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Prusynski RA, Frogner BK, Rundell SD, Pradhan S, Mroz TM. Is More Always Better? Financially Motivated Therapy and Patient Outcomes in Skilled Nursing Facilities. Arch Phys Med Rehabil 2024; 105:287-294. [PMID: 37541357 PMCID: PMC10837324 DOI: 10.1016/j.apmr.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE To determine if financially motivated therapy in Skilled Nursing Facilities (SNFs) is associated with patient outcomes. DESIGN Cohort study using 2018 Medicare administrative data. SETTING AND PARTICIPANTS 13,949 SNFs in the United States. PARTICIPANTS 934,677 Medicare Part A patients admitted to SNF for post-acute rehabilitation (N=934,677). INTERVENTIONS The primary independent variable was an indicator of financially motivated therapy, separate from intensive therapy, known as thresholding, defined as when SNFs provide 10 or fewer minutes of therapy above weekly reimbursement thresholds. MAIN OUTCOME MEASURES Dichotomous indicators of successful discharge to the community vs institution and functional improvement on measures of transfers, ambulation, or locomotion. Mixed effects models estimated relations between thresholding and community discharge and functional improvement, adjusted for therapy intensity, patient, and facility characteristics. Sensitivity analyses estimated associations between thresholding and outcomes when patients were stratified by therapy volume. RESULTS Thresholding was associated with a small positive effect on functional improvement (odds ratio 1.07; 95% CI 1.06-1.09) and community discharge (odds ratio 1.03, 95% CI 1.02-1.05). Effect sizes for functional improvement were consistent across patients receiving different volumes of therapy. However, effect sizes for community discharge were largest for patients in low-volume therapy groups (odds ratio 1.27, 95% CI 1.18-1.35). CONCLUSIONS Patients who experienced thresholding during post-acute SNF stays were slightly more likely to improve in function and successfully discharge to the community, especially for patients receiving lower volumes of therapy. While thresholding is an inefficient and financially motivated practice, results suggest that even small amounts of extra therapy time may have contributed positively to outcomes for patients receiving lower-volume therapy. As therapy volumes decline in SNFs, these results emphasize the importance of Medicare payment policy designed to promote, not disincentivize, potentially beneficial rehabilitation services for patients.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle WA; Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle WA.
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle WA
| | - Sean D Rundell
- Department of Rehabilitation Medicine, University of Washington, Seattle WA
| | - Sujata Pradhan
- Department of Rehabilitation Medicine, University of Washington, Seattle WA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle WA; Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle WA
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Bacci JL, Pollack SW, Skillman SM, Odegard PS, Danielson JH, Frogner BK. Impact of the COVID-19 Pandemic on the Community Pharmacy Workforce. Med Care Res Rev 2024; 81:39-48. [PMID: 37830446 DOI: 10.1177/10775587231204101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
This study sought to describe the impact of the COVID-19 pandemic on community pharmacy practice and its workforce. Interviews were conducted with 18 key informants from pharmacy associations and community pharmacists representing chain and independent pharmacy organizations across the United States from January to May 2022. Interview notes were analyzed using a rapid content analysis approach. Four themes resulted: (a) patient care at community pharmacies focused on fulfilling COVID-19 response needs; (b) pharmacists' history as immunizers and scope of practice expansions facilitated COVID-19 response efforts; (c) workforce supply shortages impeded COVID-19 response efforts and contributed to burnout; and (d) maintaining community pharmacy workforce's readiness will be critical to future emergency preparedness and response efforts. Formalizing scope of practice expansion policies and reimbursement pathways deployed during the COVID-19 pandemic could facilitate the community pharmacy workforce's ability to address ongoing public health needs and respond to future public health emergencies.
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Al Achkar M, Dahal A, Frogner BK, Skillman SM, Patterson DG. Integrating Immigrant Health Professionals into the U.S. Healthcare Workforce: Barriers and Solutions. J Immigr Minor Health 2023; 25:1270-1278. [PMID: 37084020 PMCID: PMC10119818 DOI: 10.1007/s10903-023-01472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2023] [Indexed: 04/22/2023]
Abstract
Internationally educated immigrant healthcare workers face skill underutilization working in lower-skilled healthcare jobs or outside healthcare. This study explored barriers to and solutions for integrating immigrant health professionals. Content analysis identifying key themes from semi-structured qualitative interviews with representatives from Welcome Back Centers (WBCs) and partner organizations. 18 participants completed interviews. Barriers facing immigrant health professionals included lack of access to resources, financial constraints, language difficulties, credentialing challenges, prejudice, and investment in current occupations. Barriers facing programs that assist immigrant health professionals included eligibility restrictions, funding challenges, program workforce instability, recruitment difficulties, difficulty maintaining connection, and pandemic challenges. Long-term program success depended on partner networks, advocacy, addressing prejudice, a client-centered approach, diverse resources and services, and conducting research. Initiatives to integrate immigrant health professionals require multi-level responses to diverse needs and collaborations among organizations that support immigrant health professionals, healthcare systems, labor, and other stakeholders.
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Affiliation(s)
- Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA.
| | - Arati Dahal
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Susan M Skillman
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
| | - Davis G Patterson
- Department of Family Medicine, University of Washington, Box 356390, Seattle, WA, 98195-6390, USA
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Abstract
PURPOSE Lack of health care providers' knowledge about the experience and needs of individuals with disabilities contribute to health care disparities experienced by people with disabilities. Using the Core Competencies on Disability for Health Care Education, this mixed methods study aimed to explore the extent the Core Competencies are addressed in medical education programs and the facilitators and barriers to expanding curricular integration. METHOD Mixed-methods design with an online survey and individual qualitative interviews was used. An online survey was distributed to U.S. medical schools. Semi-structured qualitative interviews were conducted via Zoom with five key informants. Survey data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. RESULTS Fourteen medical schools responded to the survey. Many schools reported addressing most of the Core Competencies. The extent of disability competency training varied across medical programs with the majority showing limited opportunities for in depth understanding of disability. Most schools had some, although limited, engagement with people with disabilities. Having faculty champions was the most frequent facilitator and lack of time in the curriculum was the most significant barrier to integrating more learning activities. Qualitative interviews provided more insight on the influence of the curricular structure and time and the importance of faculty champion and resources. CONCLUSIONS Findings support the need for better integration of disability competency training woven throughout medical school curriculum to encourage in-depth understanding about disability. Formal inclusion of the Core Competencies into the Liaison Committee on Medical Education standards can help ensure that disability competency training does not rely on champions or resources.
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Affiliation(s)
- Danbi Lee
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Samantha W Pollack
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Tracy Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
| | - Susan M Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, USA
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Islas IG, Brantley E, Portela Martinez M, Salsberg E, Dobkin F, Frogner BK. Documenting Latino Representation In The US Health Workforce. Health Aff (Millwood) 2023; 42:997-1001. [PMID: 37406235 DOI: 10.1377/hlthaff.2022.01348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
We compared the representation of the four largest Latino subpopulation groups in the health workforce with that group's representation in the US workforce, using 2016-20 data. Mexican Americans were the most underrepresented subpopulation in professions requiring advanced degrees. All groups were overrepresented in occupations requiring less than a bachelor's degree. Among recent health professions graduates, overall Latino representation has been increasing over time.
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Affiliation(s)
- Indira Ghandi Islas
- Indira Ghandi Islas , Congressional Hispanic Caucus Institute, Washington, D.C
| | - Erin Brantley
- Erin Brantley, NORC at the University of Chicago, Chicago, Illinois
| | | | | | | | - Bianca K Frogner
- Bianca K. Frogner, University of Washington, Seattle, Washington
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Cole MB, Lee EK, Frogner BK, Wright B. Changes in Performance Measures and Service Volume at US Federally Qualified Health Centers During the COVID-19 Pandemic. JAMA Health Forum 2023; 4:e230351. [PMID: 37027165 PMCID: PMC10082403 DOI: 10.1001/jamahealthforum.2023.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Importance Stay-at-home orders, site closures, staffing shortages, and competing COVID-19 testing and treatment needs all potentially decreased primary care access and quality during the COVID-19 pandemic. These challenges may have especially affected federally qualified health centers (FQHCs), which serve patients with low income nationwide. Objective To examine changes in FQHCs' quality-of-care measures and visit volumes in 2020 to 2021 vs prepandemic. Design, Setting, and Participants This cohort study used a census of US FQHCs to calculate changes in outcomes between 2016 and 2021 using generalized estimating equations. Main Outcomes and Measures Twelve quality-of-care measures and 41 visit types based on diagnoses and services rendered, measured at the FQHC-year level. Results A total of 1037 FQHCs were included, representing 26.6 million patients (63% 18-64 years old; 56% female) in 2021. Despite upward trajectories for most measures prepandemic, the percentage of patients served by FQHCs receiving recommended care or achieving recommended clinical thresholds showed a statistically significant decrease between 2019 and 2020 for 10 of 12 quality measures. For example, declines were observed for cervical cancer screening (-3.8 percentage points [pp]; 95% CI, -4.3 to -3.2 pp), depression screening (-7.0 pp; 95% CI, -8.0 to -5.9 pp), and blood pressure control in patients with hypertension (-6.5 pp; 95% CI, -7.0 to -6.0 pp). By 2021, only 1 of these 10 measures returned to 2019 levels. From 2019 to 2020, 28 of 41 visit types showed a statistically significant decrease, including immunizations (incidence rate ratio [IRR], 0.76; 95% CI, 0.73-0.78), oral examinations (IRR, 0.61; 95% CI, 0.59-0.63), and supervision of infant or child health (IRR, 0.87; 95% CI, 0.85-0.89); 11 of these 28 visits approximated or exceeded prepandemic rates by 2021, while 17 remained below prepandemic rates. Five visit types increased in 2020, including substance use disorder (IRR, 1.07; 95% CI, 1.02-1.11), depression (IRR, 1.06; 95% CI, 1.03-1.09), and anxiety (IRR, 1.16; 95% CI, 1.14-1.19); all 5 continued to increase in 2021. Conclusions and Relevance In this cohort study of US FQHCs, nearly all quality measures declined during the first year of the COVID-19 pandemic, with most declines persisting through 2021. Similarly, most visit types declined in 2020; 60% of these remained below prepandemic levels in 2021. By contrast, mental health and substance use visits increased in both years. The pandemic led to forgone care and likely exacerbated behavioral health needs. As such, FQHCs need sustained federal funding to expand service capacity, staffing, and patient outreach. Quality reporting and value-based care models must also adapt to the pandemic's influence on quality measures.
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Affiliation(s)
- Megan B Cole
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Eun Kyung Lee
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington School of Medicine, Seattle
| | - Brad Wright
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia
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Prusynski RA, Humbert A, Leland NE, Frogner BK, Saliba D, Mroz TM. Dual impacts of Medicare payment reform and the COVID-19 pandemic on therapy staffing in skilled nursing facilities. J Am Geriatr Soc 2023; 71:609-619. [PMID: 36571515 PMCID: PMC9880747 DOI: 10.1111/jgs.18208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/14/2022] [Accepted: 10/09/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Implementation of new skilled nursing facility (SNF) Medicare payment policy, the Patient Driven Payment Model (PDPM), resulted in immediate declines in physical and occupational therapy staffing. This study characterizes continuing impacts of PDPM in conjunction with COVID-19 on SNF therapy staffing and examines variability in staffing changes based on SNF organizational characteristics. METHODS We analyzed Medicare administrative data from a national cohort of SNFs between January 2019 and March 2022. Interrupted time series mixed effects regression examined changes in level and trend of total therapy staffing minutes/patient-day during PDPM and COVID-19 and by type of staff (therapists, assistants, contractors, and in-house staff). Secondary analyses examined the variability in staffing by organizational characteristics. RESULTS PDPM resulted in a -6.54% level change in total therapy staffing, with larger declines for assistants and contractors. Per-patient staffing fluctuated during COVID-19 as the census changed. PDPM-related staffing declines were larger in SNFs that were: Rural, for-profit, chain-affiliated, provided more intensive therapy, employed more therapy assistants, and admitted more Medicare patients before PDPM. COVID-19 resulted in larger staffing declines in rural SNFs but smaller early declines in SNFs that were hospital-based, for-profit, or received more relief funding. CONCLUSIONS SNFs that historically engaged in profit-maximizing behaviors (e.g., providing more therapy via lower-paid assistants) had larger staffing declines during PDPM compared to other SNFs. Therapy staffing fluctuated during COVID-19, but PDPM-related reductions persisted 2 years into the pandemic, especially in rural SNFs. Results suggest specific organizational characteristics that should be targeted for staffing and quality improvement initiatives.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle WA, USA
| | - Andrew Humbert
- Department of Rehabilitation Medicine, University of Washington, Seattle WA, USA
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh PA, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle WA, USA
| | - Debra Saliba
- UCLA Borun Center, University of California Los Angeles, Los Angeles CA, USA
- VA Geriatric Research Education and Clinical Center, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle WA, USA
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle WA, USA
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8
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Lee D, Kett PM, Mohammed SA, Frogner BK, Sabin J. Inequitable care delivery toward COVID-19 positive people of color and people with disabilities. PLOS Glob Public Health 2023; 3:e0001499. [PMID: 37074996 PMCID: PMC10115306 DOI: 10.1371/journal.pgph.0001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 01/10/2023] [Indexed: 04/20/2023]
Abstract
This study aimed to explore provider observations of inequitable care delivery towards COVID-19 positive patients who are Black, Indigenous, and Other People of Color (BIPOC) and/or have disabilities and to identify ways the health workforce may be contributing to and compounding inequitable care. We conducted semi-structured interviews between April and November 2021 with frontline healthcare providers from Washington, Florida, Illinois, and New York. Using thematic analysis, major themes related to discriminatory treatment included decreased care, delayed care, and fewer options for care. Healthcare providers' bias and stigma, organizational bias, lack of resources, fear of transmission, and burnout were mentioned as drivers for discriminatory treatment. COVID-19 related health system policies such as visitor restrictions and telehealth follow-ups inadvertently resulted in discriminatory practices towards BIPOC patients and patients with disabilities. As patients experience lower quality healthcare during the pandemic, COVID-19-related restrictions and policies compounded existing inequitable care for these populations.
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Affiliation(s)
- Danbi Lee
- Department of Rehabilitation Medicine and Disability Studies Program, University of Washington, Seattle, WA, Untied States of America
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
| | - Paula M Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
| | - Selina A Mohammed
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA, Untied States of America
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
| | - Janice Sabin
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA, Untied States of America
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, Untied States of America
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Parrish C, Basu A, McConnell KJ, Frogner BK, Reddy A, Zatzick DF, Kreuter W, Sabbatini AK. Evaluation of a Health Information Exchange for Linkage to Mental Health Care After an Emergency Department Visit. Psychiatr Serv 2022; 74:555-558. [PMID: 36545771 PMCID: PMC10159871 DOI: 10.1176/appi.ps.20220231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Aligning with Washington State's goal of reducing unnecessary emergency department (ED) use and improving linkage to outpatient primary and behavioral health care, this study evaluated whether an Emergency Department Information Exchange (EDIE) improved linkage to care for Medicaid enrollees with mental health conditions. Follow-up with any physician at 30 days increased slightly, although mental health-specific follow-up declined over time. Difference-in-differences estimates revealed no effect of EDIE on linkage to care after an ED visit. Medicaid beneficiaries with mental health needs and high utilization of the ED likely require additional support to increase timely and appropriate follow-up care.
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Affiliation(s)
- Canada Parrish
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Anirban Basu
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - K John McConnell
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Bianca K Frogner
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Ashok Reddy
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Douglas F Zatzick
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - William Kreuter
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
| | - Amber K Sabbatini
- Department of Emergency Medicine, Section of Population Health (Parrish, Sabbatini), Comparative Health Outcomes, Policy and Economics Institute (Basu, Kreuter), Departments of Health Services and Economics (Basu), Department of Family Medicine and Center for Workforce Studies (Frogner), Department of Medicine, Division of General Internal Medicine (Reddy), Department of Psychiatry and Behavioral Sciences and Center for Scholarship in Patient Care and Quality and Safety (Zatzick), and Center for Health Innovation and Policy (Sabbatini), University of Washington, Seattle; Department of Emergency Medicine and Center for Health Systems Effectiveness, Oregon Health and Sciences University, Portland (McConnell); VA Health Services Research and Development, Seattle (Reddy)
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Sabin J, Guenther G, Ornelas IJ, Patterson DG, Andrilla CHA, Morales L, Gurjal K, Frogner BK. Brief online implicit bias education increases bias awareness among clinical teaching faculty. Med Educ Online 2022; 27:2025307. [PMID: 35037585 PMCID: PMC8765255 DOI: 10.1080/10872981.2021.2025307] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
PROBLEM AND PURPOSE Healthcare provider implicit bias influences the learning environment and patient care. Bias awareness is one of the key elements to be included in implicit bias education. Research on education enhancing bias awareness is limited. Bias awareness can motivate behavior change. The objective was to evaluate whether exposure to a brief online course, Implicit Bias in the Clinical and Learning Environment, increased bias awareness. MATERIALS AND METHODS The course included the history of racism in medicine, social determinants of health, implicit bias in healthcare, and strategies to reduce the impact of implicit bias in clinical care and teaching. A sample of U.S. academic family, internal, and emergency medicine providers were recruited into the study from August to December 2019. Measures of provider implicit and explicit bias, personal and practice characteristics, and pre-post-bias awareness measures were collected. RESULTS Of 111 participants, 78 (70%) were female, 81 (73%) were White, and 63 (57%) were MDs. Providers held moderate implicit pro-White bias on the Race IAT (Cohen's d = 0.68) and strong implicit stereotypes associating males rather than females with 'career' on the Gender-Career IAT (Cohen's d = 1.15). Overall, providers held no explicit race bias (Cohen's d = 0.05). Providers reported moderate explicit male-career (Cohen's d = 0.68) and strong female-family stereotype (Cohen's d = 0.83). A statistically significant increase in bias awareness was found after exposure to the course (p = 0.03). Provider implicit and explicit biases and personal and practice characteristics were not associated with an increase in bias awareness. CONCLUSIONS Implicit bias education is effective to increase providers' bias awareness regardless of strength of their implicit and explicit biases and personal and practice characteristics. Increasing bias awareness is one step of many toward creating a positive learning environment and a system of more equitable healthcare.
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Affiliation(s)
- Janice Sabin
- Department of Biomedical Informatics and Medical Education, University of Washington, the University of Washington Center for Health Workforce Studies, UW School of Medicine, Seattle, WA, USA
- CONTACT Janice Sabin Department of Biomedical Informatics and Medical Education, University of Washington, The University of Washington Center for Health Workforce Studies, UW School of Medicine, SeattleWA, USA
| | - Grace Guenther
- Research, University of Washington Center for Health Workforce Studies, Seattle, WA, USA
| | - India J. Ornelas
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Davis G. Patterson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - C. Holly A. Andrilla
- Research, University of Washington Center for Health Workforce Studies, WWAMI Rural Health Research Center, Seattle, WA, USA
| | - Leo Morales
- Department of Medicine, School of Medicine, Center of Health at the University of Washington, Seattle, WA, USA
| | - Kritee Gurjal
- U.S. Department of Veterans Affairs, The Health Economics Resource Center (HERC), Menlo Park, CA, USA
| | - Bianca K. Frogner
- Department of Family Medicine, University of Washington (UW), UW Center for Health Workforce Studies, Seattle, WA, USA
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Nasseh K, Frogner BK, Vujicic M. A Closer Look at Disparities in Earnings between White and Minoritized Dentists: Income Disparities in Dentistry. Health Serv Res 2022; 58:705-732. [PMID: 36307983 PMCID: PMC10154170 DOI: 10.1111/1475-6773.14095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the factors that account for differences in dentist earnings between White and minoritized dentists. DATA SOURCES We used data from the American Dental Association's Survey of dental practice, which includes information on 2001-2018 dentist net income, practice ZIP code, patient mix between private and public insurance, and dentist gender, age, and year of dental school graduation. We merged the data on dentist race and ethnicity and school of graduation from the American Dental Association masterfile. Based on practice ZIP code, we also merged the data on local area racial and ethnic composition from the American Community Survey. STUDY DESIGN We used a linear Blinder-Oaxaca decomposition to assess observable characteristics that explain the gap in earnings between White and minoritized dentists. To assess differences in earnings between White and minoritized dentists at different points of the income distribution, we used a re-centered influence function and estimated an unconditional quantile Blinder-Oaxaca decomposition. DATA EXTRACTION METHODS We extracted data for 22,086 dentists ages 25-85 who worked at least 8 weeks per year and 20 hours per week. PRINCIPAL FINDINGS Observable characteristics accounted for 58% of the earnings gap between White and Asian dentists, 55% of the gap between White and Hispanic dentists, and 31% of the gap between White and Black dentists. The gap in earnings between White and Asian dentists narrowed at higher quantiles of the income distribution. CONCLUSIONS Compared to other minoritized dentists, Black dentists have the largest earnings disparities relative to White dentists. While the level of the explained component of the disparity for Black dentists is comparable to the explained part of the disparities for other minoritized dentists, the excess percentage of the unexplained component for Black dentists accounts for the additional amount of disparity that Black dentists experienced. Persistent income disparities could discourage minoritized dentists from entering the profession.
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Affiliation(s)
- Kamyar Nasseh
- Health Economist, Health Policy Institute American Dental Association, 211 East Chicago Avenue Chicago IL
| | - Bianca K. Frogner
- Department of Family Medicine University of Washington School of Medicine, 4311 11 Ave NE, Suite 210 Seattle WA
| | - Marko Vujicic
- Chief Economist & Vice President Health Policy Institute, American Dental Association, 211 East Chicago Avenue Chicago IL
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12
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Skillman SM, Johnson HM, Frogner BK. Pathways to Registered Nursing: Influences of Health-Related Work Experience and Education Financing. Policy Polit Nurs Pract 2022; 23:228-237. [PMID: 35989641 DOI: 10.1177/15271544221120205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A larger and more diverse registered nurse (RN) workforce in the U.S. is needed to meet growing demand and address social determinants of health and improve health equity. To improve understanding of pathways and barriers to becoming an RN, this study examined prior health care employment and financial assistance factors associated with completion of pre-licensure RN education programs, by initial entry degree (associate degree or bachelor of science in nursing) and across racial and ethnic groups, using the 2018 National Sample Survey of Registered Nurses. The study found higher percentages of associate degree-entry RNs held a health-related job prior to completing their initial RN program than did bachelor's degree entrants. Employer support for education financing as well as reliance on loans and scholarships increased among RNs graduating in 2000 and later, and reliance on self-financing was reported less frequently. Hispanic associate degree-entry RNs reported education financing from only federal loans more frequently compared with White RNs, and higher percentages of Black, multiracial, and "some other race" baccalaureate degree entry RNs accessed federal loans compared with White baccalaureate degree-entry RNs. These findings indicate diversifying the RN workforce should remain a priority to increase representation by underrepresented racial and ethnic groups. Equitable pathways into the RN profession will be facilitated and expedited through policies that overcome financial and social barriers that enable individuals from population groups underrepresented in the nursing workforce to identify with the RN role and route to the profession.
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Affiliation(s)
- Susan M Skillman
- Center for Health Workforce Studies, 7284University of Washington, 4311 11th Ave NE, Suite 210, Seattle, WA 98105
| | - Hannah M Johnson
- Department of Health Systems and Population Health, 7284University of Washington, 3980 15th Ave NE, Fourth Floor, Box 351621, Seattle, WA 98195
| | - Bianca K Frogner
- Center for Health Workforce Studies, 7284University of Washington, 4311 11th Ave NE, Suite 210, Seattle, WA 98105
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13
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van Eijk MS, Prueher L, Kett PM, Frogner BK, Guenther GA. Financial Instability of Federal Navigator Program Challenges Organizations to Help Uninsured Enroll in Health Insurance Coverage. J Health Care Poor Underserved 2022; 33:1555-1568. [DOI: 10.1353/hpu.2022.0129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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14
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Frogner BK. Patients Receive Flexible And Accessible Care When State Workforce Barriers Are Removed. Health Aff (Millwood) 2022; 41:1139-1141. [PMID: 35914201 DOI: 10.1377/hlthaff.2022.00759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In response to COVID-19, many states increased their supply of health care workers, using emergency policies to remove barriers such as state licensure requirements. The experience in New Jersey suggests that most health care workers who obtained a temporary license, including physicians, nurses, and mental health providers, provided care for existing patients for COVID-19- and non-COVID-19-related conditions, mostly through telehealth. State variation in licensure requirements, as well as scope of practice, may be a barrier to patients having flexible, accessible, and continuous care. As states emerge from the pandemic, emergency policies that expand health workforce supply by removing these state-level barriers should be made permanent.
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Affiliation(s)
- Bianca K Frogner
- Bianca K. Frogner , University of Washington, Seattle, Washington
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15
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Jopson AD, Cummings AG, Frogner BK, Skillman SM. Employers' Perspectives on the Use of Medical Assistant Apprenticeships: A Qualitative Study. J Ambul Care Manage 2022; 45:191-201. [PMID: 35612390 DOI: 10.1097/jac.0000000000000424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medical assistants (MAs) are among the fastest-growing occupations in the United States, yet health care employers report high turnover rates and difficulty filling MA positions. Employers are increasingly using apprenticeship to meet emerging workforce needs. This qualitative study examined the perspectives of 14 employers using registered MA apprenticeships in 8 states. The findings revealed motivations for using apprenticeship, perceived benefits to the organization, challenges with implementation, and reflections on successful implementation. We detail how MA apprenticeship is successfully meeting recruitment and training needs in a variety of health care organizations, especially where program support resources are available.
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Affiliation(s)
- Andrew D Jopson
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland (Mr Jopson); and Center for Health Workforce Studies, Department of Family Medicine (Dr Frogner and Ms Skillman), Department of Family Medicine (Dr Cummings), University of Washington, Seattle
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16
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van Eijk MS, Kett PM, Prueher L, Frogner BK, Guenther GA. Lack of Consistent Investment in Federal Insurance Navigator Program Undermines Navigators' Equity Work in Vulnerable Communities. J Public Health Manag Pract 2022; 28:399-405. [PMID: 35121713 DOI: 10.1097/phh.0000000000001503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONTEXT Navigators in the federal Insurance Navigator Program ("Navigator Program"), who are employed by organizations in states with Federally Facilitated Marketplaces, provide enrollment assistance, outreach, and education to individuals who are eligible for health insurance coverage. Such work is central to public health efforts to address inequities but continues to be poorly understood and undervalued. More information is needed to understand the components of navigators' equity work and how decreases in program funding have affected their service provision. OBJECTIVE To examine navigators' labor at a granular level to better understand and highlight the equity work they do, the training and skills required for this work, and the Navigator Program-based challenges they face. DESIGN This was a descriptive qualitative study using data collected from interviews conducted in February-May 2021. We used a thematic analysis approach to develop major themes and subthemes. SETTING This was a national study. PARTICIPANTS We conducted 18 semistructured interviews with 24 directors, navigators, and other professionals at organizations funded as federally certified Navigator Programs. MAIN OUTCOME MEASURES Components of navigators' work; required training and skills; and challenges faced in accomplishing the work. RESULTS We identified 3 major themes: (1) navigators' health equity work goes beyond required responsibilities; (2) equity skills are built on the job; and (3) financial instabilities challenge navigators' health equity work. CONCLUSION Navigators bring specialized and essential skills and services to underserved communities. They are trusted sources of information, advocates, resource connectors, and, most significantly, health equity workers. However, the Navigator Program fails to support navigators' work and the communities they serve in the long term. To facilitate organizations' capacities to train, keep, and support navigators in this health equity work and to guarantee long-term enrollment assistance for underserved communities, efforts to stabilize funding are needed.
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Affiliation(s)
- Marieke S van Eijk
- Departments of Anthropology (Drs Van Eijk and Prueher) and Family Medicine (Drs Kett and Frogner and Ms Guenther), Center for Health Workforce Studies, University of Washington, Seattle, Washington
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17
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Van Eijk MS, Guenther GA, Jopson AD, Skillman SM, Frogner BK. Health Workforce Challenges Impact the Development of Robust Doula Services for Underserved and Marginalized Populations in the United States. J Perinat Educ 2022; 31:133-141. [PMID: 36643390 PMCID: PMC9829116 DOI: 10.1891/jpe-2021-0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Evidence of doulas' positive impacts on maternal health outcomes, particularly among underserved populations, supports expanding access. Health workforce-related barriers challenge the development of robust doula services in the United States. We investigated organizations' barriers regarding training, recruitment, and employment of doulas. We conducted literature and policy reviews and 16 semi-structured interviews with key informants who contribute to state policymaking and from organizations involved in training, certifying, advocating for, and employing doulas. Our study shows barriers to more robust doula services, including varying roles and practices, prohibitive costs of training and certification, and insufficient funding. This study underscores the importance of doulas in providing support to clients from underserved populations. Health workforce-related challenges remain, especially for community-based organizations seeking to serve underserved communities.
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Affiliation(s)
- Marieke S. Van Eijk
- Correspondence regarding this article should be directed to
Marieke S. Van Eijk,
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18
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Harwood KJ, Pines JM, Andrilla CHA, Frogner BK. Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US. BMC Health Serv Res 2022; 22:694. [PMID: 35606781 PMCID: PMC9128255 DOI: 10.1186/s12913-022-08092-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 05/09/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs. METHODS Using national private health insurance claims data, individuals age 18 or older were retrospectively assigned to cohorts based on the first provider seen at the index date of LBP diagnosis. Exclusion criteria included individuals with a diagnosis of LBP or any serious medical conditions or an opioid prescription recorded in the 6 months prior to the index date. Outcome measures included use of imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care) twelve months post-index date. We used a two-stage residual inclusion (2SRI) estimation approach comparing copay for the initial provider visit and differential distance as the instrumental variable to reduce selection bias in the choice of first provider, controlling for demographics. RESULTS Among 3,799,593 individuals, cost and utilization varied considerably based on the first provider seen by the patient. Copay and differential distance provided similar results, with copay preserving a greater sample size. The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. The frequency and time to serious illness varied little across providers. Total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205). CONCLUSION The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness.
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Affiliation(s)
- Kenneth J Harwood
- College of Health and Education, Marymount University, Arlington, VA, USA.
| | | | - C Holly A Andrilla
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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19
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Abstract
Question Which health care workers were at highest risk of leaving the workforce during the COVID-19 pandemic compared with prepandemic levels? Findings This observational cross-sectional study among 125 717 health care workers found that long-term care workers and physicians saw an upward trend in turnover rates. Health care workers employed as health aides and assistants, those of historically marginalized racial and ethnic groups, and those with young children, particularly women, had persistently high turnover rates and were experiencing a slow recovery. Meaning These findings suggest that turnover rates are returning to prepandemic levels across most groups of health care workers, yet the recovery is uneven; targeted solutions are needed to ensure an adequate health care workforce is available to meet patient demand. Importance The health care sector lost millions of workers during the COVID-19 pandemic and job recovery has been slow, particularly in long-term care. Objective To identify which health care workers were at highest risk of exiting the health care workforce during the COVID-19 pandemic. Design, Setting, and Participants This was an observational cross-sectional study conducted among individuals employed full-time in health care jobs from 2019 to 2021 in the US. Using the data from the Current Population Survey (CPS), we compared turnover rates before the pandemic (preperiod, January 2019-March 2020; 71 843 observations from CPS) with the first 9 months (postperiod 1, April 2020-December 2020; 38 556 observations) and latter 8 months of the pandemic (postperiod 2, January 2021-October 2021; 44 389 observations). Main Outcomes and Measures Health care workforce exits (also referred to as turnover) defined as a health care worker's response to the CPS as being unemployed or out of the labor force in a month subsequent to a month when they reported being actively employed in the health care workforce. The probability of exiting the health care workforce was estimated using a logistic regression model controlling for health care occupation, health care setting, being female, having a child younger than 5 years old in the household, race and ethnicity, age and age squared, citizenship status, being married, having less than a bachelor’s degree, living in a metropolitan area, identifier for those reporting employment status at the first peak of COVID-19, and select interaction terms with time periods (postperiods 1 and 2). Data analyses were conducted from March 1, 2021, to January 31, 2022. Results The study population comprised 125 717 unique health care workers with a mean (SD) age of 42.3 (12.1) years; 96 802 (77.0%) were women; 84 733 (67.4%) were White individuals. Estimated health care turnover rates peaked in postperiod 1, but largely recovered by postperiod 2, except for among long-term care workers and physicians. We found a 4-fold difference in turnover rates between physicians and health aides or assistants. Rates were also higher for health workers with young children (<5 years), for both sexes and highest among women. By race and ethnicity, persistently higher turnover rates were found among American Indian/Alaska Native/Pacific Islander workers; White workers had persistently lower rates; and Black and Latino workers experienced the slowest job recovery rates. Conclusions and Relevance The findings of this observational cross-sectional study suggest that although much of the health care workforce is on track to recover to prepandemic turnover rates, these rates have been persistently high and slow to recover among long-term care workers, health aides and assistants, workers of minoritized racial and ethnic groups, and women with young children. Given the high demand for long-term care workers, targeted attention is needed to recruit job-seeking health care workers and to retain those currently in these jobs to lessen turnover.
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Affiliation(s)
- Bianca K. Frogner
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle
| | - Janette S. Dill
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
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20
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Sabbatini AK, McConnell KJ, Parrish C, Frogner BK, Reddy A, Zatzick DF, Kreuter W, Basu A. Impact of a Statewide Emergency Department Information Exchange on Health Care Use and Expenditures. Health Serv Res 2022; 57:603-613. [PMID: 35235203 DOI: 10.1111/1475-6773.13963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 02/07/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the effects of a program mandating the statewide adoption of an emergency department information exchange (EDIE) on health care utilization and spending among Medicaid enrollees in Washington state. DATA SOURCE Medicaid claims and managed care encounters from the Washington Health Care Authority. STUDY DESIGN A difference-in-differences analysis with trends was used to compare changes in ED visits, inpatient admissions, primary care visits, and expenditures among frequent ED users (≥5 ED visits in past year) to those of infrequent users through the second year Washington's program. DATA EXTRACTION The study population included adult Medicaid enrollees with ED visits between January 2010-October 2014. PRINCIPAL FINDINGS There were 505,667 ED visits among 153,543 unique enrollees included in the analysis. Washington's program was associated with a small, but statistically significant differential change of -0.70 ED visits per enrollee per year (95% CI: -1.24, -0.16) in the first year after EDIE was mandated, or 8.2% of the baseline ED visit rate among frequent users. However, by the second year of implementation, these effects on ED use were no longer significant, nor were there any measurable effects on inpatient admissions, primary care use or expenditures in any period. CONCLUSIONS Statewide implementation of EDIE was associated with a small reduction in ED use among frequent users in the first year of the program but did not change overall spending or other utilization outcomes.
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Affiliation(s)
- Amber K Sabbatini
- Magnuson Health Sciences Building, 1705 NE Pacific Street, Box 357235, Seattle, WA, United States
| | - K John McConnell
- Director of Center for Health Systems Effectiveness, Oregon Health and Sciences University, 3030 SW Moody, Portland, Oregon, United States
| | - Canada Parrish
- Department of Emergency Medicine, Section of Population Health, University of Washington, 1705 NE Pacific Street, Box 357235, Seattle, WA, United States
| | - Bianca K Frogner
- Director of Primary Care Innovation Lab, University of Washington, 4225 Roosevelt Way NE, Suite 308, Seattle, WA, United States
| | - Ashok Reddy
- Division of General Internal Medicine, University of Washington, 325 Ninth Ave, Box 359780, Seattle, WA, United States
| | | | - William Kreuter
- Research Consultant in Department of Pharmacy, University of Washington, 1959 Nebraska Pacific Street, Box 357630, Seattle, Washington, United States
| | - Anirban Basu
- Comparative Health Outcomes, Policy and Economics (CHOICE) Institute in Department of Pharmacy, University of Washington, 1959 NE Pacific Street, Box 357631 H375Q, Seattle, WA, United States
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21
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Van Eijk MS, Guenther GA, Kett PM, Jopson AD, Frogner BK, Skillman SM. Addressing Systemic Racism in Birth Doula Services to Reduce Health Inequities in the United States. Health Equity 2022; 6:98-105. [PMID: 35261936 PMCID: PMC8896213 DOI: 10.1089/heq.2021.0033] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/20/2022] Open
Abstract
Purpose: Birth doulas support pregnant people during the perinatal period. Evidence of doulas' positive impacts on pregnancy and birth outcomes, particularly among underserved populations, supports expanding access. However, health workforce-related barriers challenge the development of robust doula services in the United States. This study examined the various approaches organizations have taken to train, recruit, and employ doulas as well as their perspectives on what system-level changes are needed to redress health inequities in underserved communities and expand access to birth doula services. Methods: In addition to literature and policy reviews, we conducted 16 semistructured interviews from March to August 2020 with key informants from organizations involved in training, certifying, advocating for, and employing doulas, and informants involved in state policy making. We analyzed data using qualitative analysis software to identify cross-cutting themes. Results: The landscape of organizations involved in doula training and certification is diverse. In discussing their training and curriculum, interviewees from large organizations and community-based organizations (CBOs) stressed the importance of incorporating a focus on structural racism in maternal health into training curricula. CBOs specifically offered three areas of systems-level change that can help equitably grow doula services: the importance of addressing structural racism, changing the balance of power in decision making and policy making, and a cautious approach to Medicaid reimbursement. Conclusion: This study provides evidence of how doula organizations move the field toward better serving the specific needs of underserved populations. It recognizes the expertise of CBOs in developing policy to expand doula services to communities in need. The information from this study highlights the complexities of facilitating consistency across doula training and certification requirements and implementing a sustainable funding mechanism while also meeting communities' unique needs.
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Affiliation(s)
- Marieke S. Van Eijk
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Grace A. Guenther
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Paula M. Kett
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Andrew D. Jopson
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Bianca K. Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Susan M. Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, Washington, USA
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22
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Frogner BK. How the health services research workforce supply in the United States is evolving. Health Serv Res 2022; 57:364-373. [PMID: 34982473 DOI: 10.1111/1475-6773.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate how the health services research (HSR) workforce supply in the United States has evolved over the last 5 years. DATA SOURCES Membership data of AcademyHealth participants, professional networking websites, PubMed, grant databases, and the Integrated Postsecondary Education Data System. STUDY DESIGN Descriptive study comparing size and characteristics of the HSR workforce and graduates identified across multiple data sources. Lists of authors and principal investigators (PIs) were merged and de-duplicated to identify unique counts. Pearson's chi-squared test was used to compare characteristics between members and nonmembers of AcademyHealth. DATA COLLECTION Downloaded files from websites and received survey data extracted by AcademyHealth between 2016 and 2020. PRINCIPAL FINDINGS The workforce size ranged from 9610 to 28,136, depending on data source. Common employers included universities, government settings, and health systems. Little overlap in employers existed for individuals with potentially competing skill sets. The HSR workforce appeared more diverse than the US adult population, with two to three times greater representation among Asian individuals yet lower representation among Black/African American (30%) and Hispanic (75%) individuals compared with the US population. Exactly 87,721 master's and 3105 doctoral degree graduates from core HSR fields were added over 5 years from public and not-for-profit institutions. Including for-profit institution graduates increased the count by 15% for master's and 30% for doctoral graduates. Hispanic (any race), Black/African American, and multiracial individuals gained representation among core HSR graduates, with for-profit institutions substantially contributing to the number of Black/African American graduates. CONCLUSIONS The HSR workforce is growing with increasing diversity among its graduates compared with previous studies. Additional work is needed to understand how employers value the contributions of those trained in HSR. Continued efforts are needed to ensure HSR workforce diversity to frame critical research questions and develop programs and policies that reflect the needs of the community.
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Affiliation(s)
- Bianca K Frogner
- Department of Family Medicine, Center for Health Workforce Studies, University of Washington School of Medicine, Seattle, Washington, USA
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23
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Abstract
BACKGROUND Prior studies demonstrated that wage disparities exist across race and ethnicity within selected health care occupations. Wage disparities may negatively affect the industry's ability to recruit and retain a diverse workforce throughout the career ladder. OBJECTIVE To determine whether wage disparities by race and ethnicity persist across health care occupations and whether disparities vary across the skill spectrum. RESEARCH DESIGN Retrospective analysis of 2011-2018 data from the Current Population Survey using Blinder-Oaxaca decomposition regression methods to identify sources of variation in wage disparities. Separate models were run for 9 health care occupations. SUBJECTS Employed individuals 18 and older working in health care occupations, categorized by race/ethnicity. MEASURES Annual wages were predicted as a function of race/ethnicity, age, sex, marital status, having a child under 5 in the household, living in a metro area, highest education attained, and usual hours worked. RESULTS Non-Hispanics consistently made more than Hispanic licensed practical/vocational nurses (LPNs/LVNs), aides/assistants, technicians, and community-based workers. Asian/Pacific Islanders consistently made more than Black, American Indian/Alaska Native, and Multiracial individuals across occupations except physicians, advanced practitioners, or therapists. Asian/Pacific Islanders only made significantly less when compared with White physicians, but more than White advanced practitioners, registered nurses, LPNs/LVNs, and aides/assistants. Based on observed attributes, Black registered nurses, LPNs/LVNs, and aides/assistants were predicted to make more than their White peers, but unexplained variation negated these gains. CONCLUSIONS Many wage gaps remained unexplained based on measured factors warranting further study. Addressing wage disparities is critical to advance in careers and reduce job turnover.
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Prusynski RA, Frogner BK, Skillman SM, Dahal A, Mroz TM. Therapy Assistant Staffing and Patient Quality Outcomes in Skilled Nursing Facilities. J Appl Gerontol 2021; 41:352-362. [PMID: 34291695 DOI: 10.1177/07334648211033417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Therapy staffing declined in response to Medicare payment policy that removes incentives for intensive physical and occupational therapy in skilled nursing facilities, with therapy assistant staffing more impacted than therapist staffing. However, it is unknown whether therapy assistant staffing is associated with patient outcomes. Using 2017 national data, we examined associations between therapy assistant staffing and three outcomes: patient functional improvement, community discharge, and hospital readmissions, controlling for therapy intensity and facility characteristics. Assistant staffing was not associated with functional improvement. Compared with employing no assistants, staffing 25% to 75% occupational therapy assistants and 25% to 50% physical therapist assistants were associated with more community discharges. Higher occupational therapy assistant staffing was associated with higher readmissions. Higher intensity physical therapy was associated with better quality across outcomes. Skilled nursing facilities seeking to maximize profit while maintaining quality may be successful by choosing to employ more physical therapy assistants rather than sacrificing physical therapy intensity.
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Mroz TM, Patterson DG, Frogner BK. The Impact Of Medicare's Rural Add-On Payments On Supply Of Home Health Agencies Serving Rural Counties. Health Aff (Millwood) 2021; 39:949-957. [PMID: 32479227 DOI: 10.1377/hlthaff.2019.00952] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Intermittently since 2001, Medicare has provided a percentage increase over standard payments to home health agencies that serve rural beneficiaries. Yet the effect of rural add-on payments on the supply of home health agencies that serve rural communities is unknown. Taking advantage of the pseudo-natural experiment created by varying rural add-on payment amounts over time, we used data from Home Health Compare to examine how the payments affected the number of home health agencies serving rural counties. Our results suggest that while supply changes are similar in rural counties adjacent to urban areas and in urban counties regardless of add-on payments, only higher add-on payments (of 5 percent or 10 percent) keep supply changes in rural counties not adjacent to urban areas on pace with those in urban counties. Our findings support the recent shift from broadly applied to targeted rural add-on payments but raise questions about the effects of the amount and eventual sunset of these payments on the supply of home health agencies serving remote rural communities.
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Affiliation(s)
- Tracy M Mroz
- Tracy M. Mroz is an assistant professor in the Department of Rehabilitation Medicine, University of Washington, in Seattle
| | - Davis G Patterson
- Davis G. Patterson is a research assistant professor in the Department of Family Medicine, University of Washington
| | - Bianca K Frogner
- Bianca K. Frogner is an associate professor in the Department of Family Medicine, University of Washington
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Prusynski RA, Leland NE, Frogner BK, Leibbrand C, Mroz TM. Therapy Staffing in Skilled Nursing Facilities Declined after Implementation of the Patient-Driven Payment Model. J Am Med Dir Assoc 2021; 22:2201-2206. [PMID: 33965404 DOI: 10.1016/j.jamda.2021.04.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/25/2021] [Accepted: 04/03/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The Patient-Driven Payment Model (PDPM), a new reimbursement policy for Skilled Nursing Facilities (SNFs), was implemented in October 2019. PDPM disincentivizes provision of intensive physical and occupational therapy, however, there is concern that declines in therapy staffing may negatively impact patient outcomes. This study aimed to characterize the SNF industry response to PDPM in terms of therapy staffing. DESIGN Segmented regression interrupted time series. SETTING AND PARTICIPANTS 15,432 SNFs in the United States. METHODS Using SNF Payroll Based Journal data from January 1, 2019, through March 31, 2020, we calculated national weekly averages of therapy staffing minutes per patient-day for all therapy staff and for subgroups of physical and occupational therapists, therapy assistants, contract staff, and in-house employees. We used interrupted time series regression to estimate immediate and gradual effects of PDPM implementation. RESULTS Total therapy staffing minutes per patient-day declined by 5.5% in the week immediately following PDPM implementation (P < .001), and the trend experienced an additional decline of 0.2% per week for the first 6 months after PDPM compared with the negative pre-PDPM baseline trend (P < .001), for a 14.7% total decline by the end of March 2020. Physical and occupational therapy disciplines experienced similar immediate and gradual declines in staffing. Assistant and contract staffing reductions were larger than for therapist and in-house employees, respectively. All subgroups except for assistants and contract staff experienced significantly steeper declines in staffing trends compared with pre-PDPM trends. CONCLUSIONS AND IMPLICATIONS SNFs appeared to have responded to PDPM with both immediate and gradual reductions in therapy staffing, with an average decline of 80 therapy staffing minutes over the average patient stay. Assistant and contract staff experienced the largest immediate declines. Therapy staffing and quality outcomes require ongoing monitoring to ensure staffing reductions do not have negative implications for patients.
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Affiliation(s)
- Rachel A Prusynski
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
| | - Christine Leibbrand
- Center for Studies in Demography & Ecology, University of Washington, Seattle, WA, USA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
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Mohammed SA, Guenther GA, Frogner BK, Skillman SM. Examining the racial and ethnic diversity of associate degree in nursing programs by type of institution in the US, 2012-2018. Nurs Outlook 2021; 69:598-608. [PMID: 33867155 DOI: 10.1016/j.outlook.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/29/2020] [Accepted: 01/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Increasing nursing workforce diversity is essential to quality health care. Associate Degree in Nursing (ADN) programs are a primary path to becoming a registered nurse and an important source of nursing diversity. PURPOSE To examine how the number of graduates and racial/ethnic student composition of ADN programs have changed since the Institute of Medicine's recommendation to increase the percentage of bachelor's-prepared nurses to 80%. METHODS Using data from the Integrated Postsecondary Education System, we analyzed the number of graduates and racial/ethnic composition of ADN programs across public, private not-for-profit, and private for-profit institutions, and financial aid awarded by type of institution from 2012-2018. DISCUSSION Racial/ethnic diversity among ADN programs grew from 2012-2018. Although private for-profits proportionally demonstrated greater ADN student diversity and provided financial aid institutionally to a higher percentage of students, public schools contributed the most to the number and racial/ethnic diversity of ADN graduates. CONCLUSION Given concerns regarding private for-profits, promoting public institutions may be the most effective strategy to enhance diversity among ADN nurses.
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Affiliation(s)
- Selina A Mohammed
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA.
| | - Grace A Guenther
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA
| | - Bianca K Frogner
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA
| | - Susan M Skillman
- Center for Health Workforce Studies, Department of Family Medicine, University of Washington, Seattle, WA
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Prusynski RA, Frogner BK, Dahal AD, Skillman SM, Mroz TM. Skilled Nursing Facility Characteristics Associated With Financially Motivated Therapy and Relation to Quality. J Am Med Dir Assoc 2020; 21:1944-1950.e3. [DOI: 10.1016/j.jamda.2020.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/31/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
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Affiliation(s)
- Bianca K. Frogner
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle
| | - Susan M. Skillman
- Center for Health Workforce Studies, Department of Family Medicine, School of Medicine, University of Washington, Seattle
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Abstract
The health workforce has been greatly affected by COVID-19. In this commentary, we describe the articles included in this health workforce research supplement and how the issues raised by the authors relate to the COVID-19 pandemic and rapidly changing health care environment.
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Affiliation(s)
| | - Jean Moore
- University at Albany, SUNY, Rensselaer, NY, USA
| | - Erin P Fraher
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA.,University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Joanne Spetz
- University of California, San Francisco, CA, USA
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Mroz TM, Dahal A, Prusynski R, Skillman SM, Frogner BK. Variation in Employment of Therapy Assistants in Skilled Nursing Facilities Based on Organizational Factors. Med Care Res Rev 2020; 78:40S-46S. [PMID: 32856545 DOI: 10.1177/1077558720952570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Employment of therapy assistants enables skilled nursing facilities to provide more therapy services at lower costs. Yet little is known about employment of therapy assistants relative to organizational characteristics. Taking advantage of publicly available Medicare administrative data from 2016, we examined the relationships between organizational characteristics of skilled nursing facilities and employment of therapy assistants. Therapy assistants represent approximately half of the therapy workforce in skilled nursing facilities. Regression analyses indicate significantly higher percentages of therapy assistants are employed in facilities that are staffed by contract therapists, provide more therapy, have more total stays, operate in rural areas, and are located in states with certificate of need laws or moratoria. Skilled nursing facility quality was not significantly associated with employment of therapy assistants. As new payment mechanisms change incentivizes for therapy in skilled nursing facilities, employment of therapy assistants may be a cost-effective way to continue to provide services when necessary.
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Affiliation(s)
- Erin P Fraher
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Patricia Pittman
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Bianca K Frogner
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Joanne Spetz
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Jean Moore
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Angela J Beck
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - David Armstrong
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Peter I Buerhaus
- From the Carolina Health Workforce Research Center, the Cecil G. Sheps Center for Health Services Research, and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Department of Health Policy and Management and the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the Department of Family Medicine and the Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle (B.K.F.); the Health Workforce Research Center on Long-Term Care, the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the New York Center for Health Workforce Studies (J.M.) and the Health Workforce Technical Assistance Center (D.A.), SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and the Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies, College of Nursing, Montana State University, Bozeman (P.I.B.)
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Frogner BK, Fraher EP, Spetz J, Pittman P, Moore J, Beck AJ, Armstrong D, Buerhaus PI. Modernizing Scope-of-Practice Regulations - Time to Prioritize Patients. N Engl J Med 2020; 382:591-593. [PMID: 32053296 DOI: 10.1056/nejmp1911077] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Bianca K Frogner
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Erin P Fraher
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Joanne Spetz
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Patricia Pittman
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Jean Moore
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Angela J Beck
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - David Armstrong
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
| | - Peter I Buerhaus
- From the Center for Health Workforce Studies and the Department of Family Medicine, School of Medicine, University of Washington, Seattle (B.K.F.); the Carolina Health Workforce Research Center and the Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill (E.P.F.); the Health Workforce Research Center on Long-Term Care and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco (J.S.); the Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, DC (P.P.); the New York Center for Health Workforce Studies (J.M.) and the Workforce Technical Assistance Center (D.A.), University at Albany-SUNY School of Public Health, Rensselaer; the Behavioral Health Workforce Research Center and School of Public Health, University of Michigan, Ann Arbor (A.J.B.); and the Center for Interdisciplinary Health Workforce Studies and the College of Nursing, Montana State University, Bozeman (P.I.B.)
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Abstract
PURPOSE While the number of physician assistants (PAs) participating in the primary care workforce continues to rise, the proportion of PAs practicing in primary care rather than other specialties has decreased. The purpose of this study was to identify the characteristics of matriculating PA students planning to enter primary care specialties and compare them with students planning on entering other specialties. METHODS Data from the Physician Assistant Education Association Matriculating Student Survey (MSS) from 2013 and 2014 were analyzed. In a series of bivariate analyses, demographic characteristics, educational backgrounds, clinical experiences, and practice expectations of students intending to enter primary care practice were compared with those of their counterparts who did not intend to enter primary care. Logistic regression was used to assess the overall importance of demographic, background, and practice expectations variables on practice intentions. RESULTS A total of 9283 students responded to the MSS from 2013 and 2014. More than half (58.3%) stated an intention to practice in primary care upon graduation. Those students were more likely than their counterparts to be married, to be Hispanic or Asian, and to have participated in community service prior to starting PA training. They were also less likely to view high income as essential to their careers and more likely to view practicing in rural or underserved areas favorably. CONCLUSIONS The findings of this study could be used to identify student characteristics associated with an interest in primary care and could contribute to more successful student recruitment and PA curriculum design, especially for PA training programs with a mission focused on producing primary care PAs.
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Affiliation(s)
- Eric H Larson
- Eric H. Larson, PhD, is a research professor and director of the WWAMI Rural Health Research Center, MEDEX Northwest, Department of Family Medicine at the University of Washington, Seattle, Washington. Bianca K. Frogner, PhD, is an associate professor and director of the Center for Health Workforce Studies, Department of Family Medicine at the University of Washington, Seattle, Washington
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Abstract
OBJECTIVE To determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices. DESIGN Systematic review METHODS: We searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections. RESULTS Of the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus, Clostridiumdifficile, vancomycin-resistantenterococci and Escherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection. CONCLUSIONS Computer keyboards and peripheral devices are frequently contaminated; however, our findings do not allow us to draw firm conclusions about their relative impact on the transmission of pathogens or nosocomial infection. Additional studies measuring the incidence of healthcare-acquired infections from computer hardware, the relative risk they pose to healthcare and evidence for effective and practical cleaning methods are needed.
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Affiliation(s)
- Nicole Ide
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Cynthia M LeRouge
- Department of Information Systems & Business Analytics, Florida International University, Miami, Florida, USA
| | - Patrick Vigil
- Family Medicine, Pacific Northwest University, Yakima, Washington, USA
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Skillman SM, Dahal A, Frogner BK, Andrilla CHA. Frontline Workers' Career Pathways: A Detailed Look at Washington State's Medical Assistant Workforce. Med Care Res Rev 2018; 77:285-293. [PMID: 30451087 DOI: 10.1177/1077558718812950] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medical assistants (MAs) are a rapidly growing and increasingly important workforce. High MA turnover, however, is common and employers report applicants frequently do not meet their needs. We collected survey responses from a representative sample of 3,355 of Washington's MAs with certified status (MA-Cs) to understand their demographic, education, and employment backgrounds; job satisfaction; and career plans. Descriptive analyses showed 93.0% were female with a $19.91 mean hourly wage, and while generally satisfied, 56.2% indicated they would seek training or employment in another health care occupation within 5 years, with higher percentages among MA-Cs who felt overwhelmed by their workload and/or not satisfied with promotion opportunities. Regression analyses showed Hispanic, Black, and Asian MA-Cs were more likely than White MA-Cs to express interest in other health care careers. Strategies that strengthen MA career pathways and retain qualified workers should reward both employers and MAs and contribute to a stable and diverse workforce.
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Affiliation(s)
- Susan M Skillman
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
| | - Arati Dahal
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
| | - Bianca K Frogner
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
| | - C Holly A Andrilla
- Center for Health Workforce Studies, University of Washington, Seattle, WA, USA
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Coppess S, Soares J, Frogner BK, DeMarre K, Faherty A, Hoang J, Shah M, MacKinnon M, Johnson K. A pilot study assessing clinic value in pediatric pharyngeal dysphagia: The OPPS/cost method. Laryngoscope 2018; 129:1527-1532. [PMID: 30284270 DOI: 10.1002/lary.27552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS Given the costs of healthcare, capitation, and desires for quality improvement (QI), there is a need to better assess healthcare value. Time-driven activity-based costing and the Quadruple Aim have evaluated value by assessing health outcomes and provider experiences relative to costs. The proposed OPPS/Cost method expands on this to examine value for aerodigestive clinic treatment of pediatric persistent pharyngeal dysphagia: O + P1 + P2 + S/Cost (O = objective health [video-fluoroscopic swallow study results], P1 = patient/family experience [Consumer Assessment of Healthcare Providers and Systems], P2 = provider experience [Copenhagen Burnout Inventory {CBI}], S = subjective health [Feeding/Swallowing-Impact Survey], C = cost [time-driven activity-based costing]). STUDY DESIGN Use of QI time data, surveys, and retrospective chart review for 56 patient encounters. METHODS Staff interviews were used to develop process maps, and monetary values were assigned to activities. OPPS/Cost outcomes were normalized amongst variables, and composite values were calculated. Comparisons were made using a Student t test for pre- and postclinic relocation over a 14-month period. RESULTS Time reductions were check-in (13 minutes/patient), rooming (21 minutes/patient), and providers (4 minutes/patient). Patient in-room wait time increased (4 minutes/patient). The CBI identified burnout as an area for improvement. OPPS/Cost composite values increased by 14%, with a 1.7% cost reduction, improvement in objective and subjective health outcomes of 47.4% (P < .05) and 7.3%, respectively, and stable patient/family experience. CONCLUSIONS OPPS/Cost is feasible in an interdisciplinary clinic and helped evaluate value during a clinic relocation. The QI opportunities identified are indicative of the potential of OPPS/Cost. LEVEL OF EVIDENCE NA Laryngoscope, 129:1527-1532, 2019.
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Affiliation(s)
- Steven Coppess
- University of Washington School of Medicine, University of Washington, Seattle, Washington, U.S.A
| | - Jennifer Soares
- Department of Anesthesiology, Virginia Mason Medical Center, Seattle, Washington
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington, Seattle, Washington, U.S.A.,Center for Health Workforce Studies, University of Washington, Seattle, Washington, U.S.A
| | - Kimberley DeMarre
- Speech Language Pathology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | - Amy Faherty
- Speech Language Pathology, Seattle Children's Hospital, Seattle, Washington, U.S.A
| | | | - Mahek Shah
- Institute for Strategy and Competitiveness, Harvard Business School, Boston, Massachusetts, U.S.A
| | - Matthew MacKinnon
- Department of Psychiatry, University of Washington, Seattle, Washington, U.S.A
| | - Kaalan Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.,Division of Pediatric Otolaryngology-Head and Neck Surgery, Seattle Children's Hospital, Seattle, Washington, U.S.A
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Abstract
OBJECTIVE This study examines the stock and supply including educational pipeline of health services researchers (HSRers) in the United States. DATA SOURCES National Institutes of Health Research Portfolio Online Reporting Tools, Agency for Healthcare Research and Quality Grants On-Line Database, Health Services Research Projects in Progress, PubMed, Integrated Postsecondary Education Data System, AcademyHealth membership database, and social networks. STUDY DESIGN Exploratory descriptive analysis of individuals involved in health services research (HSR) in the United States as of 2015/16. PRINCIPAL FINDINGS The HSRer stock grew by 25 percent to 45 percent between 2007 and 2015/16, which was slower than the previous measurement period. The growth in the number of doctoral and master's degrees conferred in core HSR fields has been slowing in recent years. Minorities are underrepresented among HSRers, but this trend may improve over time given the diversity of the educational pipeline. Hispanics, however, were generally underrepresented in the educational pipeline. CONCLUSIONS The average annual growth rate of HSRers appears to be within range of national recommendations. Additional work is needed to assess whether supply of HSRers is meeting demand and to ensure a competent and diverse educational pipeline that meets the needs of an evolving health system.
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Affiliation(s)
- Bianca K. Frogner
- Department of Family MedicineUniversity of Washington Center for Health Workforce StudiesSeattleWA
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Frogner BK, Harwood K, Andrilla CHA, Schwartz M, Pines JM. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Health Serv Res 2018; 53:4629-4646. [PMID: 29790166 DOI: 10.1111/1475-6773.12984] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare differences in opioid prescription, health care utilization, and costs among patients with low back pain (LBP) who saw a physical therapist (PT) at the first point of care, at any time during the episode or not at all. DATA SOURCES Commercial health insurance claims data, 2009-2013. STUDY DESIGN Retrospective analyses using two-stage residual inclusion instrumental variable models to estimate rates for opioid prescriptions, imaging services, emergency department visits, hospitalization, and health care costs. DATA EXTRACTION Patients aged 18-64 years with a new primary diagnosis of LBP, living in the northwest United States, were observed over a 1-year period. PRINCIPAL FINDINGS Compared to patients who saw a PT later or never, patients who saw a PT first had lower probability of having an opioid prescription (89.4 percent), any advanced imaging services (27.9 percent), and an Emergency Department visit (14.7 percent), yet 19.3 percent higher probability of hospitalization (all p < .001). These patients also had significantly lower out-of-pocket costs, and costs appeared to shift away from outpatient and pharmacy toward provider settings. CONCLUSIONS When LBP patients saw a PT first, there was lower utilization of high-cost medical services as well as lower opioid use, and cost shifts reflecting the change in utilization.
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Affiliation(s)
- Bianca K Frogner
- Department of Family Medicine, University of Washington Center for Health Workforce Studies, Seattle, WA
| | - Kenneth Harwood
- Health Care Quality Program, The George Washington University, Washington, DC
| | - C Holly A Andrilla
- Department of Family Medicine, University of Washington Center for Health Workforce Studies, Seattle, WA
| | - Malaika Schwartz
- Department of Family Medicine, University of Washington, Seattle, WA
| | - Jesse M Pines
- Center for Health Innovation and Policy Research, The George Washington University, Washington, DC
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Snyder CR, Dahal A, Frogner BK. Occupational mobility among individuals in entry-level healthcare jobs in the USA. J Adv Nurs 2018; 74:1628-1638. [DOI: 10.1111/jan.13577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Cyndy R. Snyder
- Department of Family Medicine; University of Washington School of Medicine; Center for Health Workforce Studies; Seattle Washington USA
| | - Arati Dahal
- Department of Family Medicine; University of Washington School of Medicine; Center for Health Workforce Studies; Seattle Washington USA
| | - Bianca K. Frogner
- Department of Family Medicine; University of Washington School of Medicine; Center for Health Workforce Studies; Seattle Washington USA
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Snyder CR, Frogner BK, Skillman SM. Facilitating Racial and Ethnic Diversity in the Health Workforce. J Allied Health 2018; 47:58-65. [PMID: 29504021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/03/2017] [Indexed: 06/08/2023]
Abstract
Racial and ethnic diversity in the health workforce can facilitate access to healthcare for underserved populations and meet the health needs of an increasingly diverse population. In this study, we explored 1) changes in the racial and ethnic diversity of the health workforce in the United States over the last decade, and 2) evidence on the effectiveness of programs designed to promote racial and ethnic diversity in the U.S. health workforce. Findings suggest that although the health workforce overall is becoming more diverse, people of color are most often represented among the entry-level, lower-skilled health occupations. Promising practices to help facilitate diversity in the health professions were identified in the literature, namely comprehensive programs that integrated multiple interventions and strategies. While some efforts have been found to be promising in increasing the interest, application, and enrollment of racial and ethnic minorities into health profession schools, there is still a missing link in understanding persistence, graduation, and careers.
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Affiliation(s)
- Cyndy R Snyder
- Dep. of Family Medicine, Research Section, University of Washington, 4311 Roosevelt Way NE, Seattle, WA 98105, USA. Tel 206-616-9253.
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Abstract
Health care has been cited as a job engine for the U.S. economy. This study used the Current Population Survey to examine the sector and occupation shifts that underlie this growth trend. Health care has had a cyclical relationship with retail trade, leisure and hospitality, education, and professional services. The entering workforce has been increasingly taking on low-skilled occupations. The exiting workforce has not been necessarily retiring or going back to school, but appeared to be leaving without a job, with potentially more child care duties, and with high rates of disability and poverty levels. This study also found that the number of workers staying in health care has been slowly declining over time. As the United States moves toward team-based care, more attention should be paid to the needs of the lower skilled workers to reduce turnover and ensure delivery of quality care.
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Frogner BK, Wu X, Park J, Pittman P. The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers. Health Serv Res 2017; 52 Suppl 1:407-421. [PMID: 28127772 DOI: 10.1111/1475-6773.12648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess how medical staffing mix changed over time in association with the adoption of electronic health records (EHRs) in community health centers (CHCs). STUDY SETTING Community health centers within the 50 states and Washington, DC. STUDY DESIGN Estimated how the change in the share of total medical staff full-time equivalents (FTE) by provider category between 2007 and 2013 was associated with EHR adoption using fractional multinomial logit. DATA COLLECTION 2007-2013 Uniform Data System, an administrative data set of Section 330 federal grant recipients; and Readiness for Meaningful Use and HIT and Patient Centered Medical Home Recognition Survey responses collected from Section 330 recipients between December 2010 and February 2011. PRINCIPAL FINDINGS Having an EHR system did significantly shift the share of workers over time between physicians and each of the other categories of health care workers. While an EHR system significantly shifted the share of physician and other medical staff, this effect did not significantly vary over time. CHCs with EHRs by the end of the study period had a relatively greater proportion of other medical staff compared to the proportion of physicians. CONCLUSIONS Electronic health records appeared to influence staffing allocation in CHCs such that other medical staff may be used to support adoption of EHRs as well as be leveraged as an important care provider.
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Affiliation(s)
- Bianca K Frogner
- Department of Family Medicine, UW Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle, WA
| | - Xiaoli Wu
- GW Health Workforce Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC
| | - Jeongyoung Park
- School of Nursing, The George Washington University, Washington, DC
| | - Patricia Pittman
- Department of Health Policy and Management, GW Health Workforce Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC
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Frogner BK, Frech HE, Parente ST. Comparing efficiency of health systems across industrialized countries: a panel analysis. BMC Health Serv Res 2015; 15:415. [PMID: 26407626 PMCID: PMC4583987 DOI: 10.1186/s12913-015-1084-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 09/21/2015] [Indexed: 11/10/2022] Open
Abstract
Background Rankings from the World Health Organization (WHO) place the US health care system as one of the least efficient among Organization for Economic Cooperation and Development (OECD) countries. Researchers have questioned this, noting simplistic or inappropriate methodologies, poor measurement choice, and poor control variables. Our objective is to re-visit this question by using newer modeling techniques and a large panel of OECD data. Methods We primarily use the OECD Health Data for 25 OECD countries. We compare results from stochastic frontier analysis (SFA) and fixed effects models. We estimate total life expectancy as well as life expectancy at age 60. We explore a combination of control variables reflecting health care resources, health behaviors, and economic and environmental factors. Results The US never ranks higher than fifth out of all 36 models, but is also never the very last ranked country though it was close in several models. The SFA estimation approach produces the most consistent lead country, but the remaining countries did not maintain a steady rank. Discussion Our study sheds light on the fragility of health system rankings by using a large panel and applying the latest efficiency modeling techniques. The rankings are not robust to different statistical approaches, nor to variable inclusion decisions. Conclusions Future international comparisons should employ a range of methodologies to generate a more nuanced portrait of health care system efficiency.
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Affiliation(s)
- Bianca K Frogner
- Department of Family Medicine, School of Medicine, University of Washington, 4311 11th Ave. NE, Suite 210, Box 354982, Seattle, WA, 98195, USA.
| | - H E Frech
- Department of Economics, University of California, Santa Barbara, 2127 North Hall, Mail Stop 9210, Santa Barbara, CA, 93106, USA.
| | - Stephen T Parente
- Finance Department, Carlson School of Management, University of Minnesota, 321 19th St. South, 3-122, Minneapolis, MN, 55455, USA.
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Abstract
Concern abounds about whether the health care workforce is sufficient to meet changing demands spurred by the Affordable Care Act (ACA). We project that by 2022 the health care industry needs three to four million additional workers, forty percent of which is related to demand growth under the ACA. We project faster job growth in the ambulatory care sector, especially in home health care. Given the current profile, we expect that the future health care workforce will be increasingly female, young, racially/ethnically diverse, not US-born, at or below the poverty level and at a low level of educational attainment.
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Affiliation(s)
| | - Joanne Spetz
- University of California, San Francisco, San Francisco, CA, USA
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Ku L, Frogner BK, Steinmetz E, Pittman P. Community Health Centers Employ Diverse Staffing Patterns, Which Can Provide Productivity Lessons For Medical Practices. Health Aff (Millwood) 2015; 34:95-103. [DOI: 10.1377/hlthaff.2014.0098] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Leighton Ku
- Leighton Ku ( ) is a professor in the Department of Health Policy, Milken School of Public Health, George Washington University (GWU), in Washington, D.C
| | - Bianca K. Frogner
- Bianca K. Frogner is an associate professor in the Department of Family Medicine at the University of Washington, in Seattle. At the time of this research, she was an assistant professor in the Department of Health Services Management and Leadership, Milken School of Public Health, GWU
| | - Erika Steinmetz
- Erika Steinmetz is a senior research scientist in the Department of Health Policy, Milken School of Public Health, GWU
| | - Patricia Pittman
- Patricia Pittman is an associate professor in the Department of Health Policy, Milken School of Public Health, GWU
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Frogner BK, Westerman B, DiPietro L. The Value of Athletic Trainers in Ambulatory Settings. J Allied Health 2015; 44:169-176. [PMID: 26342615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 10/02/2014] [Indexed: 06/05/2023]
Abstract
Athletic trainers (ATs) are increasingly used in ambulatory care settings. This study piloted a new survey instrument to assess the value that ATs add to these settings. The survey collected data on six domains: 1) general facility characteristics, 2) AT staffing characteristics, 3) other staffing characteristics, 4) patient characteristics, 5) billing practices, and 6) participation in innovations. A national sample of physician practices using ATs was recruited to participate in a web-based survey. The study found that ATs were among the most common clinical occupations in the practice. Practices were almost all "very satisfied" with the services provided by ATs with equal expectations to either maintain or increase the number of ATs. While most practices invested in training and continuing education units, the larger practices were more likely to do so. Practices were more likely to bill for AT services if ATs had a national provider identifier. The mean number of clinical visits, rate of billing, patient scheduling, wait times, and participation in innovations did not vary significantly by the number of ATs employed. Overall, the study found evidence that ambulatory care practices see value in hiring ATs.
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Affiliation(s)
- Bianca K Frogner
- Department of Family Medicine, School of Medicine, University of Washington, Box 354982, 4311 11th Ave. NW Ste 210, Seattle, WA 98105, USA. Tel 206-616-9657.
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Abstract
OBJECTIVE The impact of consumer-driven health plans (CDHPs) has primarily been studied in a small number of large, self-insured employers, but this work may not generalize to the wide array of firms that make up the overall economy. The goal of our research is to examine effects of health savings accounts (HSAs) on total, medical, and pharmacy spending for a large number of small and midsized firms. DATA SOURCES Health plan administrative data from a national insurer were used to measure spending for 76,310 enrollees over 3 years in 709 employers. All employers began offering a HSA-eligible plan either on a full-replacement basis or alongside traditional plans in 2006 and 2007 after previously offering only traditional plans in 2005. STUDY DESIGN We employ difference-in-differences generalized linear regression models to examine the impact of switching to HSAs. DATA EXTRACTION METHODS; Claims data were aggregated to enrollee-years. PRINCIPAL FINDINGS For total spending, HSA enrollees spent roughly 5-7 percent less than non-HSA enrollees. For pharmacy spending, HSA enrollees spent 6-9 percent less than traditional plan enrollees. More of the spending decrease was observed in the first year of enrollment. CONCLUSIONS Our findings are consistent with the notion that CDHP benefit designs affect decisions that are at the discretion of the consumer, such as whether to fill or refill a prescription, but have less effect on care decisions that are more at the discretion of the provider.
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Affiliation(s)
- Anthony T Lo Sasso
- Division of Health Policy and Administration, School of Public Health, University of Illinois, 1603 W. Taylor Street, Chicago, IL 60612, USA.
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Abstract
This article explores human capital investment to understand cross-sectional variation and differences in growth of health spending among the US, Australia and Canada. Using a human capital model developed by Mincer, the article examines how rate of return to schooling and years of schooling impact wage rate levels in healthcare. The model is extended to approximate the probable trajectory of healthcare wage rate growth and thus the impact on health spending. The results suggest that a higher rate of return to schooling and a more educated healthcare workforce in the US may contribute to higher healthcare wage rates and thus contribute to higher health spending levels than in Canada and Australia. The results also suggest that average healthcare wage rates are growing at the rate of potential GDP; healthcare wage rates are not driving the growth of health spending.
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Affiliation(s)
- Bianca K Frogner
- The George Washington University School of Public Health and Health Services, Washington, DC 20037, USA.
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Affiliation(s)
| | - Bianca K. Frogner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland
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