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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 16 of 16 Research Studies Displayed
Goodwin JS, Agrawal P, Li S
Growth of physicians and nurse practitioners practicing full time in nursing homes.
This retrospective cohort study examined the growth of physicians and nurse practitioners (NPs) and physician assistants (PAs) who work full time in nursing homes, and to assess resident and nursing home characteristics associated with receiving care from full-time providers. Researchers looked at a 20% national sample of Medicare data on long-term care residents in 2008 and 2018 and the physicians, NPs, and PAs who submitted charges for services rendered in nursing homes. Full-time nursing home providers increased from 26% in 2008 to 44.6% in 2017. The largest increase from 2008 to 2017 was in NPs with 1986 total in 2008 increasing 44.6% in 2017. Residents with an NP primary care provider were 23 times more likely to have a full-time provider. Residents who received care from both a physician and an NP or PA increased from 33.5% in 2008 to 62.5% in 2018. There was large variation in the percentage of residents with full-time providers, with 5.72% of residents in the bottom quintile of facilities to 91.4% in the top quintile.
Citation: Goodwin JS, Agrawal P, Li S . Growth of physicians and nurse practitioners practicing full time in nursing homes. J Am Med Dir Assoc 2021 Dec;22(12):2534-39.e6. doi: 10.1016/j.jamda.2021.06.019..
Keywords: Nursing Homes, Long-Term Care, Provider: Clinician, Provider: Physician, Provider: Nurse, Workforce
Neprash HT, Zink A, Sheridan B
The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care.
Citation: Neprash HT, Zink A, Sheridan B . The effect of Medicaid expansion on Medicaid participation, payer mix, and labor supply in primary care. J Health Econ 2021 Dec;80:102541. doi: 10.1016/j.jhealeco.2021.102541..
Keywords: Medicare, Healthcare Utilization, Primary Care, Workforce, Health Insurance
Vranas KC, Golden SE, Mathews KS
The influence of the COVID-19 pandemic on ICU organization, care processes, and frontline clinician experiences: a qualitative study.
The COVID-19 pandemic resulted in unprecedented adjustments to intensive care unit (ICU) organization and care processes globally. The investigators examined if hospital emergency responses to the COVID-19 pandemic differed depending on hospital setting and explored which strategies worked well to mitigate strain as perceived by intensivists. The investigators concluded that their study demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
Citation: Vranas KC, Golden SE, Mathews KS . The influence of the COVID-19 pandemic on ICU organization, care processes, and frontline clinician experiences: a qualitative study. Chest 2021 Nov;160(5):1714-28. doi: 10.1016/j.chest.2021.05.041..
Keywords: COVID-19, Intensive Care Unit (ICU), Critical Care, Healthcare Delivery, Workforce, Public Health
Kaderka R, Hild SJ, Bry VN, Kaderka R, Hild SJ, Bry VN, , Hild SJ, Bry VN
Wide-scale clinical implementation of knowledge-based planning: an investigation of workforce efficiency, need for post-automation refinement, and data-driven model maintenance.
Investigators sought to investigate the effect of automated knowledge-based planning (KBP) on real-world clinical workflow efficiency, to assess whether manual refinement of KBP plans improves plan quality across multiple disease sites, and to develop a data-driven method to periodically improve KBP automated planning routines. They found that KBP increased clinical efficiency by significantly reducing planning time. On average, human refinement offered minimal dose improvements over KBP-only plans.
Citation: Kaderka R, Hild SJ, Bry VN, Kaderka R, Hild SJ, Bry VN, , Hild SJ, Bry VN . Wide-scale clinical implementation of knowledge-based planning: an investigation of workforce efficiency, need for post-automation refinement, and data-driven model maintenance. Int J Radiat Oncol Biol Phys 2021 Nov 1;111(3):705-15. doi: 10.1016/j.ijrobp.2021.06.028..
Keywords: Workforce, Implementation
Germack HD, Kandrack R, Martsolf GR
Relationship between rural hospital closures and the supply of nurse practitioners and certified registered nurse anesthetists.
This study sought to examine the extent to which rural hospital closures are associated with changes in the NP (nurse practitioner) and CRNA (certified registered nurse anesthetist) workforce. The authors used the Area Health Resources Files (AHRF) data from 2010-2017 to estimate the relationship between rural hospital closures and changes in the supply of NPs and CRNAs. They found 151 hospital closures among 1,544 rural counties. After controlling for local market characteristics, they did not find a significant relationship between hospital closure and the supply of NPs and CRNAs.
Citation: Germack HD, Kandrack R, Martsolf GR . Relationship between rural hospital closures and the supply of nurse practitioners and certified registered nurse anesthetists. Nurs Outlook 2021 Nov-Dec;69(6):945-52. doi: 10.1016/j.outlook.2021.05.005..
Keywords: Provider: Nurse, Workforce, Hospitals
Valbuena VSM, Obayemi JE, Purnell TS
Gender and racial disparities in the transplant surgery workforce.
This review explores trends in the United States (US) transplant surgery workforce with a focus on historical demographics, post-fellowship job market, and quality of life reported by transplant surgeons. Ongoing efforts to improve women and racial/ethnic minority representation in transplant surgery are highlighted in this paper. Future directions to create a transplant workforce that reflects the diversity of the US population are discussed.
AHRQ-funded; HS024600; HS000053.
Citation: Valbuena VSM, Obayemi JE, Purnell TS . Gender and racial disparities in the transplant surgery workforce. Curr Opin Organ Transplant 2021 Oct 1;26(5):560-66. doi: 10.1097/mot.0000000000000915..
Keywords: Workforce, Provider: Physician, Transplantation, Racial / Ethnic Minorities
Marchetti KA, Oerline M, Hollenbeck BK
Urology workforce changes and implications for prostate cancer care among Medicare enrollees.
The purpose of this study was to characterize national trends in urologist workforce, practice organization, and management of incident prostate cancer. The investigators characterized shifts in urologist membership from smaller, independent groups to larger, multispecialty or hospital-owned practices. They indicated that this trend coincided with higher utilization of observation and surgical treatment for prostate cancer.
Citation: Marchetti KA, Oerline M, Hollenbeck BK . Urology workforce changes and implications for prostate cancer care among Medicare enrollees. Urology 2021 Sep;155:77-82. doi: 10.1016/j.urology.2020.12.051..
Keywords: Cancer: Prostate Cancer, Cancer, Workforce, Practice Patterns
Escarce JJ, Wozniak GD, Tsipas S
Effects of the Affordable Care Act Medicaid expansion on the distribution of new general internists across states.
The objective of this study was to determine whether the Medicaid expansion influenced the states selected by physicians just completing graduate medical education for establishing their first practices. Thirty-three states and the District of Columbia expanded Medicaid by the end of the study period. Findings showed that physicians in one specialty group, general internal medicine, were increasingly likely to locate in expansion states after the expansion. The Medicaid expansion influenced the practice location choices of men and international medical graduates in general internal medicine, while women and United States medical graduates did not alter their pre-expansion location patterns. States that opted not to expand Medicaid under the Affordable Care Act lost general internists to expansion states, potentially affecting access to care for all of their residents regardless of insurance coverage.
Citation: Escarce JJ, Wozniak GD, Tsipas S . Effects of the Affordable Care Act Medicaid expansion on the distribution of new general internists across states. Med Care 2021 Jul;59(7):653-60. doi: 10.1097/mlr.0000000000001523..
Keywords: Medicaid, Health Insurance, Provider: Physician, Workforce
Measuring caregiver retention in nursing homes.
This study examined the retention of nursing home caregivers using a survey of nursing home administrators conducted in 2016 from 2,898 facilities. Survey data was matched with Nursing Home Compare and the Certification and Survey Provider Enhanced Reporting data. Four measures of retention were associated with each of three types for caregivers: nurse aids (NAs), registered nurses (RNs), and licensed practical nurses with six quality indicators. Retention rates at 5 years was shown to be low for all three of these caregiver types. Regression estimates showed some support for the theory that different measures of retention were more/less associated with quality. The 3- and 5-year retention measures had the strongest associations with quality of care.
Citation: Castle NG . Measuring caregiver retention in nursing homes. Gerontologist 2021 Jun 2;61(4):e118-e28. doi: 10.1093/geront/gnab012..
Keywords: Nursing Homes, Long-Term Care, Provider: Health Personnel, Workforce
Kandrack R, Barnes H, Martsolf GR
Nurse practitioner scope of practice regulations and nurse practitioner supply.
This study’s objective was to estimate associations between adopting full nurse practitioner (NP) scope of practice (SOP) and improved access to care. The authors used county-level data to estimate the association between adopting full NP SOP and NP supply in general, and in rural and health professional shortage area-designed counties specifically. They estimated positive associations, although the relationship was only statistically significant in health professional shortage areas.
Citation: Kandrack R, Barnes H, Martsolf GR . Nurse practitioner scope of practice regulations and nurse practitioner supply. Med Care Res Rev 2021 Jun;78(3):208-17. doi: 10.1177/1077558719888424..
Keywords: Provider: Nurse, Provider: Clinician, Workforce, Policy
Gettel CJ, Canavan ME, D'Onofrio G
Who provides what care? An analysis of clinical focus among the national emergency care workforce.
This study looked at the clinical focus of emergency department (ED) workers using the 2017 Medicare Public Use Files for clinicians receiving reimbursement for emergency care Evaluation & Management (E/M) services for Medicare fee-for-service Part B. Clinicians were categorized as EM physicians, non-EM physicians, and advanced practice providers (APPs). Of the 65,710 unique clinicians providing care, 59.4% were classified as EM physicians, 12.4% as non-EM physicians, and 28.5% as APPs. EM physicians have twice as much clinician median focus in comparison to EM physicians providing emergency care (92.8% vs 45.2) and APPs are focused 100%.
Citation: Gettel CJ, Canavan ME, D'Onofrio G . Who provides what care? An analysis of clinical focus among the national emergency care workforce. Am J Emerg Med 2021 Apr;42:228-32. doi: 10.1016/j.ajem.2020.11.069..
Keywords: Emergency Department, Workforce, Provider: Physician, Provider: Clinician, Provider, Medicare
Ingraham AM, Chaffee SM, Ayturk MD
Gaps in emergency general surgery coverage in the United States.
Researchers sought to measure gaps in round-the-clock emergency general surgery (EGS) care via a survey of all US adult acute care general hospitals with an emergency room, at least 1 operating room. They found that 17.1% of hospitals responding were unable to always provide round-the-clock EGS care. Rural location, smaller bed size, and non-teaching status were associated with lack of round-the-clock care. Inconsistent surgeon coverage was the primary reason for this lack. However, lack of a tiered system for booking emergency cases, no anesthesia availability overnight, and no stipend for EGS call were also associated with the inability to provide round-the-clock EGS care.
AHRQ-funded; HS025224; HS022694.
Citation: Ingraham AM, Chaffee SM, Ayturk MD . Gaps in emergency general surgery coverage in the United States. Ann Surg Open 2021 Mar;2(1). doi: 10.1097/as9.0000000000000043..
Keywords: Surgery, Emergency Department, Hospitals, Access to Care, Workforce
Luo Q, Dor A, Pittman P
Optimal staffing in community health centers to improve quality of care.
The authors explored optimal workforce configurations in the production of care quality in community health centers (CHCs), accounting for interactions among occupational categories, as well as contributions to the volume of services. By linking the Uniform Data System with Internal Revenue Service nonprofit tax return data, they found that primary care physicians and advanced practice clinicians achieved similar quality outcomes. They recommended that CHCs optimize their workforce configuration to improve quality with further hiring of advanced practice clinicians as a cost-effective investment for CHCs.
Citation: Luo Q, Dor A, Pittman P . Optimal staffing in community health centers to improve quality of care. Health Serv Res 2021 Feb;56(1):112-22. doi: 10.1111/1475-6773.13566..
Keywords: Community-Based Practice, Workforce, Quality of Care
Wilson BL, Butler RJ
Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours.
Numerous studies have identified a relationship between nurse staffing and adverse patient outcomes in medical / surgical patient populations. However, little is known about the impact of labor and delivery (L&D) nurse staffing and adverse birth outcomes, such as unintended cesarean delivery, in low-risk term-gestation women. In this study the investigators examined nurse staffing patterns on the likelihood of cesarean sections (C-sections) among low- risk, full gestation births and provided a testing framework to distinguish optimal from ineffective levels of nurse staffing.
Citation: Wilson BL, Butler RJ . Identifying optimal labor and delivery nurse staffing: the case of cesarean births and nursing hours. Nurs Outlook 2021 Jan-Feb;69(1):84-95. doi: 10.1016/j.outlook.2020.07.003..
Keywords: Provider: Nurse, Provider, Workforce, Labor and Delivery, Pregnancy, Quality of Care, Risk, Women
Cohen C, Baird M, Koirola N
The surgical and anesthesia workforce and provision of surgical services in rural communities: a mixed-methods examination.
This mixed-methods study described the distribution of the surgical and anesthesia workforce and qualitatively explored how such workforce and other factors influenced rural hospitals' provision of surgical services. Using American Hospital Association survey data, the researchers found that within rural counties, 55.1% had no surgeon, 81.2% had no anesthesiologist, and 58.1% had no Certified Registered Nurse Anesthetist. While rural hospitals reported meeting community needs for elective and noncomplex surgeries, these hospitals continued to face significant challenges providing subspecialty surgeries, emergency surgeries, and 24-hour obstetrical services.
Citation: Cohen C, Baird M, Koirola N . The surgical and anesthesia workforce and provision of surgical services in rural communities: a mixed-methods examination. J Rural Health 2021 Jan;37(1):45-54. doi: 10.1111/jrh.12417..
Keywords: Rural Health, Access to Care, Surgery, Workforce, Provider: Physician, Provider: Nurse, Provider, Hospitals
Dill JS, Morgan JC, Weiner B
Frontline health care workers and perceived career mobility: do high-performance work practices make a difference?
This study examined how high-performance work practices (HPWPs) that focus on career development are related to an individuals' perceived mobility with their current employer, and also examined the relationships between perceived mobility, job satisfaction, and turnover intent. The findings suggest that tuition remission and educational release time positively predict perceived mobility, while measures of perceived organizational support in one's current position and perceived supervisor support for career development are also significant predictors of perceived mobility. Additionally, perceived mobility is a significant predictor of job satisfaction and intent to stay with current employer.
Citation: Dill JS, Morgan JC, Weiner B . Frontline health care workers and perceived career mobility: do high-performance work practices make a difference? Health Care Manage Rev 2014 Oct-Dec;39(4):318-28. doi: 10.1097/HMR.0b013e31829fcbfd.
Keywords: Provider: Health Personnel, Provider Performance, Workforce