-year, 4-

year, and graduate programs, to identify the

most prevalent benefits of student internships.

4. Contact a representative sample of allied 

health professional organizations to determine

if information is available about the value to

the clinical site of hosting an education

program.

5. Develop a model for use by educational

programs to document the cost benefit of

serving as a clinical education site.

6. Assess the appropriateness of the model by

seeking input from the professional 

community and employer consultants.

It is anticipated that the time line for the 

project will be as follows, measured from the

beginning of the project:

• 3 months: focus group developed

• 9 months: information collected and responses

reviewed

• ? months: summary and a final report

completed

Impact of Plan

These models and documentation can be used

to develop partnerships between the educational

institutions and the health services industry to

meet new educational needs and workforce

demands in an effort to maximize resources. The 

 

determining the cost-benefit analysis, which will

be used to assist the educational institutions. The

projected long-term impact will be to meet the

needs of the health care workforce by developing

a better-prepared health care worker, and to

validate for the providers the real cost of

supporting the educational process for health care

workers.

increasing diversity in allied health

education programs.

NCAH recommendation addressed:

Recommendation 3. As a matter of priority, care

should be taken to attain representation that

better reflects the populations served by allied

health providers. If the goal is optimal delivery of

care, relevant and accessible education, and

performance of high-quality research, every part

of the system must speak to the consumer.

Purpose of Plan

Current enrollments across the allied health

professions do not reflect the diversity of the

population served. In 1988, the Sixth Report to

the President and Congress on the Status of

Health Personnel in the United States (USDHHS

1988) identified a misrepresentation of blacks,

Hispanics, and Native Americans in health care

fields. This report further predicted a continuing

shortage of these minorities, yet little has been

done in the past 10 years to achieve a balance in

allied health. Subsequent reports (1990, 1992)

confirmed that this trend had not improved, but

instead had worsened as the population served

included increasing numbers of the members of

these groups (USDHHS 1990, 1992).

Diversity in the field of health care has been an

issue for many years and will continue to worsen
Building the Future of Allied Health

24 Education

if active steps are not taken to resolve the issues. 3. Communicate to the health education

The problem is less severe in allied health than in community the recommended action for

other health professions. However, the numbers advancing diversity in allied health.

still do not represent the community of the

individuals served. While specific programs to

remedy the imbalance have operated at various

schools, there has been no unified effort to date 

on the part of the allied health community to

achieve diversity in that area of health care. Since

allied health includes multiple disciplines, it is

very likely that this issue will not be addressed

unless there is action to bring the stakeholders to

the table specifically to discuss lack of diversity

issues.

Achieving diversity should be a goal for the

allied health professions as well as the educational programs for those disciplines. More

colleges and universities with predominantly

minority student bodies must begin to 

incorporate allied health studies into their

curriculum. Only 2.7 percent of these institutions

offer allied health programs. In addition,

initiatives such as “Tech Prep” and “Building

Linkages” should be expanded in areas with large

minority and disabled populations. These

programs must be carefully integrated into the

existing allied health programs. To better meet

the needs of the community and of the individuals seeking care, the background of the health

care workforce should be similar to that of the

clients. Efforts to recruit into the health care field

those individuals who live in the communities of

greatest needs should be addressed in a coordinated manner at a national level and instituted

at the local level in the university and college

programs.

Goals of Plan

1. Create a forum for discussion of existing

successful models for creating the appropriate

diversity mix in current allied health programs

in the 2- and 4-year academic programs.

2. Identify the resources for and constraints of

achieving diversity at the 2- and 4-year

academic institutions.

Implementation Plan

1. Bring together representatives from the 2- and

4-year college programs to work in concert to

address the issue of diversity as it relates to the

allied health programs within the constraints 

of those institutions.

2. Collect existing models and use them to

develop models that are part of a coordinated

approach, for use by institutions in the allied

health educational arena in the effort to

increase diversity among entering students.

3. Incorporate recruitment, admission,

matriculation, graduation, and placement of

minority students as the models are developed.

4. Join with ongoing needs assessment projects

for allied health professions—such as those

being conducted in South Carolina, Texas, and

Maine—in an expanded project to address the

entire country in terms of needs and diversity. 

The outcomes of these projects were to include

restructuring of health professions programs as

necessary to (a) produce graduates with a mix

of needed skills and competencies, (b) define a

funding mechanism to move toward an

academic program mix that will produce

graduates with an appropriate mix of

competencies and skills, (c) promote

development of a workforce more reflective of

the ethnic and cultural mix of the population,

and (d) establish a lasting consortium to link

academic programs with communities to

produce health in the State.

If item 4 above is conducted jointly with the

existing pilot projects, this implementation plan

could be completed within 1 year and publicized

and distributed to 2- and 4-year academic

programs for allied health.
Report of the NCAH Implementation Task Force

Education 25

Impact of Plan

Educating the public about allied health

professions is critical to increasing diversity. 

Many of those in the community who are

selecting health care as a career do not know

about the various professions of allied health. In

order to effectively address the issue of diversity,

we must begin to educate the community about

allied health and its important role in health care. 

Another issue to be addressed is development of

workforce needs data, including the appropriate

diversity mix for different areas of the country. 

Finally, documenting the benefits of diversity

through a comparison of outcomes (patient

satisfaction, compliance, and reduced length of

illness) using (1) the current health care workforce

and (2) an appropriately diverse health care

workforce would provide a powerful tool for

influencing educators, providers, and potential

students to actively support greater diversity. 

Implementing all of the strategies outlined in this

plan will have a significant impact, over time, on

diversity in the allied health professions.

Plan: Define appropriate scopes of practice for health care fields. Informed and coordinated

allied health professions.

NCAH recommendations addressed:

Recommendation 5. Allied health professionals,

other members of the health care team, and health

care management should collaborate to foster

understanding and appreciation of one another’s

unique and collective interests and capabilities.

Recommendation 6. Professional associations,

credentialing agencies, accrediting agencies,

payers, consumer groups, and government 

should undertake efforts to reduce existing

barriers to clinically effective and cost-efficient

scopes of practice for those whose scope of

training currently exceeds their scope of practice

and for those who add new or multiple

competencies in the future.

Recommendation 7. As is the case for all health

professions, the provision and financing of 

 

services furnished by allied health professionals

should be based on objective and scientific

information that validates the clinical

effectiveness and cost efficiency of service 

delivery models.

Purpose of Plan

A current imperative of the health industry is

to manage more illness with fewer resources,

while promoting wellness and prevention. One

result of these pressures—and a major issue 

facing health care—is that some workers are 

being asked to perform tasks for which they have

no education or experience, while others who

have the appropriate education are underutilized

in the health care setting. The allied health

professions can meet the criteria to provide the

high-quality, low-cost services demanded in

today’s environment. Many of the skills desired

in the health care arena today are taught in allied

health curricula. Unfortunately, so little is known

by the public and the payers about the allied

health fields that employers are often unaware of

the abilities of these professionals in specific

planning is essential as future changes occur in

health care. Without involving all parties in the

process, the efficiency of allied health education

may decline. Allied health educational systems

must collaborate with the key stakeholders

(employers, insurance companies, State licensing

agencies, accrediting bodies, professional

associations, the public, and other consumers) to

create educational offerings that are responsive to

the needs of the emerging health care system—

and to revise educational preparation and

continuing education programs to promote

multicompetent health professionals.

Allied health professionals must change the

way they view themselves and what they 

consider to be within their scope of practice. At

the same time, employers of those individuals

must have input to the educational process so that

the employee will be able to function at the

desired level. The Education Committee of the

National Commission on Allied Health reported, 

 
Building the Future of Allied Health

26 Education

“Even though the allied health education system 2. Produce, as an end product, a more efficient

comprises over 4,000 active programs and health care workforce with a higher level of

annually graduates over 100,000 students in skill and no sacrifice in quality of care. Barriers

programs based in hospitals, in 2- and 4-year and turf issues will be addressed, and the

colleges, and in universities, little has been done appropriate scopes of practice and levels of

to better understand and mobilize this health care delivery will be determined. 

tremendous resource. A more complete Education will become more efficient and

understanding of the current as well as future allied health professionals will be fully used to

potential of allied health education is a critical assure high-quality, low-cost health care.

first step in addressing market needs for access,

quality, and cost containment.”

The ability of allied health professionals to

deliver a wide range of health care has long been

overlooked. While allied health professionals are

essential players in hospitals and outpatient

facilities, the core skills of these individuals in the

various disciplines are often not well known to

the public, other health care workers, and those

who purchase the services they can provide. As a

result, they are greatly underutilized. In many

cases, skill mixes of allied health practitioners

could be incorporated into other professional

categories, yet barriers to such change have not

been challenged. Failure to act on these recommendations from the National Commission on

Allied Health will result in an ineffective,

inappropriate, and costly health care delivery

system.

Goals of Plan

1. Conduct a formal study involving payers,

providers, educators, and the professions to

determine the most efficacious mix of skills for

each allied health profession. The stakeholders

should make these determinations collaboratively so as to remove existing barriers to

communication and understanding between

employers, educators, and the professions. 

This strategy would result in a determination

of the effectiveness both of the current skill mix

for allied health professionals and of an

expanded skill mix and would identify those

skills that are appropriate to a certain level of

the practitioner.

Implementation Plan

1. Collect the scopes of practice for all allied

health disciplines, nursing, and pharmacy and

consider those along with the skills typically

considered to be those of the physician or

dentist.

2. Develop a model to compare and contrast

various skill mixes of allied health

professionals. A representative group of

payers, employers, educators, professions, and

accreditors must be involved in the process.

3. Recommend skill expansions where

appropriate to further enhance the value of the

allied health worker and increase the costeffectiveness of providing higher quality and

lower cost health care.

4. Make recommendations to allied health

educators, legislators, and State regulatory

bodies concerning the need to educate and

retrain allied health professionals so that 

health care provision will be as efficient and

efficacious as possible.

Impact of Plan

Implementing this plan will address the critical

issue of defining the appropriate skill mix for

allied health professionals and the appropriate

educational level for that mix. The project will

also address relevant curriculum, licensing,

accreditation, and turf issues and will identify the

skill mix desired by the employers of allied health

personnel. Changing curricula typically is a slow

process. Implementing this plan will require 
Report of the NCAH Implementation Task Force

Education 27

collaboration and understanding, but the result threatened could participate in the development

will be a more effective and efficient educational of curriculum changes; they would realize they

process and health care system. can benefit from sharing those portions of the

Plan: Establish core competencies of allied

health.

NCAH recommendations addressed:

Recommendation 5. Allied health professionals,

other members of the health care team, and health

care management should collaborate to foster

understanding and appreciation of one another’s

unique and collective interests and capabilities.

Recommendation 6. Professional associations,

credentialing agencies, accrediting agencies,

payers, consumer groups, and government 

should undertake efforts to reduce existing

barriers to clinically effective and cost-efficient

scopes of practice for those whose scope of

training currently exceeds their scope of practice

and for those who add new or multiple

competencies in the future.

Purpose of Plan

Without a major effort to effect changes in the

delivery of allied health curricula, professional

groups will not advance rapidly, if ever, toward

needed integration of allied health disciplines. 

Changing the educational and accreditation

processes is slow at best; implementing this plan

to define and establish core competencies will

facilitate such efforts and produce change more

rapidly. Many skills currently are taught to all

allied health professionals. In many cases these

skills are, or should be, generic to all health care

workers. Identifying these skills and collaborating across professions to establish core

competencies will increase the efficiency of

educational delivery—and help ensure

appropriate training for future needs.

Barriers that prevent crossing professional

boundaries and foster opposition to change 

would be greatly reduced if those who feel 

curriculum where there is overlap without losing

professional autonomy. The barriers must be

removed if health practice and education are to

change to meet the new demands for both

efficiency and effectiveness. Undertaking a true

collaborative effort to identify core skills will

focus attention on the need for reform in

educational and professional boundaries and

advance productive change.

Recommendations 5 and 6 from the National

Commission call for collaboration among allied

health professions and more efficient delivery of

the educational programs for the disciplines of

allied health. Collaboration has been hampered

by barriers between credentialing, licensing, and

accrediting bodies as well as between professional

groups, in the form of turf battles. It has been

suggested that allied health professions must

strive to “up-skill” themselves. There has been no

action on this suggestion, however. Certain skills

in each profession are universal (i.e., common to

all the professions), some are shared by some

professions, and some are unique to one

profession. This project would bring all of the

universal skill sets together and begin the process

of moving toward a more responsive workforce. 

Success in this effort requires representation from

all professional groups, and open communication

and sharing. Recommendations from the Pew

Commission and, subsequent to that, from Far

West Laboratories have included models for

clustering of allied health professions. These

models have been accepted by some of the

stakeholders, but there has been little action to

move them forward and increase acceptance

within the various disciplines. These models 

have not addressed the issues of licensing and

certification.

Goals of Plan

1. Advance the previous work of Far West

Laboratories and the National Committee on
Building the Future of Allied Health

28 Education

Health Science and Education Technology on Materials developed through the Pew

better preparing the allied health professions. Commission and Far West Laboratories have

2. Identify those skills that are generic to all allied

health professional curricula.

3. Encourage collaboration among the

stakeholders of the health care system in

identifying and establishing core 

competencies.

4. Create a more efficient method of educational

delivery and a more acceptable graduate for

the workforce.

Implementation Plan

1. Collect information from the professional

organizations on the scopes of practice.

2. Review and integrate the materials, along with

the materials developed through the Far West

Laboratories and Pew Commission, into a

single plan of core education for the 2- and 4-

year programs.

3. Conduct a roundtable of stakeholders to

review the document and recommend

appropriate action. 

4. Encourage the Health Care Financing

Administration to incorporate the skill mix

information into the reimbursement programs

they coordinate.

5. Publicize the document to the education,

accreditation, credentialing, and employment

bodies for their use.

promise for creating a less barrier-driven system

in terms of skill mix and efficiency of delivery, yet

no pilots have been conducted. These plans also

have not been used to address the issues of

credentialing, accreditation, licensing, and

professional boundaries. This project would not

only promote coordination and collaboration, but

would also incorporate into planning the payers

of the health care system and a more diverse

representation of the allied health professions.

Impact of Plan

All of the issues surrounding scopes of

practice, turf, and licensing will be addressed as

the project develops. This plan will advance the

revision of accreditation standards and

professional curricula to meet the demands of the

core concept. While much of the groundwork has

been completed for such a project, the key to

acceptance will be early participation by the

professional organizations involved in the

changes. Implementation of this plan will

encourage employers to begin to fully utilize the

core of knowledge that allied health professionals

possess and to realize that an expansion of this

knowledge is within reach.
Report of the NCAH Implementation Task Force

Outcomes Research 29

Few data are available to document

the added benefits that allied health

personnel contribute in terms of

quality, cost-effectiveness, and access

to health care.

Chapter 3. Outcomes Research

Purpose

Allied health providers are the largest and

most diverse group among the health care

professions, representing approximately 50 to 60

percent of the total health care workforce (O’Neil

1993). Economic and consumer pressures to

provide cost-effective, quality health care services,

as well as an aging population requiring home

care and extended care, will increase the demand

for allied health staff. Conversely, uninformed or

shortsighted cost-cutting measures could delay or

prevent appropriate use of this workforce. As

with nearly all health professions, few data are

available to document the added benefits that

allied health personnel contribute in terms of

quality, cost-effectiveness, and access to health

care (Barr 1993). This deficiency is due, in part, to

the lack of outcomes assessment data and the lack

of training for allied health professionals to

perform outcomes research.

Obstacles to obtaining the needed data include

both the way allied health services are organized

in the treatment setting and the organization of

allied health training programs. Most allied

health providers practice as part of a multidisciplinary team providing a number of

therapies. Isolating the contributions of each 

team member to the well-being of the patient, for

assessment purposes, is difficult. Furthermore,

there is little opportunity for health services

researchers to interact with allied health

providers; and few allied health education

programs include matters germane to outcomes

research (Benjamin 1995). This section of Chapter

3 summarizes the need for assessment data on

allied health services, the types of research

needed, and the obstacles to be overcome; the last

section of the chapter, “Implementation Plans for

Outcomes Research,” presents the strategies

selected by the Implementation Task Force to

advance the research needed as an objective

foundation for future change.

There is an overwhelming need for a

prioritized research agenda and for quality

research, particularly outcomes assessment

research (Barr 1995). This need is predicated on

two imperatives, one societal and the other

individual. From the societal standpoint, the 

need is economic: the requirement to develop a

more cost-effective national health care system. 

From an individual standpoint, the need is to

factor into care-delivery models the patient’s

assessment of the clinical effectiveness of

treatments and interventions. In order to address

the need for outcomes assessment, allied health

disciplines must build an infrastructure for

research by strengthening the research orientation

of graduate programs targeting the practitioner. 

Additionally, the establishment of researcher

mentorships will ensure the continuity of the

programs.

As noted in the recommendations of the National

Commission on Allied Health (NCAH), provision

and financing of services furnished by allied

health professionals must be based on objective,

scientific information that validates the clinical

effectiveness and cost efficiency of service 

delivery models. Without quality outcomes

assessment data and reliable, research-based

support for the cost- and care-effective contributions of allied health professionals, these

disciplines cannot realize their enormous

potential to promote quality care at an affordable

cost to patients as rapid change continues in the

health care system.

The National Commission identified several

assumptions related to research that are still 

 
Building the Future of Allied Health

30 Outcomes Research

Research will enable us to factor into

care-delivery models the patient’s

assessment of the clinical effectiveness 

of treatments and interventions.

useful. Three of those assumptions are especially

noteworthy (U.S. Department of Health and

Human Services [DHHS] 1995):

1. Payers of health care expenses such as large

managed care organizations, employers, and

insurers will shape future clinical practice.

2. Payers will use cost as the primary measure to

determine practice. Although quality issues

will exert some pressure patterns, costs will

remain the main driving force of practice

decisions.

3. Determination of clinical effectiveness and

outcomes assessment will drive payment and

practice decisions which currently tend to be

based solely on cost.

Although it has been 3 years since the National

Commission published its report, these

assumptions seem to be alive and well. All

stakeholders, from consumers to providers and

payers, want reimbursement decisions to be 

based on effectiveness. However, a very small

amount of funding is available to conduct

outcomes research, especially if that research

relates to allied health. Yet the guidance needed

to optimize cost constraint without compromising

the quality of allied health clinical services must

originate from objective evidence relating to

outcomes for clinical effectiveness. Clearly,

obtaining such evidence will require collaborative

effort—a meaningful partnership of all stakeholders. However, even if such a partnership

were in place, are there enough allied health

researchers available to participate in studies of

both profession-specific and collective contributions of allied health professionals? The

establishment of postgraduate training programs

in health services research is essential. Researchers who understand the clinical practice of

various health disciplines and are capable of

integrating those perspectives into outcomes

studies are vital (Benjamin 1995). 

Type of Research Needed

Research documenting the contributions of 

component groups of allied health professionals 

is desperately needed. This type of research will

focus on outcomes—essentially, effectiveness

research. When is it appropriate to employ the

services of an allied health worker? What is the

impact of using allied health practitioners on the

cost, quality, and accessibility of health care? 

What are the effects on patient outcomes of

substituting less-skilled workers? What are the

safety implications of using substitutes? How are

allied health services provided? What is the

impact of disease management programs utilizing

allied health practitioners? One basic requirement for future research is to develop a

patient-centered rather than profession-centered

evaluation language that includes patient-related

outcomes measures and accompanying

assessments of their validity and reliability.

Allied health outcomes research should seek to

measure outcomes that are unique to a specific

allied health profession, but additional efforts

should address the collective contributions of the

allied health professional community. Currently, 

relatively little outcomes research exists in the

context of allied health. Future research efforts

could act as a catalyst for change toward a more

effective, efficient, and accessible health care

delivery system—particularly since most allied

health practices are folded into the classic

comprehensive approach to the treatment of most

clinical conditions.

Allied Health Effectiveness

The allied health community must view

outcomes research not only as a way to document 
Report of the NCAH Implementation Task Force

Outcomes Research 31

Provision and financing of allied health

services must be based on objective,

scientific information that validates the

clinical effectiveness and cost 

efficiency of service delivery models.

performance, but also as a way to discover safety of patients being compromised by

opportunities for improving its effectiveness. By employing less-skilled personnel in the treatment

examining the effectiveness of service provided plan? How and where are health care services

by allied health professionals, we can identify the provided? Answers to these questions and many

most cost-efficient methods available to deliver more must be sought through well-designed

care. By sheer weight of numbers, the services outcomes research efforts. Successful efforts must

these professionals provide must account for a include allied health researchers as well as

substantial segment of this country’s health care representatives of other components of the health

expenditures. When outcomes research efforts care delivery system. The National Commission

are undertaken on a much broader scale than at and the Task Force believe that more innovative,

present, the health care delivery system and all its efficient, and effective utilization of allied health

stakeholders will make further progress toward professionals will dramatically decrease the cost

the goal of providing accessible health care of care while increasing access and assuring a

services of high quality and acceptable cost. quality safety net for consumers.

Allied health professionals are well-positioned Delivery models are changing, and existing

to provide curative, rehabilitative, and primary anecdotal information encourages further

health care services. These professionals possess research. Many innovative delivery models are

an in-depth knowledge of all clinical inter- being developed at the local level (Perry, Freed,

ventions and services provided in their specialty and Kushman 1994). For these efforts to obtain

areas. Thus, they are experts who can add national credibility, they must be studied on a

incremental value in the emerging health care national level using generally accepted

delivery system. They promote wellness through methodologies. Even though outcomes

preventive practices, they can function as disease assessment is relatively new, most agree that it

managers across the continuum of care, they can can drive decision making about appropriate care. 

deliver high quality care, and through their Allied health researchers can contribute if they

educational efforts they can empower patients obtain expertise in outcomes or effectiveness

and family caregivers. research.

But this cannot be accomplished without an

objective, scientific basis for decision making by

both practitioners and those who determine the

makeup of care teams. Are our service delivery

models as efficient and as effective as possible? 

Are the skill mixes that reside within all health

care provider professions consistent with the

goals of high quality, accessible, cost-effective

care? Are the appropriate allied health care

workers involved in the treatment plan? How

does the utilization of allied health personnel

affect the quality of and access to care? Is the 

 

The private sector has shown substantial

interest in outcomes research, yet collaboration

between the allied health professions and these

potential partners has been limited. It is ironic

that medicine, which is most often associated 

with the treatment of pathology, has received a

great deal of attention, while allied health

providers, who focus on the elimination or

amelioration of impairment or disability after the

physician has eliminated or ameliorated the

disease, have been given short shrift. Managed

care organizations focus on the appropriateness 

of care and want medical decisions to be driven

by practice guidelines. In recent years, several

allied health professions have developed practice

guidelines that have contributed to more effective

utilization of services, yet the contributions of the

allied health professions are vastly underappreciated in the outcomes research arena.
Building the Future of Allied Health

32 Outcomes Research

There is no question that the supply of

allied health researchers does not

meet current demand.

Outcomes Researchers

The reason for this underappreciation of allied

health in the outcomes research community can

be traced to the fact that the allied health

professions do not possess a critical mass of

outcomes researchers (Benjamin 1995). The

problem lies in the commitment of allied health

educators to prepare practitioners with strong

clinical skills. Few of the limited resources

available for education are devoted to the

development of research skills or to the requisite

social sciences for this type of research. The allied

health professions, like medicine, nursing, and

others, have prepared persons to conduct basic

science and clinical efficacy research, but relatively few are skilled in effectiveness research. 

There is no question that the supply of allied

health researchers does not meet current demand.

The National Commission reported that there

has been virtually no concerted effort to advance

the role of research related to allied health

practices. Despite increased awareness of the

importance of outcomes assessment in most of the

allied health professions (Ohman 1995), there

seems to be a disconnect between recognizing the

importance of such efforts and the ability to

follow through. This disconnect is due in large

part to the fact that not all allied health professional researchers are facile in the design and

implementation of scientific investigations related

to effectiveness research.

The Commission and the Task Force recognize

that there is a general shortage of allied health

practitioners holding graduate degrees with a

research orientation who could serve as faculty

and mentors for practitioners entering the

professions. It is also recognized that research

efforts should be tied to improving the efficiency

and effectiveness of allied health services. The

roles of allied health professionals continue to

evolve, but within the context of health services

delivery teams. Allied health professionals are

currently being educated in a discipline-specific

environment. Indeed, their roles are defined by a

discipline-specific professional code of ethics. It

follows, therefore, that their research is conducted

from a discipline-specific perspective, with much

of it concentrated in the educational preparation

of allied health workers. Although there is a need

for such discipline-specific activity, we must also

recognize that the allied health professions are a

component of a much larger system. To bring

about true synergy, it is essential that we develop

a core group of allied health researchers who can

undertake outcomes research efforts that include 

a cross-disciplinary component incorporating

patient-centered outcome assessments.

As an interim measure, before a cadre of allied

health professionals possessing the proper

research degrees and skills is developed, we

should link allied health practitioners with

graduate students, forming mentoring

partnerships to develop effectiveness research

expertise.

While the emerging model of care delivery is

establishing new requirements, the current

academic structure helps produce behaviors that

may be inefficient or impede a person’s ability to

adapt to the demands of the evolving health care

delivery system. One of the biggest challenges

facing the allied health community is to eliminate

obstacles, such as the lack of a common definition

for outcomes measures, that stand in the way of

the successful application of clinical and health

services research. When these barriers are

eliminated, we will be better positioned to assure

that allied health education and clinical practice

are tied to the values of the emerging health care

delivery system.

Allied Health Research Agenda

The ongoing change in the Nation’s health care

delivery system is driven more by concerns over

the cost of care than the quality of care. Utilization of allied health professionals based on
Report of the NCAH Implementation Task Force

Outcomes Research 33

The allied health professional is in an

excellent position to expand his or her 

role as a utilization gatekeeper.

As an essential first step, we must 

develop a common research agenda

through collaboration with all major

stakeholders in the health care system.

effectiveness research will lead to a better, more

balanced and productive use of resources. The

allied health professional is in an excellent

position to expand his or her role as a utilization

gatekeeper. Since utilization of health care

resources drives costs, there is a tremendous

opportunity for allied health to make a significant

contribution to cost constraint without compromising the quality of care. In order to step up

allied health research efforts, however, a great

deal needs to be done. Synergy among allied

health professions must increase. As an essential

first step, we must develop a common research

agenda through collaboration with all major

stakeholders in the health care system.

A number of outcomes research studies have

been reported in allied health journals (Ohman

1995). These studies have attempted to measure

the clinical and economic outcomes of specific

allied health clinical interventions and delivery

models. Examples of ongoing efforts include the

Bureau of Health Professions’ Allied Health

Special Projects grant to develop monographs and

videotapes on outcomes assessment in chronic

obstructive pulmonary disease, stroke, and

arthritis for distribution to baccalaureate level

physical therapy, occupational therapy,

respiratory therapy, and speech-language

pathology programs; establishment of the

National Education and Research Center for

Outcomes Assessment in Healthcare (NERCOA)

at Northeastern University; and practice-based

outcomes and economics research on allied health

and pharmacy practices (Barr 1995). Many

associations—including the American Physical

Therapy Association (APTA), the American

Speech-Language-Hearing Association (ASLHA),

the American Occupational Therapy Association

(AOTA), and the American Dietetic Association

(ADA)—have made outcomes research a highpriority item on their agendas. The American

Association for Respiratory Care (AARC) and

APTA have sponsored workshops for their

members on outcomes research methods, and

APTA has also published a bibliography of

outcomes research specific to physical therapy

interventions (Benjamin 1995).

Unfortunately, there is no comprehensive,

aggressive research agenda for allied health. Such

an agenda would promote a greater degree of

coordination among allied health professionals

and other providers, encourage a more

transdisciplinary approach, and, as a result,

increase the value of the findings of these

scientific investigations while identifying highpriority research projects.

The Task Force recognizes the critical need for

practice effectiveness studies that include the cost

efficiency of services and the effectiveness of

interventions in assessing clinical outcomes. But 

investigations must also examine the method of

health care service delivery (Lyons 1994). 

Rehabilitation research, particularly that

related to the measurement of functional

outcomes and quality-of-life issues, must be a

research priority; so, too, should studies that

describe the relationship between educational

preparation, credentialing requirements, and

clinical effectiveness. Research undertaken now

must deal with the present, but it must also guide

us through decision making as it relates to

reengineering our workforce.

Much research has been done in the areas of

health promotion, disease prevention, and disease

state management. But relatively little research

has been conducted to learn the key determinants

of success. Such information should prove

invaluable to educators and practitioners alike.
Building the Future of Allied Health

34 Outcomes Research

Funding Outcomes Research

Funding has been identified by many in allied

health as an obstacle to the pursuit of outcomes

research. Therefore, we must undertake a

significant collaboration effort that will lead to

partnerships. These partnerships must expand

beyond educational institutions and professional

associations to include payers. The allied health

community understands that stakeholders will 

not offer funding for studies that do not tie into

their values. Allied health professionals,

educational institutions, associations, employers,

foundations, payers, and the public share a

number of values. Through collaboration,

common values can be identified. From this

process will flow a research agenda with 

priorities (Brook and Lohr 1985).

The allied health professions must also be

prepared to invest in themselves. If they want to

evolve along with the health care delivery

system—to be integrated appropriately into the

new system—the allied health professions must

provide the resources necessary for qualified

researchers to undertake efforts to identify

innovative service delivery models and optimal

skill mixes for their respective professions. 

Success in these endeavors cannot help but lead 

to a more efficient utilization of the allied health

workforce; and the result will be significant

progress toward the overarching goal of a balance

between health care resource need and health 

care resource demand. Critical in this process is

identifying misallocation of resources.

All stakeholders, including consumers, payers,

and providers, are willing to change as the health

care system evolves; but all these stakeholders

need guidance from objective evidence rather 

than from assumptions about convenience, or

wishful thinking. The only way the allied health

community will successfully navigate the

challenges of the current, dynamic health care

environment is to (1) fully franchise allied health

professionals as outcomes researchers, and (2)

facilitate collaboration with all stakeholders to

form an ongoing research collaborative in which a

common research agenda can be developed and

prioritized. Coordinated efforts could then be

undertaken to obtain funding and institutional

support to assure that all research efforts are

credible and generalizable across the United

States. The allied health professional, by virtue of

specialized education and competency testing, is

in one of the best positions to guide appropriate

utilization of health care services without

compromising the quality of care. Such efforts

will lead to significant cost reduction—to the

benefit of all stakeholders—since utilization is the

ultimate cost driver.

Implementation Plans for

Outcomes Research

Plan: Develop clinical outcomes measures for

allied health treatment across multiple

patient care settings for disease states.

NCAH recommendation addressed:

Recommendation 7. As is the case for all health

professions, the provision and financing of

services furnished by allied health professionals

should be based on objective and scientific

information that validates the clinical

effectiveness and cost efficiency of service 

delivery models.

Purpose of Plan

The National Commission on Allied Health

concluded that more innovative, efficient, and

effective utilization of allied health professionals

will dramatically decrease the cost of health care

while increasing access to and the quality of care. 

As an essential first step in advancing these goals,

the Commission recommended that improved

measures of clinical outcomes and cost should be

developed for treatments across patient care

settings and that these standard guidelines should

be disseminated to health-care providers, 

insurers, and professional associations. The 

 
Report of the NCAH Implementation Task Force

Outcomes Research 35

Implementation Task Force reviewed the 2. A competitive request for proposals should be

recommendations of the National Commission developed by an advisory task force composed

within the context of the current environment and of the stakeholders, including allied health

concluded that the recommendations are still professionals, payers, researchers, and

appropriate and, as yet, unfulfilled. The progress consumers of health care. The project should

of health care outcomes research has not kept identify measurable clinical outcomes from the

pace with the evolving health care system. With care and treatment of patients across the

few exceptions, clinical research on outcomes and continuum of care for disease states.

cost in allied health has not progressed to a useful

level. It is imperative that joint research programs

be undertaken integrating the perspectives of

various health disciplines. The Implementation

Task Force offers this plan and the three other

recommended research plans in the belief that

allied health must advance an aggressive research

agenda to dramatically decrease the cost of health

care while increasing access and assuring quality.

Goals of Plan

1. Create, through a collaborative research

project, models of validation for the clinical

effectiveness and cost efficiency of allied health

services.

2. Distribute the project’s findings, including

clinical outcomes measures and a model for

stakeholder partnership in outcomes research

in allied health, to key stakeholders.

Implementation Plan

1. The Bureau of Health Professions, Agency for

Health Care Policy and Research, payers, and

professional associations should develop

competitive research grants and partnerships

for the development of outcomes research in

allied health. These funding and partnership

opportunities should include measurement of

the clinical outcomes effectiveness of allied

health service delivery in high-cost, highvolume, and high-risk patient populations. 

Disease states such as asthma, diabetes, stroke,

and cancer should be included in multiple

settings such as inpatient, outpatient, home

health, and long-term care.

3. Components of allied health professional

training, education, and practice across a broad

spectrum of disciplines should be represented

on the research team.

4. The research project should also examine

existing guidelines for measurement of

outcomes, such as the Health Plan Employer

Data and Information Set (HEDIS) developed

by the National Committee for Quality

Awareness (NCQA).

5. A published report of the findings of the

research project, including a model for

stakeholder partnership in outcomes research

in allied health, should be distributed to

professional associations, payers, and the

Agency for Health Care Policy and Research

(AHCPR).

6. Potential leadership and funding sources

include AHCPR, the Centers for Disease

Control and Prevention (CDC), the Association

of Academic Health Centers, the National

Education and Research Center for Outcomes

Assessment in Healthcare (NERCOA), and

payers in general. It is noted that AHCPR has

announced that its fiscal year (FY)1999 budget

is $171 million. An increase in funding of 17

percent over the FY 98 budget was intended to

support investigator-initiated research to

improve health outcomes and strengthen

quality measurement and quality improvement, including the organizational and

financial aspects of health care. Priorities

identified by AHCPR include the following: 

(1) Support improvements in health outcomes;

(2) strengthen quality measurement and

improvement; and (3) identify strategies to

improve access, foster appropriate use, and

reduce unnecessary expenditures.
Building the Future of Allied Health

36 Outcomes Research

Impact of Plan

Developing clinical outcomes measures for

allied health treatment across multiple patient

care settings for disease states will provide the

basic tools needed to objectively assess alternative

service delivery models. Thus it will help

document the most clinically effective and costefficient skill mixes and delivery modes and

improve the quality and cost efficiency of future

health care.

Plan: Create a data base of State licensure develop outcomes-based criteria for licensure

requirements for allied health

professionals and promote outcomesbased criteria.

NCAH recommendation addressed:

Recommendation 8. Model scope of practice

regulations should be developed based on proven

outcomes and effectiveness measures. States that

have developed improved models should share

such information widely.

Purpose of Plan

The purpose of this plan is to stimulate a

reduction in State-to-State variations in practice

regulation and promote improved models. 

Creating a data base of all State licensure

requirements for allied health professionals and

identifying those with outcomes-based criteria

will focus attention on unnecessary variations and

on model regulations.

Goals of Plan

1. Evaluate State licensure guidelines for allied

health professionals and develop a data base

that highlights outcomes-based models of State

regulation.

2. Promote greater uniformity in State licensure

requirements for allied health professionals.

3. Promote development and adoption of model

guidelines for use by State licensure agencies

and professional regulatory boards.

Implementation Plan

1. Convene a task force of allied health

professional associations and networks to plan

the development of a data base of State

licensure guidelines for allied health

professionals. The task force should develop a

plan to compare State guidelines and adopt or

and professional regulatory boards to reduce

State-to-State variations in practice.

2. The lead professional association or network

will organize the evaluation of State licensure

guidelines and coordinate development of a

data base for access by all allied health

professionals.

3. Allied health professional associations will

collaborate to examine and identify how

outcomes-based guidelines can be developed,

introduced into State regulatory agencies, and

used to reduce State-to-State variations in

professional practice.

4. The lead professional association or network

will convene a summit conference of allied

health associations to (a) review the data base

of State measures, (b) develop a plan to initiate 

a proposed practice act for legislators, and (c)

facilitate development of a uniform State

model for presentation to the Council of State

Governments and State legislatures. Consumer stakeholders should also be invited to

serve as patient advocates and reviewers

during the development of recommendations

to the State regulatory agencies.

5. The Health Professions Network and the

Council on Licensure Enforcement and

Regulation (CLEAR) should partner in leading

the project in collaboration with the

Association of Schools of Allied Health

Professions and the National Network of TwoYear Schools in Health Science and Technology
Report of the NCAH Implementation Task Force

Outcomes Research 37

Education. Existing members of the Health practices that will improve quality, decrease cost,

Professions Network have indicated that they and increase access.

have grassroots member organizations that

would be willing to assist.

6. A report of the findings and recommendations

should be distributed to and published by

allied health professional associations. The

report should also be distributed to the State

regulatory agencies and to schools and colleges

of allied health.

Impact of Plan

Implementing this plan will lead to a more

uniform standard of State licensure requirements

for allied health professionals based on outcomes

and effectiveness measures. Implementation

should help increase awareness among all health

professions of the high standards and objective

criteria used to qualify allied health professionals. 

Over the longer term, more uniform criteria based

on outcomes and effectiveness measures will

improve health care delivery.

Plan: Establish contracts or Requests for

Proposals (RFPs) to examine the clinical

and cost effectiveness of allied health

practitioners.

NCAH recommendation addressed:

Recommendation 13. Create incentives for

public/private partnerships to share, support, 

and accelerate outcomes-based research studies to

identify clinical and cost-effective allied health

practices that will improve quality, decrease cost,

and increase access.

Purpose of Plan

The purpose of this plan is to create incentives

for public/private partnerships to share, support,

and accelerate outcomes-based research studies to

identify clinical and cost-effective allied health

Goals of Plan

1. Stimulate outcomes-based research to assess

and improve the effectiveness and efficiency of

allied health practices.

2. Support public/private partnerships to

conduct outcomes-based research on allied

health practices.

3. Develop models of clinically effective, costefficient allied health practices.

Implementation Plan

1. The Bureau of Health Professions, the Health

Care Financing Administration, or the Agency

for Health Care Policy and Research should

initiate contracts that give priority funding to

applicants who partner with an allied health

profession, health care provider, and a payer/

insurer to examine the clinical and cost

effectiveness of allied health practitioners and

to develop models of allied health practices

that are as effective as, and more efficient than,

traditional health-care delivery patterns. 

Coordinated by the Health Professions

Network, professional organizations

representing the various allied health

disciplines would collect data on how

increased utilization of allied health

professionals could expand access to services

for previously underserved populations.

2. The contractors, consisting of an allied health

profession, an academic institution, a health

care provider, and a payer/insurer (which

could be the same as the health care provider)

will develop outcomes-based research studies

designed to document the clinical and costeffective allied health practices that will

improve quality, decrease cost, and increase

access. These studies should use appropriate,

published practice guidelines as the basis of the

research design. Current guidelines for 
Building the Future of Allied Health

38 Outcomes Research

outcomes measurements developed by the patients studied under typical conditions, not the

Health Plan Employer Data and Information commonly defined efficacy studies, which focus

Set (HEDIS) should be employed. on a narrow range of questions related to the

3. Partners must define the respective roles and

the responsibilities of each member. Financial

analysis should calculate and compare the cost NCAH recommendations addressed:

for the delivery of the health care service with

and without the contribution of the allied

health profession. Total service cost should be

used.

4. Appropriate project leadership includes the effective, efficient, and accessible health care

Bureau of Health Professions or the Health delivery system. This agenda must be supported

Care Financing Administration, professional by an infrastructure of allied health professionals

associations, health care providers, and trained as health services researchers who are

payers/insurers. The successful bidder will supported by technology, information systems,

manage the contract under the supervision of and adequate funding.

the Bureau of Health Professions or the Health

Care Financing Administration.

5. Results of the outcomes research for specific career development of allied health clinical

allied health professions will be published and researchers.

disseminated to all partners, which include the

allied health professional organizations, the

health care providers, and the payers/insurers.

Impact of Plan

Implementing this plan will help document the states.

most clinically effective and cost efficient allied

health practices and how they improve the

quality, cost, and accessibility of health care. As a

result, the strategy will (1) identify best practices

to advance the state of the art of allied health

professions, and (2) provide objective data to

enable allied health professionals to be integrated

most productively into the evolving health care

system.

Plan: Establish an institute for outcomes

measurement training of allied health

professionals that is treatment/patient

focused.

This is effectiveness research training with an

emphasis on real practices, providers, and

safety or viability of a clinical treatment of an

experimental nature.

Recommendation 14. Develop and implement a

prioritized health services research agenda to

examine the unique and collective contributions

allied health professionals might make to a more

Recommendation 15. Develop the infrastructure

to support allied health clinical research and the

Purpose of Plan

The purpose of this plan is to provide training

to allied health professionals in the measurement

process for assessing outcomes in specific disease

Goals of Plan

1. Develop the infrastructure to support allied

health clinical research and the career

development of allied health clinical

researchers.

2. Establish an institute for outcomes

measurement training to advance the goal of

obtaining objective data on the clinical and cost

effectiveness of allied health practices. 

Implementation Plan

1. Establish an institute for outcomes

measurement training that will provide

ongoing support and infrastructure for training

allied health professionals as researchers
Report of the NCAH Implementation Task Force

Outcomes Research 39

supported by technology, information systems, 4. The contractor will produce and disseminate a

and adequate funding. A Request for Proposals monograph on outcomes assessment

(RFP) to plan and conduct a training conference measurement for allied health professionals.

on outcomes assessment will be open to bidders

in FY 99.

2. The contractor will provide the administrative,

logistical, and professional services necessary

to conduct a workshop (3–5 days) to train

allied health professionals in the outcomes

assessment process. The contractor will

convene an Outcomes Research Advisory

Board (Board) of stakeholders to assist in

developing the curriculum and establishing the

selection criteria for participants. The Board

shall include, but not be limited to, two

members from academic institutions, two from

professional associations, a representative of a

health care plan, an appropriate Federal and

State representative, a consumer advocate, and

one member from the Implementation Task

Force. The Agency for Health Care Policy and

Research should be invited to participate as the

Federal representative to the Board. In

addition, the National Committee for Quality

Assurance should be represented. The Board

shall not exceed nine members. Based upon the

recommendations of the Board, the contractor

shall (1) select appropriate, nationally

recognized researchers to participate in the

project, and (2) specify curriculum and work

materials for the outcomes research workshop. 

The curriculum shall focus on outcomes

measurement training that is based on the

patient’s disease state. It is expected that

selected academic faculty will work with the

Board to develop the curriculum and work

materials required for the project.

3. Appropriate leadership for the project includes

the Agency for Health Care Policy and

Research, the Health Professions Network

volunteer task force, and the Bureau of Health

Professions. The successful bidder will 

manage the contract under the supervision of

the Bureau of Health Professions.

Impact of Plan

Implementing this plan will increase the ranks

of appropriately trained outcomes researchers

among allied health professionals. Thus it will

enable these researchers to take their appropriate

place in the research community and both

document and publish information about the

objective performance of allied health in patient

care. As a result, opportunities for allied health

professionals to be integrated most effectively 

into evolving modes of health care delivery will

be greatly enhanced. In addition, objective data

on alternative practices will spur changes to

increase the clinical effectiveness and cost

efficiency of allied health services delivery.

Implementing all of the research plans

presented in this chapter will have a significant

impact, over time, on both research and

education. Research capabilities and results will

be enhanced in several ways: (1) Data will be

accumulated on the contribution of the allied

health professions to patient care outcomes; (2)

outcomes data that documents the relationship

between cost-effectiveness and patient outcomes

will be generated to provide the basis for effective

treatment protocols; (3) a cadre of allied health

research mentors and researchers will be created

to ensure continued acquisition of outcomes

measurements; and (4) accreditation processes

that reduce unnecessary duplication and conserve

resources will be a by-product of effectiveness

measurements.

The impact of outcomes research will extend

beyond the domains of research and practice. 

Ultimately, the data collected on effectiveness will

significantly affect the manner in which allied

health professionals are trained. This result will

be responsive to the following statement made by

the National Commission on Allied Health in its

final report:
Building the Future of Allied Health

40 Outcomes Research

Eventually, all allied health curricula will are designed primarily to facilitate collection of

need to better address new ways to expand the kinds of data that will be integral to

access, ensure appropriate services, involve reformulating curricula and treatment modalities. 

patients and family in decisions, and assess The strategies are also intended to promote

appropriateness of technology. collaboration among educational systems,

Revisions to allied health curricula undertaken

to meet the needs of the marketplace must be

based upon outcomes data that document the

interrelationships among patient outcomes, costeffectiveness, and curricular competencies. The

proposed implementation strategies for research 

professional associations, the health care services

industry, and payers to ensure responsiveness to

workplace demands, create clinical experiences

that are appropriate for the practice settings, and

coordinate accreditation processes to conserve

resources and reduce unnecessary duplication.
Report of the NCAH Implementation Task Force

Collaboration 41

Collaboration could produce a

synergy that would lead to a more

evidence-based decision-making

model.

Chapter 4. Collaboration

Purpose

Throughout the Report of the National

Commission on Allied Health (U.S. Department of

Health and Human Services [DHHS] 1995),

collaboration is identified as indispensable to

the successful implementation of all of the

Commission’s recommendations. Collaboration 

is necessary both among allied health professions

and between these professionals and other

stakeholders.

One of the major assets of the allied health

community is that each profession possesses

unparalleled expertise in its respective specialty

area. Unfortunately, this extraordinary depth of

knowledge has contributed to a tendency by

many allied health professions to focus inwardly. 

Traditionally, these professions undertake

activities aimed at improving a particular

profession’s ability to ensure quality care within

its specialty area. These activities take the form of

analyzing the adequacy of current educational

preparation, competency testing, and service

delivery models. While these activities should

continue, it is essential that efforts expand to

encompass all stakeholders involved in the

Nation’s health care delivery system.

The National Commission and the

Implementation Task Force recognize the

challenges manifest in organizing effective,

ongoing, collaborative efforts; but the significant

benefits of such collaboration—to allied health

and to the entire health care system—are clearly

worth the effort required. It is important for the

allied health professions to (1) gain a more

comprehensive knowledge of their sister

professions in the allied health community, and

(2) advance mutual understanding among all

stakeholders of the capabilities, potential

contributions, and needs of each. If the allied

health community is to succeed in efforts to

increase understanding by all stakeholders of its 

 

potential contributions and value, it must first

organize and unify itself in order to present,

clearly and strongly, information about the allied

health professions that will promote such

understanding. Since most stakeholders are

unaware of the contributions that allied health

professionals can make, current impressions of

services provided by these professionals run the

gamut from discretionary to life support.

Before the advent of managed care, there was

little appreciation of the allied health professional’s role as a resource gatekeeper. Yet, if a

successful gatekeeper must possess knowledge

about indications, contraindications, and costs,

then many of the allied health workforce are well

positioned not only to provide services, but also

to minimize misallocation of resources by

ensuring appropriate utilization of those services.

Furthermore, the benefits of collaboration will

lead to more effective delivery of services,

increased patient satisfaction, better problem

solving, and ultimately, improved quality of care. 

Recognition of this added value could promote

innovations in the areas of education, skill mix,

and service delivery models. The National

Commission has affirmed that the allied health

community wants to work with all stakeholders. 

With such collaboration, a synergy could occur

that would lead to a more evidence-based

decision-making model.

Chapter 4 is divided into two main sections. 

This “Purpose” section identifies principal areas

where collaboration is needed and explains why 

it is needed; the final section of the chapter

presents implementation plans developed by the

Implementation Task Force to advance 

 
Building the Future of Allied Health

42 Collaboration

Involving the allied health community

in research projects with other

components of the health care system

would make it more likely that costs

would indeed be reduced rather than

shifted from one area to another. 

collaboration in support of shared values, reduced rather than shifted from one area to

pursuant to recommendations of the National another. If we are pursuing a reduction in total

Commission. health care cost, we must, therefore, commit to

Collaborating on Research

Much has been written about the need for

outcomes or effectiveness research. Although the

allied health community has initiated some

research efforts, there is a notable lack of studies

that include more than one profession. Since it is

extremely difficult, and in some cases impossible,

to sequester the contributions of an individual

discipline (Benjamin 1995), it follows that if we 

are to use research results to guide innovation in

new approaches of care and perhaps new skill

mixes, we must increase collaborative research

efforts among allied health professions. We must

also organize an ongoing collaborative research

activity that includes the public, employers and

employee groups, foundations, professional

associations, State and Federal Government

agencies, educational institutions, and representatives of health care delivery systems. If such

an effort were to come to fruition, the benefits for

all players within the health care delivery system

would be profound.

All stakeholders have indicated the need to

improve access to health care and decrease costs

without compromising quality. Transdisciplinary

research is essential if we hope to realize all three

goals. There have been sporadic efforts to

innovate in terms of skill mix and delivery

models; but thus far, progress toward reducing

costs without compromising quality or access has

met with limited success. (According to the

Health Care Financing Administration, health

care costs will exceed $2 trillion by 2007, as

compared with approximately $73 billion in 1970

and more than $699 billion in 1990 [Smith et al.

1998].)

Involving the allied health community in

research projects with other components of the

health care system would make additional insight

and expertise available. Such involvement would

make it more likely that costs would indeed be 

 

broad collaboration that includes all stakeholders,

in research as well as other areas.

Collaborating on Education

The allied health education system needs to

introduce creative, “outside the box” methods to

prepare the allied health professionals of the

future. It has been noted all too often that the

paradigm that existed under the cost-plusreimbursement system has been superseded. We

must prepare allied health professionals to go

beyond the obsolete “wait and treat” approach;

we must empower them through education not

only to provide consistently high quality care, but

also to enhance critical thinking and communication skills in order to help patients avoid

triggers that lead to more costly health care

events. These goals cannot be achieved by allied

health educators alone. Nor can they be achieved

solely by expanding the educational efforts to

involve allied health practitioners. We must

include payers, consumers, and provider

employers as well. Once again, we return to the

need for collaboration.

The outlines of the emerging health care

delivery system are becoming clear. The system

needs care providers who are prepared to work

across the health care delivery spectrum—from

critical care to assisting patients in their homes

and all points in between. Success in this

endeavor requires extraordinary collaboration, in

education as in other areas, between provider,

payer, and consumer groups. Their combined

input will ensure that the allied health 

 
Report of the NCAH Implementation Task Force

Collaboration 43

The emerging health care delivery

system needs care providers who are

prepared to work across the health

care delivery spectrum—from critical

care to assisting patients in their

homes.

professional of the future is sensitive to the three the design of studies that result in generalizable

key health care issues—access, quality, and cost— observations that are relevant nationally. 

and their interrelationships. Moreover, stake- Moreover, collaboration can also encourage other

holder input will assure that 50 to 60 percent of professions to investigate the use of protocols

the health care workforce—allied health—is in within their specific disciplines.

step with the values that are emerging along with

the new health care delivery system (O’Neil 1993).

Cost Reduction

In an environment of extraordinary change, it

is not unusual to experience tensions. This is

particularly true when, as today, cost reduction is

a major goal. Currently, for example, there is a

move toward multiskilling, and in some instances, de-skilling. These efforts may conflict

with activities that are leading to “up-skilling.” 

Many policymakers lack an understanding of the

role of allied health professionals and think that

they just perform tasks, whether those tasks be

therapeutic or diagnostic. These policymakers do

not recognize that allied health professionals

know not just the motor skills aspect of the

intervention, but also the indications,

contraindications, and alternatives that are

available and consistent with the patient’s care

plan. Many allied health professionals have not

only clinical, but also relative-cost knowledge and

are well-positioned to contribute to cost-effective

care. No one is better positioned than the allied

health professional.

Several allied health professions have

developed practice guidelines (Ohman 1994). 

These guidelines assist allied health professionals

in their efforts to allocate resources effectively and

minimize misallocation. In many instances, these

guidelines have been used to develop Assess and

Treat Protocols. These algorithms, when used by

allied health professionals, have been found to

minimize misallocation of care and to have a

positive effect upon the constraint of health care

costs (Stoller 1996). Unfortunately, these studies

were conducted at the local or institutional level

rather than under a multicenter design that would

produce results that could be generalized

nationally. Meaningful collaboration can lead to 

 

Care in Alternative Settings

Over the past few years, the use of care settings

outside of hospitals has increased substantially. 

As an example, according to the Health Care

Financing Administration (HCFA) Office of the

Actuary, as of December 1997, Medicare Part A

Home Health Care Use included 3.58 million

beneficiaries served in the year 1996. These

persons averaged 79 home visits each, for a total

of approximately 283 million visits. Six years

earlier, in 1990, Medicare beneficiaries averaged

44 home visits per person, resulting in almost 100

million total visits spread over 2.26 million

beneficiaries. Thus we observe not only an

increase in the number of beneficiaries served, but

also a significant increase in the total number of

home health care visits under Medicare Part A.

Skilled nursing facilities (SNFs) have also

experienced a significant increase in Medicare

beneficiary activity. HCFA data show that in 

1994 Medicare received from Medicare SNFs

slightly more than 300,000 claims representing

$493 million in charges for respiratory therapy

services. By 1996, Medicare was receiving from

Medicare SNFs more than 580,000 claims

representing $1.1 billion in charges for respiratory

therapy services. This represents a growth of

280,620 claims and $658 million in charges. In the

same period, claims from acute-care hospitals for

respiratory therapy services decreased by more 
Building the Future of Allied Health

44 Collaboration

Collaboration is the key to harnessing

the enormous influence of the allied

health professions on our Nation’s

health care system so that it

complements the current and future

efforts of other stakeholders and

advances common goals.

than 531,000, with accompanying charges improved access, quality assurance, and cost

decreasing by approximately $417 million (Muse efficacy, the overlap issue will continue to be 

& Associates 1998). These statistics clearly dealt with on an ad hoc, haphazard basis. The

demonstrate that care is being shifted from acute- allied health professions are beginning to come

care hospitals to other, less expensive care together to discuss such issues of mutual concern. 

settings. They also welcome opportunities to partner with

As the delivery of care has shifted from acutecare facilities to community-based organizations,

employment patterns of allied health professionals have also changed. These professionals

must, therefore, be prepared to be effective in a

multitude of care settings owning various

cultures. Success in this endeavor is largely

dependent upon developing a network of clinical

affiliates for allied health education programs. 

These affiliations will assist allied health

educators in preparing students to work in 

several types of care settings that provide services

ranging from direct treatment to patient 

education and consultation, including disease

state management and health promotion.

Collaboration is needed not only to advance

understanding, but also to form public-private

partnerships. An ongoing collaborative effort will

lead to an allied health agenda. This agenda must

have input from all stakeholders and must range

in subject areas from education (both professional

and consumer), clinical services, and service

delivery models to effectiveness research and

competency documentation.

Scope-of-Practice Issues

The allied health community and other

stakeholders—such as consumers, payers, and

provider employers—share basic goals for the

health care system. The National Commission

and the Task Force believe that many allied health

professionals are underutilized. This underutilization sometimes occurs because of turf

issues. Through collaborative efforts with other

providers, this problem can be addressed. For

example, there may be opportunities for skill

sharing. There certainly are scope-of-practice

overlaps; but until all stakeholders come together

and jointly embrace the overarching goals of 

 

other stakeholders to advance common goals. To

this end, the allied health community must

organize itself in such a way as to facilitate

collaboration and effective representation of the

community to other stakeholders.

Allied Health Representation

The National Commission recognized the lack

of allied health representation on policy and

advisory boards and other deliberative bodies at

the national and State levels. Some representation

is in place, but usually it is profession-specific

rather than for allied health as a whole. The allied

health community must take the initiative to

prepare individuals to serve as allied health

representatives and must communicate to such

boards and deliberative bodies the availability

and value of qualified allied health representatives. When this is accomplished, a

significant barrier to allied health representation

will be removed.

Ongoing communication efforts must be

undertaken to reach out and ensure that entities

outside of the allied health community are aware

of the availability of allied health representation. 

The implementation plans presented in the

following section of this chapter represent a start

toward organizing an ongoing mechanism within

the allied health community for intracommunity

communication and planning. Moreover, the 

 
Report of the NCAH Implementation Task Force

Collaboration 45

The implementation plans presented in

this chapter can ensure that effective,

ongoing communication occurs 

among all stakeholders. 

strategies can ensure that effective, ongoing oversee its three committees—Education, Practice,

communication occurs among all stakeholders. and Research. The coordinating board and its

The days of fragmented approaches to our committees should be representative of the

national health care problems are ending. It is following major stakeholders:

now time to expand planning efforts to a more

global level. We must undertake a 

comprehensive effort to bring about full

utilization of the potential of allied health

professionals in a variety of roles and a multitude

of care settings. The influence of the allied health

professions on our Nation’s health care system,

from both clinical and economic standpoints, is

enormous. Collaboration is the key to harnessing

this influence in such a way that it complements

the current and future efforts of other

stakeholders in the health care system and

advances common goals.

Implementation Plans for

Collaboration

Plan: Convene an Allied Health Collaborative

Steering Committee and conduct a

conference to plan collaboration

initiatives and promote an action agenda.

NCAH recommendations addressed:

Recommendation 1. Congress should authorize

the establishment of a Consortium on Allied

Health Practice, Education, and Research to guide

and broaden the interface between allied health

and other key health system players. Within this

Consortium professional associations should

work closely together to create a more unified

crosscutting agenda for allied health. The

Consortium should consist of a coordinating

board that will consider overall policy and 

• employers and employee groups

• foundations

• professional associations

• State and Federal Government agencies

• educational institutions

• health care delivery systems

• the public

Recommendation 3. As a matter of priority, care

should be taken to attain representation that

better reflects the populations served by allied

health providers. If the goal is optimal delivery of

care, relevant and accessible education, and

performance of high-quality research, every part

of the system must speak to the consumer.

Recommendation 5. Allied health professionals,

other members of the health care team, and health

care management should collaborate to foster

understanding and appreciation of one another’s

unique and collective interests and capabilities.

Recommendation 12. Educational institutions

should collaborate with the health industry,

government, and professions to implement

initiatives to achieve workforce diversity

throughout allied health.

Purpose of Plan

The Report of the National Commission on

Allied Health stated that the allied health

community is a tremendous education, research,

and service resource, but it has not yet realized its

potential in terms of contributions to education,

research, and practice. This is due, in part, to a

lack of integrated, comprehensive, and continued

collaboration across all major stakeholders within

each of these three key communities. Allied

health providers constitute the largest and most

fragmented segment of the health care workforce.

Although allied health personnel work in all of

the health care settings, they differ significantly in

terms of the work they perform, the amount of
Building the Future of Allied Health

46 Collaboration

education they possess, and the regulatory control The allied health communities must take the lead 

of their activities. Nevertheless, they form a vital in initiating collaboration among all allied health

part of the primary, secondary, and tertiary health communities-of-interest, including academia,

care infrastructure and have many values and practice, professional associations, employers,

goals in common. For these reasons, the policymakers, and consumers, to better meet the

approximately 200 different allied health evolving workforce and educational demands of

disciplines that make up a majority of the total the 21st century. Without such collaboration, the

health care workforce have the potential to potential contributions from allied health may be

positively address questions of cost, quality, overlooked, with detrimental effects on cost,

research, diversity, and access to our health care quality, diversity, and access in the emerging

system (O’Neil 1993). health care delivery system. Without proactive

To date, attempts to bring together selected

allied health professionals nationally have

focused on specific issues and, historically, have

met with only limited success. This is partially

due to the tendency to pursue discipline-specific

recognition rather than a more global perspective The Implementation Task Force developed this

toward health care delivery; lack of awareness, plan to help the allied health community rise to

understanding, and appreciation of one another’s this challenge and advance collaboration

unique and collective interests and capabilities; recommendations of the National Commission. 

and the failure to include all major stakeholders In this plan the Task Force identifies mechanisms

in addressing issues. To achieve common that are feasible for the allied health community

objectives, collaboration is essential, not only and other key stakeholders and thus hold promise

among the allied health professions, but also in to subsequently enhance the quality of health care

concert with all major stakeholders. for the public.

Allied health professions have not achieved, in

their provider ranks, a level of ethnic and cultural

diversity that reflects the population served now

and in the future. Each profession must work

toward developing a diverse workforce, thus

contributing to the health care system’s ability to

provide appropriate services to the populations

served. Cultural diversity and understanding

among service providers is especially important if

high levels of success are to be realized with

wellness and disease management efforts.

Broad-based collaboration will strengthen and

benefit all stakeholders by expanding

understanding of both the issues and the possible

solutions. Stronger collaboration will lead to a

more comprehensive effort to better address

concerns related to health care costs, quality,

diversity, and research, as well as access to health

care services. Communication, collaboration, and

cooperation among the allied health professions

and other major stakeholders is long overdue. 

 

efforts to collaborate, allied health will remain a

largely invisible giant that failed to take

responsibility for its own destiny and to make its

maximum contribution to the future of health

care.

Goals of Plan

1. To foster an integrated, comprehensive, and

continued collaboration across and between all

major stakeholders in and related to the allied

health community.

2. To create awareness, understanding, and

appreciation of each allied health profession’s

uniqueness, and their collective interests,

capabilities, and contributions.

3. To identify and include all major stakeholders

in and related to allied health professions as

they address issues relevant to the Nation’s

health care system.

4. To remedy the lack of objective information

concerning past, present, and future

contributions of allied health professionals.

5. To assist with planning for the number and 

mix of allied health professionals needed to 

 
Report of the NCAH Implementation Task Force

Collaboration 47

meet current and future demands of the cohesiveness, will be clearly delineated by the

emerging health care system for the 21st contractor in the invitations to participate.

century.

6. To promote allied health provider diversity as Committee, will provide a framework for the

reflective of current and future diverse following:

populations served.

Implementation Plan

1. Pursuant to the National Commission

recommendations and the implementation

plan developed by the Task Force, a Request

for Proposals (RFP) has been published by the

Bureau of Health Professions of the

Department of Health and Human Services’

Health Resources and Services Administration

(HRSA). The RFP solicits a contractor to

provide the administrative, logistical, and

professional services necessary to convene an

Allied Health Collaborative Steering

Committee and to conduct a conference to

bring together representatives of the allied

health community. The charge to the Steering

Committee will be to work with the contractor

to create a forum for promoting collaboration

and cohesiveness among the allied health

communities-of-interest, and to identify allied

health leaders with global perspectives to help

further define an action agenda with strategies

for improving collaboration within the allied

health community. The Steering Committee,

together with the conference participants, will

serve as the catalyst to promote collaborative

initiatives on both the national and State levels.

2. The Allied Health Collaborative Steering

Committee will be composed of two

representatives each from the Association of

Schools of Allied Health Professions (ASAHP),

the National Network of Health Career

Programs in Two-Year Colleges (NN2), the

Health Professions Network (HPN), the health

care industry (an employer and a payer), and

the Implementation Task Force membership,

and one consumer representative. Criteria for

representation, to ensure collaboration and 

 

3. The contractor, together with the Steering

a. Promoting collaboration and cohesiveness

within the health professions community

(including medicine, dentistry, pharmacy,

and health service administration) among

the allied health communities and between

allied health and other key stakeholders

such as public and private sector

purchasers, employee and employer

groups, foundations, professional

associations, State and Federal 

Government agencies, educational

institutions, and the public.

b. Planning an agenda for action and

coordinating the implementation of

strategies to address critical issues and the

National Commission on Allied Health’s

recommendations among the allied health

communities and between allied health

and key stakeholders.

c. Planning a conference consistent with the

above and to (1) initiate the interface

between allied health and key

stakeholders, (2) promote collaboration to

seek positive solutions, and (3) where

possible, highlight successful statewide

initiatives that have effectively addressed

issues and needs within a State.

d. Reviewing possible marketing strategies to

effectively promote the collaborative

agenda.

4. A final report will be submitted by the Steering

Committee to the Bureau of Health Professions

outlining recommendations, along with

implementation plans and guidelines for

promoting ongoing collaboration within the

allied health communities-of-interest. The

report should also include how collaborative

strategies can be used to address critical issues

related to cost, quality, diversity, a research 
Building the Future of Allied Health

48 Collaboration

agenda, and access to health care. The report First, collaboration among the allied health

should include plans for disseminating the professions will lead to broader and more

strategies outlined in the report. An article or effective representation of the allied health

articles should be published in appropriate community in efforts to shape the future of health

professional journals. care and improve access, cost effectiveness, and

Impact of Plan

Implementing this plan would lay the

groundwork and provide a strong impetus for

much needed collaboration within the allied

health professions and between allied health and

all related stakeholders across the education,

research, and practice communities. Over the

long term, the fruits of this plan would greatly

enhance the ability of allied health professionals

to take their appropriate place in the health care

delivery system and contribute to progress in the

quality and efficiency of health care.

In addition, implementation would achieve the

following:

1. Provide specific plans and guidelines for

promoting collaboration within the allied

health communities-of-interest.

2. Provide for dissemination of such plans to the

allied health communities-of-interest. 

3. Increase awareness on the part of Federal and

State policy and advisory boards, as well as

those in the private sector, of the competencies

of allied health professionals and their integral

role in the delivery of cost-effective, accessible,

quality health care for consumers.

4. Include allied health in policy development

and planning for the future in education,

research, and practice to increase quality 

health care for consumers.

5. Facilitate the creation of incentives for publicprivate partnerships to share, support, and

accelerate outcomes-based research studies to

identify clinically effective and cost efficient

allied health practices that will improve

quality, decrease cost, and increase access.

It cannot be overemphasized that achieving

these results requires collaboration on two levels. 

 

quality. The voice of allied health in these efforts,

to be clear and strong, needs to be as unified as

possible. Greater collaboration among allied

health professions will also lead to improved

research capability, the results of which will

provide guidance in all aspects of allied health,

including educational preparation, competency

documentation, core curriculum development,

research, and a more accurate assessment of the

impact of new models of care involving a

multidisciplinary approach.

The next level of collaboration—between the

allied health community and all other health care

system stakeholders—is critical if allied health is

to be a full partner in shaping and improving

future health care delivery. A higher degree of

collaboration among all stakeholders will lead to

a more efficient use of funds committed to

effectiveness research, a greater understanding of

the value of the allied health professional, and, of

equal importance, a greater understanding on the

part of the allied health community of the

priorities of other stakeholders. There can be no

doubt that improved collaboration at this level

will lead to a higher degree of partnering between

health care services providers, payers, and

consumers.

The efficiency of health care delivery must

improve if we hope to balance access, quality, and

cost. As paradigms are shifting, collaborative

research efforts are essential to provide objective

guidance for decision makers as they attempt to

organize new service delivery models and

broaden access across the health care continuum.

Ultimately, collaborative efforts must lead to a

comprehensive research agenda that will address

both the unique and the collective contributions 

of all components of the health care delivery

system. Enhanced collaboration will lead to

decreased compartmentalization and, as a result,

have a positive impact on the ability of health care 

 
Report of the NCAH Implementation Task Force

Collaboration 49

providers to successfully address the challenges The allied health communities must work in

of the emerging health care delivery system in collaboration with the Bureau of Health

terms of service delivery, education, and Professions and other agencies to promote

competency documentation. representation of allied health on policy and

Plan: Develop practical mechanisms to increase

representation of allied health

professionals on State, regional, and

national policy and advisory boards, and

on various key deliberative bodies within

Federal and State governments.

NCAH recommendation addressed:

Recommendation 4. Congress should authorize

the Secretary of DHHS to establish the Office of

Allied Health Professions within HRSA to:

• Advance the representation and, hence, the

visibility of current and potential contributions

of the allied health professions to education,

research, practice, and policy development.

• Collaborate with other agencies to promote the

representation of allied health on policy and

advisory boards and other key deliberative

bodies within the Federal Government. For

example, allied health currently has no

representation on the Advisory Council of the

National Health Service Corps (NHSC) and is

not even mentioned as a member of the NHSC

multidisciplinary team.

Purpose of Plan

The voice of allied health is seldom heard on

government or private-sector health policy and

advisory boards at the national, regional, and

State levels. The lack of allied health

representation, whether on Federal agency

advisory committees, research study sections,

integrated health systems’ boards, or third-party

payment policy boards, diminishes health care

progress due to a lack of information and

understanding about the potential contributions

of allied health professionals.

advisory boards and other key deliberative

bodies, not only within the Federal Government

but also in the private sector. Furthermore, allied

health State consortia and professional associations should collaborate to promote the

representation of allied health on such boards and

deliberative bodies at the State level. Increased

allied health representation will enhance the

visibility and awareness of current and potential

contributions of the allied health professions to

education, research, practice, and policy development to increase health care quality and access

for consumers at minimum cost.

Goals of Plan

1. Increase the representation of qualified allied

health professionals on Federal and State

government and private-sector health policy

and advisory boards and other key deliberative

bodies.

2. Through increased representation, advance the

visibility, knowledge, and understanding of 

the capabilities of allied health professionals

and of their potential contributions to health

care quality, access, and cost efficiency.

Implementation Plan

1. In collaboration with allied health leadership

from the Association of Schools of Allied

Health Professions, the National Network of

Health Career Programs in Two-Year Colleges,

and the Health Professions Network, the

Bureau of Health Professions is the agency to

assist in identifying Federal and State

government as well as private-sector agencies

and policy and advisory boards that do not

include allied health representation and could

benefit from allied health input.

2. Allied health leadership and the Bureau should

develop a template to use in initiating dialogue 

 
Building the Future of Allied Health

50 Collaboration

with such entities—to assess their mission and performance on policy and advisory boards is

requirements for service, and to promote a under development by CAC. The use of the

consistent message about the benefits of CAC’s model and training course, to increase

including allied health. representation, must also be encouraged at the

3. The allied health associations should compile a

data base of allied health individuals qualified

to represent allied health on such boards and

deliberative bodies, and their areas of

expertise, to aid in the appointment process.

4. To assure the availability of qualified and

effective allied health representatives to serve

on policy and advisory boards, the Task Force

recommends the adaptation and use of the

Citizen Advocacy Center (CAC) strategies for

supporting public members of health

professions boards and governing bodies. 

Through discussion and strategic workshops,

CAC identified the following three strategies to

overcome obstacles to effective public

participation, which should be adaptable to the

allied health professions serving on policy and

advisory boards:

a. Perfecting methods for locating and 

placing qualified public representatives on

regulatory or governing bodies.

b. Defining the roles and missions of public

members in the various settings in which

they serve.

c. Developing a strategic plan for training

and supporting public members to enable

them to carry out their responsibilities

more effectively.

Furthermore, a highly focused training course

to teach practical skills for more effective 

State level, with State allied health consortiums

and professional associations taking the lead

responsibility.

Impact of Plan

Implementing this plan would increase the

awareness of other stakeholders about the

competencies of allied health professionals; thus it

would increase their understanding of the value

of allied health contributions to the delivery of

cost-effective, accessible, quality health care for

consumers and communities. The longer-term

impact would be more appropriate, effective

integration of allied health professionals into the

evolving health care delivery system.

By developing a data base of allied health

professionals qualified to serve on health policy

and advisory boards and deliberative bodies in

both government and the private sector, and by

promoting such representation, this plan would

both facilitate and spur the appointment of

appropriate allied health representatives. The

result would be greater visibility for allied health

on these bodies and an increase in mutual

understanding and appreciation. Finally,

implementing the Task Force’s recommendation

about adapting and using the CAC strategies and

training course would increase the effectiveness 

of allied health representatives and their ability to

advance goals and values they share with all

stakeholders.
Report of the NCAH Implementation Task Force

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O’Neil E. Health Professions Education for the

Future: Schools in Service to the Nation. San

Francisco, CA: Pew Health Professions

Commission, 1993.

Perry DA, Freed JR, and Kushman JE. “The States. Washington, DC: U.S. Government

California Demonstration Project in Printing Office, 1992.

Independent Practice.” Journal of Dental

Hygiene 68:137–142, 1994.

Pew Health Professions Commission. Critical Seventh Report to the President and Congress

Challenges: Revitalizing the Health Professions on the Status of Health Personnel in the United

for the Twenty-first Century. Berkeley, CA: States. Washington, DC: U.S. Government

University of California at Berkeley, Center for Printing Office, 1990.

the Health Professions, 1995.

Rensch S. “Articulation and Transfer.” Developed Health Resources and Services Administration.

for the National Network of Health Programs Sixth Report to the President and Congress on

in Two-Year Colleges, Community College of the Status of Health Personnel in the United

Philadelphia, 1994. Unpublished paper. States. Washington, DC: U.S. Government

Rich MW. “A Multidisciplinary Intervention to

Prevent the Readmission of Elderly Patients U.S. Department of Health and Human Services.

with Congestive Heart Failure.” New England Report of the National Commission on Allied

Journal of Medicine 333(18):1190–5, November Health. Rockville, MD: U.S. Department of

2, 1995. Health and Human Services, Public Health

Smith S, Freeland M, Heffler S, McKusick D, and

the Health Expenditures Projection Team. “The

Next Ten Years of Health Spending: What 

Does the Future Hold?” Health Affairs

17(5):128–140, September/October 1998.

Journal 43(9):719–23, 1998.

Haney DJ. “Physician Ordered Respiratory

Care vs Physician Ordered Use of Respiratory

Therapy Consult Service: Results of a

Prospective Study.” Chest 110(2):422–29,

August 1996.

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the Status of Health Personnel in the United

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Printing Office, 1988.

Service, Health Resources and Services

Administration, Bureau of Health Professions,

Division of Associated, Dental, and Public

Health Professions, 1995.
Report of the NCAH Implementation Task Force

Postscript 53

Postscript

Since the work of the Implementation Task conferences were supported by a cooperative

Force began in December 1996, several projects grant issued by the Bureau of Health Professions,

have been undertaken that are relevant to the U.S. Department of Health and Human Services. 

National Commission on Allied Health’s The allied health community provided the

recommendations. The projects are strategic in remaining funding through its professional

nature and will improve the allied health organizations.

community’s ability to positively influence the

evolving health care delivery system.

The purpose of this postscript is to bring the following allied health organizations:

reader up to date on three of these projects—the

allied health leadership project, the education

reform conference, and the Allied Health Data

Collaborative project. (The National

Commission’s recommendation on the data

collection project is outside the mission of the

Implementation Task Force, but is relevant to its

goals.)

Leadership

In its report, the National Commission on

Allied Health made several references to the need

to develop leaders within the allied health

community. These individuals must be prepared

by experience and training to participate in

meaningful collaboration with all other health

care stakeholders. Such collaboration could then

lead to a more thoughtful use of allied health

professionals.

The Commission indicated that much health

care reform planning has occurred without

representation from the allied health community. 

The Task Force believes that several approaches,

including organizing formal collaborative efforts

with stakeholders, will further the goal of

comprehensive allied health involvement. For

these efforts to be effective and productive,

however, it is imperative that the allied health

community includes members who are qualified

to participate at the leadership level.

In 1998, two leadership conferences were held

to train potential allied health leaders in the areas

of practice, education, and research. These 

 

Conference participants were selected from

applicants who are members of one of the

• Association of Schools of Allied Health

Professions (ASAHP)

• Health Professions Network (HPN)

• National Network of Health Career Programs

in Two-Year Colleges (NN2)

Individuals selected to participate in the

program attended two separate week-long

conferences. The first was held in the spring and

the second in the fall of 1998. Participants first

received information about how national public

policy is made. Topics included the operations of

Congress, Federal agencies, and lobbyists. 

National issues that directly affect allied health

practice and education were also discussed. 

Collaboration with other allied health disciplines

was encouraged, and attendees were assigned to

interdisciplinary projects related to allied health.

The fall conference was devoted to leadership. 

Attendees received information about methods of

identifying personal leadership strengths and

weaknesses and mentoring skills. Time was also

devoted to methods of leadership for a time of

change.

Attendees generated several documents, which

ranged in subject from the development and use

of clinical practice guidelines to clinical outcomes

research for allied health professions.

Future conferences will provide education in

the areas of clinical outcomes research, allied

health awareness, promotion of diversity within

the allied health community, government

relations, practice guidelines, graduate education,
Building the Future of Allied Health

54 Postscript

and representation on deliberative bodies. 

Persons selected for the conferences must be

nominated by their respective organizations and

must have demonstrated their potential for

assuming leadership roles within their discipline

as well as in the allied health community.

Education Reform

As described in the education chapter of this

report (Chapter 2), the Implementation Task Force

designed a strategy to consider allied health

clinical education reform within the context of the

emerging values of the evolving health care

delivery system.

A national conference to pioneer allied health

clinical education reform has been planned for

July of 1999. The conference is sponsored by the

Health Resources and Services Administration,

U.S. Department of Health and Human Services,

and hosted by the Department of Medical and

Research Technology, University of Maryland

School of Medicine. The purpose of the

conference is to provide key stakeholders with an

opportunity to collaborate on a strategic plan for

clinical training, to ensure the availability of allied

health care professionals who are qualified to

meet the needs of patient populations and health

care services providers. Among the many topics

to be addressed are the following:

• Program standards

• Accreditation issues

• Service provider needs

Looking to the needs of the 21st century,

conference participants will also undertake an

assessment of the availability, appropriateness,

and cost-effectiveness of training for allied health

professionals. National professional societies,

accrediting agencies, managed care organizations,

hospital associations, third party payers, and 2-

and 4-year college programs in allied health will

be represented at the conference.

The Allied Health Data Collaborative

Project

In the spring of 1997, the U.S. Bureau of Health

Professions issued a contract to the Association of

Schools of Allied Health Professions to “establish

a partnership between data users and producers

who will comprise the Allied Health Data

Collaborative as recommended by the National

Commission on Allied Health...” (ASAHP

Proposal, 1997).

ASAHP convened more than 50 individuals

from 43 institutions, associations, agencies, and

organizations. The stated purposes of the

conference included learning about existing data

collection activities, such as those undertaken by

the U.S. Bureau of Labor Statistics, and identifying

priority gaps in data. Overarching goals of the

conference were to develop working relationships

among the organizations represented and to

formulate plans for the data collaborative.

Two invitational meetings were held with

selected organizations. These meetings provided

a common ground of knowledge regarding data

collection on the status of the allied health

workforce. Organizational commitments were

also obtained to establish the collaborative and

develop viable plans for followup steps. 

Attendees drafted a consensus statement,

which was supported by 16 organizations. 

Progress has been made toward the establishment

of a data collaborative, but it has not yet been

possible to design data collection instruments or

to undertake major primary or secondary data

collection.

A second phase of this project will be

undertaken to step up efforts to collect, analyze,

and disseminate allied health workforce data. 

These data will include information on the 

supply, demand, and utilization of the allied

health workforce. This data collection goal will be

achieved through the establishment and active

operation of a data collaborative that includes

both data producers and users. ASAHP will

oversee the development and operations of the

collaborative project.
Report of the NCAH Implementation Task Force

Appendix 55

Appendix A. Implementation Task Force of

the National Commission on

Allied Health

Chairman Project Director

Sam P. Giordano, MBA, RRT Norman Clark, DDS, MPH, JD

American Association for Respiratory Care Bureau of Health Professions

Health Resources and Services Administration

Members Consultants

Deborah Bailey Astroth, RDH, BS Caroll Deuben, PhD

University of Colorado Health Sciences Center University of Detroit

John A. Cromer, PhD Bernice Parlak

St. Petersburg Junior College Health Resources and Services Administration

Denise M. Harmening, PhD Henry Montes

University of Maryland School of Medicine Health Resources and Services Administration

Gail A. Nielsen, BSHCA, RT ® FAHRA

Iowa Health System

Wanda Hancock, MHSA

Medical University of South Carolina

Robert Thorpe, EdD, RT

University of North Carolina at Chapel Hill

Suzanne C. Mercure

Barrington & Chappell

Staff

Cygnus Corporation
Building the Future of Allied Health

56 Appendix

Appendix B. Survey Mailing List

American Association of Community Colleges International Society for Clinical Laboratory

American Association for Respiratory Care Technology

American Association of Retired Persons National Association of Community Health

American Association of State Colleges and Centers

Universities National Association of County Health Officials

American Dental Hygienists Association National Association of Emergency Medical

American Dietetic Association Technicians

American Health Care Radiology Administrators National Association of Health Services

American Health Information Management Executives

Association National Association of Home Care

American Hospital Association National Association of Rehabilitation Facilities

American Occupational Therapy Association, Inc. National Black Association for Speech, Language

American Physical Therapy Association and Hearing

American Public Health Association National Center for the Advancement of Blacks in

American Society for Clinical Laboratory Science the Health Professions

American Society of Clinical Pathologists National Consortium on Health Science and

American Society of Radiologic Technologists Technology Education

American Speech-Language-Hearing Association National Council of Community Hospitals

Association of Academic Health Centers National Health Council, Inc.

Association of Schools of Allied Health National Network for Health Care Programs in

Professions Two-Year Colleges

Association of Schools of Public Health National Rural Health Association

Benefits Administration Manager National Society of Allied Health

Citizen Advocacy Center National Society for Histotechnology

Committee on Allied Health Education and National Therapeutic Recreation Society

Accreditation 16 Institutions Health Science Consortium

Health Insurance Association of America Society of Diagnostic Medical Somnographers

Indian Health Service Society of Nuclear Medicine

International Hearing Society
Report of the NCAH Implementation Task Force

Appendix 57

Appendix C. Survey Respondents

American Association of Community Colleges

American Association for Respiratory Care

American Dietetic Association

American Occupational Therapy Association

American Society of Radiologic Technologists

American Speech-Language-Hearing Association

Association of Schools of Allied Health Professions

Citizen Advocacy Center

National Consortium on Health Science and Technology Education
Building the Future of Allied Health

58 Appendix

Appendix D. Survey

NATIONAL COMMISSION ON ALLIED HEALTH

IMPLEMENTATION TASK FORCE

SURVEY

For your additional comments, please use the space provided on pages 9–10.

I. Please identify successful projects or activities your organization has implemented in the

following areas:

A. Public relations or public awareness. Please provide a brief description of the project

including the following aspects: 

1. Identification of resources

2. Key players

3. Roles and responsibilities

4. Time lines for implementation up to and including completion
Report of the NCAH Implementation Task Force

Appendix 59

5. Measures for success

B. Has your organization developed or begun to develop a core curriculum?

1. What other groups have you contacted to assist with this project?

2. Do you anticipate that the core curriculum could be used across multiple

professions?

3. If so, which ones or how many?

C. Has your organization developed a graduate track?
Building the Future of Allied Health

60 Appendix

1. Is it specific to your profession?

2. Is it designed to develop an entry level person or as a career ladder?

II. Please provide us with information relating to efforts undertaken by your organization in the

area of collaboration. These areas can include collaboration among and between professions. 

The Task Force is especially interested in learning about the following:

A. What were the goals of the collaboration effort?

B. Briefly describe the collaboration process.

C. What resources were necessary to execute the project?

D. What were the roles and responsibilities of key players?
Report of the NCAH Implementation Task Force

Appendix 61

E. How long did the project take?

F. What measures were used to gauge success?

III. Please provide information concerning your organization’s efforts related to the development

and promulgation of practice guidelines. The Task Force is especially interested in the

following:

A. How long have you been developing practice guidelines?

B. Briefly describe the process you are using to develop the guidelines.

C. What resources are necessary to execute the project?
Building the Future of Allied Health

62 Appendix

D. What prompted your organization’s decision to become involved in guidelines

development?

E. What are the roles and responsibilities of the key players involved in this project?

F. What efforts have you undertaken to assure acceptance of the guidelines by both members

of your profession and other components of the health care delivery system?

G. For which allied health professionals have you developed practice guidelines?

IV. The Task Force is currently developing implementation strategies in three major areas—

1) Education Reform, 2) Collaboration, and 3) Outcomes Research—and asks what strategies

you would suggest to facilitate implementation of the Commission’s recommendations. Please

bear in mind that we are looking for practical, down-to-earth strategies that do not necessarily

depend on outside funding. A preferred strategy would be one that ties into an organization’s

values and can be achieved by committing resources currently available to the organization in

question. Please relate your recommended strategies to the three above-mentioned categories,

and consider the following:
Report of the NCAH Implementation Task Force

Appendix 63

A. What strategies do you recommend to facilitate implementation of the Commission’s

recommendations?

B. Who will undertake your strategies?

C. What resources are necessary to implement these strategies?

D. What is the expected result of the efforts?

E. What other organizations would be involved as collaborators, facilitators, enablers, etc?

F. What funding sources and other resources are available to implement your strategies?
Building the Future of Allied Health

64 Appendix

V. The Task Force wants to develop implementation strategies that tie into your organization’s

values. Please take a few moments to indicate to us what critical issues are facing your

organization and what you are currently doing to address these issues. The Task Force is

especially interested in learning:

A. Your critical issues.

B. The priorities of your critical issues.

C. Why you consider these issues to be critical.

D. What the projected impact would be if the issues are not addressed successfully.

E. If you would be willing to work with other organizations sharing similar critical issues.
Report of the NCAH Implementation Task Force

Appendix 65

VI. Has your organization addressed cultural diversity?

A. Do you have a committee or task force in place?

B. Have specific projects or programs been developed for this purpose?

C. If so, what are they?

D. Were they evaluated and if so, were they successful?

VII. Has your organization developed a list of core competencies? If so, please provide.
Building the Future of Allied Health

66 Appendix

ADDITIONAL COMMENTS
Report of the NCAH Implementation Task Force

Appendix 67
Building the Future of Allied Health

68 Appendix

Appendix E. Glossary

AARC—American Association for Respiratory Care, APTA—American Physical Therapy Association.

formerly the American Association for Respiratory

Therapy. ASAHP—Association of Schools of Allied Health

Accreditation—Official approval or recognition of

conformance to a set of standards; usually involves ASLHA—American Speech-Language-Hearing

providing with credentials. Association.

ADA—American Dietetic Association. CAAHEP—Commission on Accreditation of Allied

AHCPR—Agency for Health Care Policy and

Research. CAC—Citizen Advocacy Center.

Allied health professional—A health professional CAHEA—Committee on Allied Health Education

(other than a registered nurse or physician assistant) and Accreditation.

who has received a certificate, an associate’s degree,

a bachelor’s degree, a master’s degree, a doctoral Care coordinator—The health professional

degree, or postbaccalaureate training in a science responsible for the overall administration of a plan 

relating to health care; who shares in the or care for an individual patient.

responsibility for the delivery of health care services

or related services, including (1) services relating to CDC—Centers for Disease Control and Prevention.

the identification, evaluation, and prevention of

disease and disorders, (2) dietary and nutrition Certification—A form of health professions

services, (3) health promotion services, (4) regulation and title protection that specifies the

rehabilitation services, or (5) health systems requirements an individual must meet in order to 

management services; and who has not received a use a particular occupational title.

degree of doctor of medicine, a degree of doctor of

osteopathy, a degree of doctor of veterinary CLEAR—Council on Licensure Enforcement and

medicine or equivalent degree, a degree of doctor of Regulation.

optometry or equivalent degree, a degree of doctor 

of podiatric medicine or equivalent degree, a degree Clinical practice guidelines—Systematically

of bachelor of science in pharmacy or equivalent developed statements prepared by AHCPR to assist

degree, a graduate degree in public health or practitioner and patient decisions about appropriate

equivalent degree, a degree of doctor of chiropractic health care for specific clinical circumstances.

or equivalent degree, a graduate degree in health

administration or equivalent degree, a doctoral Cost containment—The use of various payment

degree in clinical psychology or equivalent degree, mechanisms, regulations, or market forces (or a

or a degree in social work or equivalent degree. combination of any or all three dynamics) to reduce 1

Allied health clinical research—Examination of

practice effectiveness and the development of tools Cost effective—A relative term used to describe an

to measure the effect. action that either provides more units of 

AOTA—American Occupational Therapy alternative action or provides the same units of

Association. effectiveness for less cost than the alternative.

Professions.

Health Educational Programs (see CAHEA).

the rate of increase in health care expenditures.

effectiveness for the same cost compared with an

However, if an action provides more outcomes

(effects) but incurs more costs, this approach can be

considered to be cost-effective if society is willing to

pay the extra expense to achieve the extra effect.

Health Professions Education Extension Amendments of 1992, 1

Sec. 701 PHS Act.
Report of the NCAH Implementation Task Force

Appendix 69

Cost efficient—The same unit of outcome achieved Home health care—Health services such as nursing,

at less cost. therapy, and health-related homemaker or social

De-skilling—The process of shifting the 

performance of specific tasks from a highly skilled, IOM—Institute of Medicine, a branch of the 

higher paid worker to another, lower paid worker National Academy of Sciences that performs studies

who has had limited educational preparation. of health care delivery.

DHHS—U.S. Department of Health and Human Licensure—A form of occupational regulation

Services. whereby the profession is given a State-sanctioned

Dual-admission—A type of articulation medicine, osteopathy, dentistry, veterinary 

arrangement in which a student who applies to a 2- medicine, optometry, and pharmacy (MODVOP) as

year college and agrees to take a specific set of well as nursing. Individuals who have satisfied the

courses can be simultaneously admitted to a 4-year educational requirements of these professions must

institution. also be licensed in the States in which they wish to

Effectiveness—Producing a desired outcome.

Efficacy—Having the capacity to produce a desired between one institution and another institution,

outcome. agency, organization, or facility for the coordination,

Employer—The health care industry employer, e.g.,

hospital, home care company, physician, or dentist. Long-term care—The wide array of health and social

HCFA—Health Care Financing Administration. disabled that they require assistance in daily, 

Health Careers Opportunity Program—Established

by the Federal Government to address Managed Care—An organized system of health care

underrepresentation of minorities throughout the delivery in which primary care providers control

health professions. utilization of and referrals to specialty care.

HEDIS—Health Plan Employer Data and Medicare—A Federal program created by Title XVIII

Information Set. of the Social Security Act that provides health

HMO—A health maintenance organization, an of 65 and others eligible for Social Security benefits.

organization that provides comprehensive health

care for a fixed monthly premium per member. Multicompetent/multiskilled—Includes three

Premiums are paid directly to the plan and do not models:

vary with utilization of services.

HPN—Health Professions Network. these individuals is designed to produce a worker

HRSA—Health Resources and Services office activities, laboratory, and radiology

Administration. (example—medical assistant). These individuals

Health services research—A field of inquiry that specific area for certification as a radiographer,

examines the impact of the organization, financing, medical laboratory technician, or medical record

and management of health care services on the technician. This person has sufficient education to

delivery, quality, cost, access to, and outcome of perform basic level functions only. Medical

such services. Assisting is a CAHEA/ CAAHEP accreditation

services provided in the patient’s home.

monopoly. As of 1920, all States had licensed

practice.

Linkage—An agreement, either written or oral,

provision, or referral of information or programs.

services for persons who are so functionally 

routine activities.

insurance benefits primarily to persons over the age

Multiple technician. The education/training for

with limited training in several areas, including

usually do not have sufficient education in a

and graduates of these institutions can be certified

in this field.
Building the Future of Allied Health

70 Appendix

Multiple credentialing. This multicompetent features of care that are important in affecting those

person would have specialized credentials in two outcomes.

or more areas, which are generally related fields.

For example, a person could hold two or more Payer—Includes individuals, insurers, and the

allied health credentials in radiology-related fields Federal Government who pay for health care.

or in the medical laboratory area. Usually the

second credential area can be acquired in reduced Pedagogy—The art and science of teaching,

education time, based on successful completion of education, and instructional methods. Translation of

the first education program and certification. the foregoing future directions into workable

Multiple credentials may also be in two unrelated recommendations and action requires careful and

fields (example: respiratory therapy and medical systematic thought.

technology), but this pattern usually requires a

longer education time to complete the require- Postsecondary education—Formal or informal

ments of the second field. education or training that occurs after high school

Practitioner with added skills. This

multicompetent practitioner would have a Primary care—“First contact” health care, as viewed

credential in a specific field and have additional by the patient, that provides at least 80 percent of

education/training in another area but not to a necessary care and a comprehensive array of

certification/credential level. For example, a preventive as well as curative services. Primary care

registered nurse may do limited laboratory tests is typically rendered by general practitioners, family

or x-ray exams. The added skill may also be in an practitioners, internists, pediatricians, obstetrician/

area where there is no specific certification. gynecologists, and mid-level allied health 2

NCAH—National Commission on Allied Health. practitioners).

NCHSTE—National Consortium of Health Science Purchaser—The individual or group seeking health

and Technology Education. care services.

NCQA—National Committee for Quality Quality of life—Defined functionally by a patient’s

Awareness. perception of performance in physical and

NERCOA—National Education and Research interaction, and somatic sensation.

Center for Outcomes Assessment in Healthcare.

NHSC—National Health Service Corps. regulation usually involving adherence to minimum

NHCSSP—National Health Care Skill Standards enforcement.

Project.

NLM—National Library of Medicine, a branch of organized professional staff that provides medical,

the National Institutes of Health. continuous nursing, and various other health and

NN2—National Network of Health Career Programs phase of illness but who require primarily 

in Two-Year Colleges. restorative or skilled nursing care on an inpatient

Outcomes research—A method of investigating

relationships that exist among outcomes of interest, Technician—A general category of allied health

variations in the process of care, and the structural professional trained and educated to render certain

instruction has been completed.

practitioners (e.g., physician assistants and nurse

occupational function, psychological state, social

Registration—A form of health professions

standards; may or may not require testing or

SNF—A skilled nursing facility. A facility with an

social services to patients who are not in an acute

basis.

basic procedures. Technicians usually receive less

than 2 years of postsecondary education and

practice; they are supervised by allied health

technologists. Technicians include physical therapy

assistants, medical laboratory technicians, radiologic

Cox K.H., Wells D.A., and Wheeler C. “Institutional 2

Responsiveness.” National Network of Health Career Programs

in Two Year Colleges. Tarrant County Junior College NE, 1994.

Unpublished paper.
Report of the NCAH Implementation Task Force

Appendix 71

technicians, and respiratory therapy technicians. Third-party payer—Insurance company or

Also referred to as allied health assistants. governmental agency that reimburses a provider for

Therapist/Technologist—A second general category such benefits.

of allied health professionals trained to instruct and

supervise allied health technicians. Technologists 2+2 program—A mutually agreed upon standard set

usually receive more than 2 years of postsecondary of courses that are completed at the 2-year college

training. Technologists are trained to evaluate and then transferred as a group to a 4-year college.

patients, diagnose problems, develop treatment

plans, and perform a variety of clinical tasks. Also

referred to as allied health therapists.

services rendered to an individual who is eligible for