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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 16 of 16 Research Studies DisplayedNguyen CA, Beaulieu ND, Wright AA
Organization of cancer specialists in US physician practices and health systems.
This study’s objective was to describe the supply of cancer specialists, the organization of cancer care within versus outside of health systems, and the distance to multispecialty cancer centers. The authors used the 2018 Health Systems and Provider Database from the National Bureau of Economic Research and 2018 Medicare data to identify 46,341 unique physicians providing cancer care. They stratified physicians by discipline (adult/pediatric medical oncologists, radiation oncologists, surgical/gynecologic oncologists, other surgeons performing cancer surgeries, or palliative care physicians), system type (National Cancer Institute [NCI] Cancer Center system, non-NCI academic system, nonacademic system, or nonsystem/independent practice), practice size, and composition (single disciplinary oncology, multidisciplinary oncology, or multispecialty). They computed the density of cancer specialists by county and calculated distances to the nearest NCI Cancer Center. Results found that more than half of all cancer specialists (57.8%) practiced in health systems, but 55.0% of cancer-related visits occurred in independent practices. A majority of system-based physicians were in large practices with more than 100 physicians, while those in independent practices were in smaller practices. Breakdown by specialty type showed that practices in NCI Cancer Center systems (95.2%), non-NCI academic systems (95.0%), and nonacademic systems (94.3%) were primarily multispecialty, while fewer independent practices (44.8%) were. Many rural areas had sparse cancer specialty density, where the median travel distance to an NCI Cancer Center was 98.7 miles. Higher-income areas had shorter distances to NCI Cancer centers than low-income areas, even for individuals in suburban and rural areas.
AHRQ-funded; HS024072.
Citation: Nguyen CA, Beaulieu ND, Wright AA .
Organization of cancer specialists in US physician practices and health systems.
J Clin Oncol 2023 Sep 10; 41(26):4226-35. doi: 10.1200/jco.23.00626..
Keywords: Cancer, Provider: Physician, Workforce
Post B, Nallamothu BK, Hollenbeck B
Hospital-cardiologist integration often occurs without a practice acquisition.
This study’s objective was to determine how much of the increase in hospital-cardiologist integration comes from acquisition of physician practices compared to individual employment decisions. Data from 2011 to 2018 was used from the American Medical Association Masterfile and Medicare. In 2011 18% of cardiologists were integrated, which rose to 25% in 2016. It was found that 48% of integrations occurred without acquisitions and that physicians who had completed residencies in the past 5 years had higher rates of integration that increased over time. Rates of early career physicians joining hospital systems also rose from 25% to 32% during that time period.
AHRQ-funded; HS025707.
Citation: Post B, Nallamothu BK, Hollenbeck B .
Hospital-cardiologist integration often occurs without a practice acquisition.
Health Serv Res 2022 Apr;57(2):333-39. doi: 10.1111/1475-6773.13929..
Keywords: Hospitals, Provider: Physician, Healthcare Delivery, Workforce
Michelson KA, Cushing AM, Bucholz EM
Association of county-level availability of pediatricians with emergency department visits.
This study examined whether children in counties with more pediatricians had fewer emergency department (ED) visits. The authors conducted a cross-sectional study of all ED visits among children younger than 18 years from 6 states. Each additional pediatrician per 1000 children was associated with a 13.7% decrease in ED visits in the state-adjusted model. In the full model however, there was no association. Other factors such as presence of an urgent care facility, high socioeconomic status, urban status and higher proportions of White race and nonpublic insurance were also associated with decreased ED visit rates.
AHRQ-funded; HS026503.
Citation: Michelson KA, Cushing AM, Bucholz EM .
Association of county-level availability of pediatricians with emergency department visits.
Pediatr Emerg Care 2022 Feb;38(2):e953-e57. doi: 10.1097/pec.0000000000002502..
Keywords: Healthcare Cost and Utilization Project (HCUP), Emergency Department, Healthcare Utilization, Workforce, Provider: Physician, Rural Health
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.
AHRQ-funded; HS020642.
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
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 and Ethnic Minorities
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.
AHRQ-funded; HS025750.
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
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%.
AHRQ-funded; HS023614.
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
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.
AHRQ-funded; HS023009.
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
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.
AHRQ-funded; HS026030.
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
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 and Ethnic Minorities, Education: Academic
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.
AHRQ-funded; HS024758.
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
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.
AHRQ-funded; HS024714.
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
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.
AHRQ-funded; HS000032.
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
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.
AHRQ-funded; HS026395.
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
Huber MT, Ham SA, Qayyum M
Association between job factors, burnout, and preference for a new job: a nationally representative physician survey.
Investigators used an experimental vignette to test associations between physician demographics, salary, and working with exemplary colleagues on the likelihood of preferring a new job among burned out and non-burned out physicians in various specialties. They found that, among burned out physicians, the opportunity for better salary and colleagues made them more likely to prefer a new job compared to non-burned out physicians, with change in salary associated with the greatest difference. They recommended focusing on improving physician-colleague relationships to improve job retention.
AHRQ-funded; HS000078.
Citation: Huber MT, Ham SA, Qayyum M .
Association between job factors, burnout, and preference for a new job: a nationally representative physician survey.
J Gen Intern Med 2018 Jun;33(6):789-91. doi: 10.1007/s11606-018-4412-z..
Keywords: Burnout, Workforce, Provider: Physician, Provider
Leyenaar JK, Frintner MP
Graduating pediatric residents entering the hospital medicine workforce, 2006-2015.
This study analyzed the population of graduating pediatric residents entering the new subspecialty – pediatric hospital medicine (PHM). Data was analyzed from the American Academic of Pediatrics Annual Survey of Graduating Residents, 2006-2015. A total of 5969 graduates completed the survey, and 10.3% reported that they were entering PHM and 33.9% were reporting subspecialty fellowships. A multivariable analysis was done of the demographics, and a higher rate of residents entering PHM were female, to have children, to report that family factors limited their job selection, and to have higher levels of student debt than residents entering fellowships.
AHRQ-funded; HS024133.
Citation: Leyenaar JK, Frintner MP .
Graduating pediatric residents entering the hospital medicine workforce, 2006-2015.
Acad Pediatr 2018 Mar;18(2):200-07. doi: 10.1016/j.acap.2017.05.001..
Keywords: Education: Continuing Medical Education, Provider, Provider: Clinician, Provider: Physician, Workforce