Current Research
Past Research
The following is a list of completed research studies by the Mullan Institute. Expand on the title to read more details about the project, including a description, related products, and staff contact for questions.
Filter by Topic
Area Deprivation and Access to Primary Care for Medicaid Beneficiaries
Socioeconomic indexes are increasingly being used to identify areas that may have access disparities and to allocate workforce resources to potentially underserved areas. This study examined how ambulatory primary care and specialist utilization, as well as utilization of community health centers (CHCs), varies by 1) the ADI, SVI, the Social Deprivation Index (SDI), and the Structural Racism Effect Index (SREI), and 2) by underlying demographic and socioeconomic variables.
Related Product:
Changing Medicaid Participation from 2016 To 2019 and Associated Factors
Medicaid beneficiaries face multiple challenges accessing care, compared to those covered by private insurance. This study explored the volume of Medicaid beneficiaries seen by primary care providers* (PCPs) from 2016 to 2019. We found that approximately 60% of PCPs that engaged with state Medicaid programs served a relatively stable number of Medicaid beneficiaries over time compared to the baseline. There was mixed evidence on state-level factors associated with changes in Medicaid participation and results also varied by primary care specialty and profession.
*PCPs included Family Physicians, Internal Medicine Physicians, OB/GYNs, Pediatricians, Nurse Practitioners, and Physician Associates
Related Product:
For questions about this study, contact Mandar Bodas.
Identifying Strategies to Address Health Worker Wellbeing, Recruitment, and Retention in FQHCs
This study utilized an exploratory descriptive design to examine strategies employed by four CHCs to address burnout and moral injury among their staff. The qualitative analysis of interviews with leaders and staff from four CHCs suggests that considerable thought and resources have been invested in reducing burnout and moral injury, especially since the COVID-19 pandemic. It is noteworthy that, for these four CHCs, the goal of enhancing employee voice was central to their strategies. This stands in contrast to the centrality of individual-level programs and wellness apps that are being used and studied in many other healthcare settings.
Related Products:
Impact of Vertical Integration on Utilization and Quality Outcomes of Community Health Center Patients
As the nation seeks to strengthen primary care and enhance health equity, we must understand how changes in the health care marketplace affect Community Health Centers (CHCs) and their patients. One such trend has been vertical integration, widespread among specialty practices. This study examined whether there are noticeable differences in utilization and quality outcomes between patients of vertically integrated CHCs and non-integrated CHCs. While our previous study indicated that integrated CHCs tend to be larger and better staffed, our current analysis provides moderate evidence that there might be some improvement in patient outcomes.
Related Products:
For questions about this study, contact Eric Luo.
Telehealth Use for Prenatal Visits Before, During, and After the COVID-19 Pandemic Among Medicaid Populations
Despite Medicaid being the largest payor of births in the United States, there are no published estimates of telehealth for pregnant Medicaid populations, before or during the pandemic. Given the telehealth payment flexibilities that were introduced under the Public Health Emergency Act, this study examined to what extent telehealth perinatal care was provided to pregnant Medicaid beneficiaries. This first estimate of telehealth provision to postpartum Medicaid beneficiaries before and during COVID-19 demonstrates that telehealth is a viable way to increase access to perinatal care for underserved populations, although broadband availability continues to be a constraint. The precipitous decline following the peak in April 2022 suggests more could be done to encourage telehealth use as a means to improve access for underserved populations and improve the nation’s maternal outcomes.
Related Products:
For questions about this study, contact Mandar Bodas.
Provision of Mental and Behavioral Health Services by Primary Care Providers: The Role of Medicaid Payment Generosity
A key challenge for states is a low PCP-to-beneficiary ratio in Medicaid, which can impact access to critical behavioral health care. Medicaid has historically paid physicians less than private insurance and Medicare for the same services. We examine the heterogenous effect of Medicaid payment for primary care services and its association with PCPs’ prescription for mental and behavioral health (referred to as prescriptions henceforth) to Medicaid patients. We utilize prescription claims by PCPs for psychotropic medications and/or medications for opioid use disorder (MOUD) from a nationwide multi-payer dataset.
Citation: Vichare A, Luo Q, Erikson C. Provision of Mental and Behavioral Health Services by Primary Care Providers: The Role of Medicaid Payment Generosity. Washington, DC: Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University; 2024.
Characteristics of the Behavioral Health Nursing Workforce: A Secondary Analysis of the National Sample Survey of Registered Nurses
It is crucial to understand the current state of the behavioral health (BH) nursing workforce and identify the characteristics and pathways that nurses take to become licensed and certified to continuously recruit and support future cohorts of BH nurses. To provide an overview of the current BH nursing workforce, this paper presents a secondary analysis of the 2018 NSSRN to enumerate the number of BH nurses and compare the professional and demographic characteristics of BH and non-BH nurses across all settings. This study further expands upon the current literature by assessing how the pathways to becoming an RN differ by race and ethnicity, illuminating strategies and policies supporting recruiting diverse BH nurses.
Citation: Schoebel V, Erikson C, Salsberg E, Muñoz L. Characteristics of the Behavioral Health Nursing Workforce: A Secondary Analysis of the National Sample Survey of Registered Nurses. Washington, DC: Fitzhugh Mullan Institute for Health Workforce Equity, George Washington University; 2024.
Documenting a Decade of Exponential Growth in Employer Demand for Peer Support Providers
The past decade has seen peer support providers increasingly incorporated as part of a recovery-oriented approach to behavioral health (BH) services for mental illness and substance use disorder. Despite this, there are few data sources to track this sector of the BH workforce, and understanding of peer support provider supply, demand, distribution, and associated factors is limited. In this retrospective, observational study, the authors analyzed job postings from 2010 to 2020 to assess employer demand for peer support providers and the factors associated with its growth, using a labor market data set from Emsi Burning Glass. The authors identified peer support job postings using a three-pronged, stepwise approach. Then, bivariate regression analyses using robust standard errors were conducted to examine state-level relationships between the number of peer support job postings per 100,000 population and Medicaid policies and indicators of states’ BH infrastructure. The authors identified approximately 35,000 unique postings, finding the number increased 17-fold between 2010 and 2020. Bivariate analysis found significant state-level associations between peer support job postings and Medicaid expansion, as well as states’ mean number of mental health facilities. This analysis represents the first to quantify employer demand for peer support providers, clearly demonstrating robust growth over time. Findings underscore the importance of continuing to develop data on this workforce to better understand factors driving its growth.
Citation: Ziemann MP, Dent RB, Schenk ED, et al. Documenting a Decade of Exponential Growth in Employer Demand for Peer Support Providers. J Behav Health Serv Res. 2023;50: 413–424.
Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit
Increasing the workforce available to treat opioid use disorder (OUD) remains a priority in light of high opioid mortality and percentages of people with OUD who do not receive treatment. The Drug Addiction Treatment Act (DATA) of 2000 created a pathway for clinicians to obtain waivers (“DATA waivers”) to simultaneously treat up to 30, 100, or 275 patients with OUD outside of an opioid treatment program, provided the clinicians met certification and training requirements. Policies in 2021 reduced waiver requirements and in 2023 removed waiver requirements, leading to expectations of increased OUD treatment. It is important to understand historical clinician prescribing patterns prior to these policy changes to track the specific effects going forward. Prior research mainly relies on DATA-waiver status or prescription data alone to estimate the workforce, leading to likely overestimates. To address these limitations, this study examined trends in DATA-waivered clinicians’ active participation in prescribing buprenorphine, overall and by patient limits, between January 2017 and May 2021.
Citation: Luo Q, Erikson CE. Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit. JAMA. 2023;329(20):1792–1794.
Tracking 5-Year Trends in the Workforce Prescribing Psychotropics and Medications for Opioid Use Disorder: A Cross-Sectional Study
The United States is facing a behavioral health crisis, compounded by increased depression and anxiety due to the COVID-19 pandemic, rises in opioid use and overdose deaths, and the declaration of a national pediatric mental health emergency. As demand for behavioral health services grow, it is more important than ever to have an adequate behavioral health workforce that is prepared to address these issues. Understanding longitudinal trends in this workforce could help inform future policy decisions on workforce investment, training, and retention We analyzed the number of prescriptions and prescribers by year, month, drug type, specialty type, payor type, and clinician county rurality.
Citation: Shenk E, Luo Q, Erikson CE. Tracking 5-Year Trends in the Workforce Prescribing Psychotropics and Medications for Opioid Use Disorder: A Cross-Sectional Study. J Gen Intern Med. 2024.