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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 25 of 61 Research Studies Displayed
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
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
Campbell AM, Mattoni M, Yefimov MN
Improving cognitive workload in radiation therapists: a pilot EEG neurofeedback study.
The authors employed an accelerated alpha-theta neurofeedback (NF) protocol to test if 12 radiation therapy therapists (RTTs) could learn the protocol and exhibit behavior and brain performance-related benefits. Following the 3-week protocol, participants showed a decrease in subjective cognitive workload and a decrease in response time during a performance task, as well as a decrease in desynchrony of the alpha electroencephalogram band. The authors concluded that the RTTs successfully learned the protocol and improved in perceived cognitive workload following 3 weeks of neurofeedback.
Citation: Campbell AM, Mattoni M, Yefimov MN . Improving cognitive workload in radiation therapists: a pilot EEG neurofeedback study. Front Psychol 2020 Dec 3;11:571739. doi: 10.3389/fpsyg.2020.571739..
Keywords: Provider, Burnout, Stress, Workforce
Shubeck SP, Newman EA, Vitous CA
Hiring practices of US academic surgery departments-challenges and opportunities for more inclusive hiring.
To increase workforce diversity among academic medical centers, the Association of American Medical Colleges recommends multiple inclusive strategies for evaluating and hiring candidates. The objective of this study was to determine (1) usual and inclusive hiring practices used among academic surgery departments and (2) the barriers to utilization of inclusive hiring practices. The investigators concluded that many chairs rely heavily on internal hires or trusted networks, which may limit both demographic and cognitive diversity.
Citation: Shubeck SP, Newman EA, Vitous CA . Hiring practices of US academic surgery departments-challenges and opportunities for more inclusive hiring. J Surg Res 2020 Oct;254:23-30. doi: 10.1016/j.jss.2020.03.054..
Keywords: Surgery, Provider: Physician, Provider, Workforce, Hospitals
de Cordova PB, Jones T, Riman KA
Staffing trends in magnet and non-magnet hospitals after state legislation.
This study examined whether there was a difference in staffing of registered nurses in Magnet and non-Magnet hospitals using unit-level, publicly available data in New Jersey. This secondary analysis of longitudinal RN staffing data was conducted using 64 hospitals representing 12 nursing specialties during the time span of 2008 to 2015. There was a slight increase in staffing at Magnet hospitals compared to non-Magnet hospitals, but RN staffing improved in all hospitals. No meaningful difference in staffing for all 12 specialties was found.
Citation: de Cordova PB, Jones T, Riman KA . Staffing trends in magnet and non-magnet hospitals after state legislation. J Nurs Care Qual 2020 Oct/Dec;35(4):323-28. doi: 10.1097/ncq.0000000000000479..
Keywords: Hospitals, Policy, Healthcare Delivery, Workforce
Womack DM, Hribar MR, Steege LM
Registered nurse strain detection using ambient data: an exploratory study of underutilized operational data streams in the hospital workplace.
Registered nurses (RNs) regularly adapt their work to ever-changing situations but routine adaptation transforms into RN strain when service demand exceeds staff capacity and patients are at risk of missed or delayed care. The purpose of this study was to assess the utility of ambient workplace data, defined as time-stamped transaction records and log file data produced by non-electronic health record care delivery tools (e.g., nurse call systems, communication devices), as an information channel for automated sensing of RN strain.
Citation: Womack DM, Hribar MR, Steege LM . Registered nurse strain detection using ambient data: an exploratory study of underutilized operational data streams in the hospital workplace. Appl Clin Inform 2020 Aug;11(4):598-605. doi: 10.1055/s-0040-1715829..
Keywords: Provider: Nurse, Provider, Health Information Technology (HIT), Workforce, Burnout
Islam N, Rogers ES, Schoenthaler EA
A cross-cutting workforce solution for implementing community-clinical linkage models.
This article discusses the use of employing community health workers (CHWs) in primary care practices to create community-clinical linkage models to address the underlying role of social determinants of health and achieve health equity. Federal initiatives such as EvidenceNOW and Million Hearts have supported a renewed focus on small, independently owned practices. These initiatives emphasize the role of practice facilitation. The authors drew from the literature and propose that small, independently owned practices strategically employ practice facilitators to help integrate CHWs into their primary care teams. These facilitators help provide a “population health management” infrastructure to develop effective partnerships. Several ways that practice facilitation can help do this is outlined in this paper.
Citation: Islam N, Rogers ES, Schoenthaler EA . A cross-cutting workforce solution for implementing community-clinical linkage models. Am J Public Health 2020 Jul;110(S2):S191-s93. doi: 10.2105/ajph.2020.305692..
Keywords: Community-Based Practice, Primary Care, Workforce, Primary Care: Models of Care, Healthcare Delivery
Poghosyan L, Ghaffari A, Liu J
Organizational support for nurse practitioners in primary care and workforce outcomes.
Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. In this study, the researchers investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. The investigators concluded that nurse practitioners from primary care practices with higher levels of organizational support were more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care.
Citation: Poghosyan L, Ghaffari A, Liu J . Organizational support for nurse practitioners in primary care and workforce outcomes. Nurs Res 2020 Jul/Aug;69(4):280-88. doi: 10.1097/nnr.0000000000000425..
Keywords: Provider: Clinician, Provider, Primary Care, Burnout, Stress, Workforce, Organization and Administration
Toledo P, Lewis CR, Lange EMS
Women and underrepresented minorities in academic anesthesiology.
The demographics of the United States is changing with 51% of the population being female, and 32% of the population identifying as an underrepresented minority (URM, ie, African American/black, Hispanic/Latino, American Indian/Alaska Native, Native Hawaiian/Pacific Islander). This article provides an overview of the current status of women and URM faculty in academic anesthesiology and provides a framework for academic advancement.
AHRQ-funded; HS025267; HS026169.
Citation: Toledo P, Lewis CR, Lange EMS . Women and underrepresented minorities in academic anesthesiology. Anesthesiol Clin 2020 Jun;38(2):449-57. doi: 10.1016/j.anclin.2020.01.004..
Keywords: Provider: Physician, Provider, Workforce, Women, Racial / Ethnic Minorities, Education: Academic
Whitaker DJ, Lyons M, Weeks EA
Does adoption of an evidence-based practice lead to job turnover? Results from a randomized trial.
It is important to understand the impact of implementation of evidence-based practices (EBPs) on the workforce. EBP implementation can increase job demands, stress, and burnout, and may thereby exacerbate turnover. This study examined the effects of implementation of an EBP on turnover among staff at nine child welfare agencies. A total of 102 providers were randomized to either adopt an EBP, SafeCare ((c)) , or continue providing services as usual.
Citation: Whitaker DJ, Lyons M, Weeks EA . Does adoption of an evidence-based practice lead to job turnover? Results from a randomized trial. J Community Psychol 2020 May;48(4):1258-72. doi: 10.1002/jcop.22305..
Keywords: Evidence-Based Practice, Workforce
Goldberg DG, Soylu TG, Grady VM
Indicators of workplace burnout among physicians, advanced practice clinicians, and staff in small to medium-sized primary care practices.
The goal of this study was to examine whether individual behaviors and attitudes towards major disruptive change has an effect on workplace burnout. Using surveys from healthcare professionals, researchers’ findings showed workplace burnout reported by 31.6% of physicians, 17.2% of advanced practice clinicians, 18.9% of clinical support staff, and 17.5% of administrative staff, with all healthcare professional groups having high levels of anxiety. Providers who experienced higher levels of anxiety and withdrawal were more than three times as likely to report burnout compared to those who experienced low levels in these domains.
Citation: Goldberg DG, Soylu TG, Grady VM . Indicators of workplace burnout among physicians, advanced practice clinicians, and staff in small to medium-sized primary care practices. J Am Board Fam Med 2020 May-Jun;33(3):378-85. doi: 10.3122/jabfm.2020.03.190260..
Keywords: Burnout, Primary Care, Provider, Workflow, Workforce
Poghosyan L, Ghaffari A, Liu J
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important. In this study, the investigators assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affected their job satisfaction, intent to leave their current job, and quality of care.
Citation: Poghosyan L, Ghaffari A, Liu J . Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey. J Gen Intern Med 2020 Apr;35(4):1021-28. doi: 10.1007/s11606-019-05509-2..
Keywords: Primary Care: Models of Care, Primary Care, Provider: Clinician, Provider: Physician, Provider, Workforce, Quality of Care
Than C, Chuang E, Washington DL
Understanding gender sensitivity of the health care workforce at the Veterans Health Administration.
Gender sensitivity of providers and staff has assumed increasing importance in closing historical gender disparities in health care quality and outcomes. The Department of Veterans Affairs (VA) has implemented several initiatives intended to improve gender sensitivity of its health care workforce. The current study examined practice- and individual-level characteristics associated with gender sensitivity of primary care providers (PCPs) and staff.
Citation: Than C, Chuang E, Washington DL . Understanding gender sensitivity of the health care workforce at the Veterans Health Administration. Womens Health Issues 2020 Mar-Apr;30(2):120-27. doi: 10.1016/j.whi.2020.01.001..
Keywords: Workforce, Provider, Veterans, Primary Care, Disparities, Quality of Care
Jalali A, Martin C, Nelson RE
Provider practice competition and adoption of Medicare's Oncology Care Model.
The purpose of this study was to measure the association between regional market competition among medical oncologists with the initial adoption of the Oncology Care Model (OCM). Findings showed that practices in competitive health care markets were more likely to adopt OCM than in noncompetitive markets. Average practice size, number of practices in a hospital referral region, and the hospital bed rate were positively associated with adoption, whereas the rate of full-time equivalent hospital employees to 1000 residents was negatively associated with adoption. Recommendations included careful monitoring of market-level changes among OCM adopters to ensure that the benefits of the OCM outweigh the negative consequences of possible changes in competition.
Citation: Jalali A, Martin C, Nelson RE . Provider practice competition and adoption of Medicare's Oncology Care Model. Med Care 2020 Feb;58(2):154-60. doi: 10.1097/mlr.0000000000001243..
Keywords: Medicare, Workforce, Provider: Physician, Provider
Baron AN, Hemler JR, Sweeney SM
Effects of practice turnover on primary care quality improvement implementation.
This study examined the effect primary care practice turnover has on quality improvement (QI) implementation. It often stops momentum in the improvement process, especially if key members leave. Key member turnover causes loss of institutional memory about QI purpose, processes, and long-term vision.
Citation: Baron AN, Hemler JR, Sweeney SM . Effects of practice turnover on primary care quality improvement implementation. Am J Med Qual 2020 Jan/Feb;35(1):16-22. doi: 10.1177/1062860619844001..
Keywords: Primary Care, Quality Improvement, Quality of Care, Workforce, Implementation
Germack HD, Kandrack R, Martsolf GR
When rural hospitals close, the physician workforce goes.
Researchers examined the relationship between rural hospital closures and the supply of physicians across different specialties in the years leading up to and after a closure. They observed significant annual reductions in the supply of general surgeons in the years leading up to a closure. They also found that rural hospital closures were associated with immediate and persistent decreases in the supply of surgical specialists and long-term decreases in the supply of physicians across multiple specialties. Because this decrease could lead to reduced access to care for rural residents, they recommended that future policy efforts focus on supporting and maintaining health care delivery models that do not depend on hospitals.
Citation: Germack HD, Kandrack R, Martsolf GR . When rural hospitals close, the physician workforce goes. Health Aff 2019 Dec;38(12):2086-94. doi: 10.1377/hlthaff.2019.00916..
Keywords: Rural Health, Hospitals, Workforce, Provider: Physician, Provider
Adams DR, Williams NJ, Becker-Haimes EM
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
In this study, the investigators prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. The investigators expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. They found that, controlling for covariates, financial strain predicted therapist turnover but not for therapists who participated in an EBP training initiative.
Citation: Adams DR, Williams NJ, Becker-Haimes EM . Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices. Adm Policy Ment Health 2019 Nov;46(6):713-23. doi: 10.1007/s10488-019-00949-8..
Keywords: Community-Based Practice, Evidence-Based Practice, Behavioral Health, Provider, Provider: Clinician, Training, Workforce
Everson J, Richards MR, Buntin MB
Horizontal and vertical integration's role in meaningful use attestation over time.
This study examined rates of attestation and attrition from the meaningful use (MU) program by independent, horizontally integrated, and vertically integrated physicians. The goal was to determine if MU created pressure for independent physicians to join integrated organizations. They compared attestation rates using secondary data from SK&A and Medicare MU Files from 2011-2016 with office-based physicians. The sample size was 291,234 physicians. Forty-nine percent of physicians that remained independent during the period attested to MU at least once during the program, compared with 70% that remained horizontally or vertically integrated. There was also significantly more attrition among independent physicians than those physicians who were integrated.
Citation: Everson J, Richards MR, Buntin MB . Horizontal and vertical integration's role in meaningful use attestation over time. Health Serv Res 2019 Oct;54(5):1075-83. doi: 10.1111/1475-6773.13193..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Workforce, Provider: Physician, Provider, Medicare
Kelly LA, McHugh MD, Aiken LH
Nurse Outcomes in Magnet(R) and non-magnet hospitals.
The goal of this study was to determine whether work environments, staffing, and nurse outcomes differ between Magnet and non-Magnet hospitals. Results demonstrated superior nurse work environments in Magnet hospitals compared with non-Magnet hospitals, with better work environments being associated with lower nurse job dissatisfaction and burnout. Three decades of evidence showing superior outcomes for Magnet hospitals place this organizational innovation into a class all of its own as best practice, deserving the attention of hospital leaders, nurses, and the public.
Citation: Kelly LA, McHugh MD, Aiken LH . Nurse Outcomes in Magnet(R) and non-magnet hospitals. J Nurs Adm 2019 Oct;49(10S Suppl):S19-s24. doi: 10.1097/nna.0000000000000801..
Keywords: Burnout, Hospitals, Provider, Provider: Nurse, Workforce
Inclusion and commitment as key pathways between leadership and nonprofit performance.
This study used longitudinal multilevel path analyses to examine whether transformational leadership influenced work group performance through creating a climate for including and increasing employee commitment in a diverse nonprofit health care organization. The results indicated that transformational leaders do help increase perceptions of inclusion, which improves employee performance and commitment to the organization.
Citation: Brimhall KC . Inclusion and commitment as key pathways between leadership and nonprofit performance. Nonprofit Manag Leadersh 2019 Fall;30(1):31-49. doi: 10.1002/nml.21368..
Keywords: Workforce, Organization and Administration
White EM, Aiken LH, McHugh MD
Registered nurse burnout, job dissatisfaction, and missed care in nursing homes.
The purpose of this article was to examine the relationship between registered nurse (RN) burnout, job dissatisfaction, and missed care in nursing homes. The investigators concluded that missed nursing care due to inadequate time or resources is common in nursing homes and is associated with RN burnout and job dissatisfaction; they indicated that improved work environments with sufficient staff hold promise for improving care and nurse retention.
Citation: White EM, Aiken LH, McHugh MD . Registered nurse burnout, job dissatisfaction, and missed care in nursing homes. J Am Geriatr Soc 2019 Oct;67(10):2065-71. doi: 10.1111/jgs.16051..
Keywords: Provider: Nurse, Provider, Burnout, Nursing Homes, Long-Term Care, Workforce