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Fitzhugh Mullan Institute for Health Workforce Equity

Health Workforce Research Centers

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Emerging Health Workforce Topics Center

Director: Patricia Pittman, PhD

Deputy Director: Clese Erikson, MPAff

 

Established in 2013, the Health Workforce Research Center (HWRC) on Emerging Health Workforce Topics is part of the Fitzhugh Mullan Institute for Health Workforce Equity. The center’s research portfolio examines how new payment and delivery models, patient centered medical homes, team-based care, telehealth, National Health Service Corps, and other emerging care management strategies impact access and quality of care for rural and underserved populations.

 

We are committed to advancing the science of workforce analysis by (1) developing cutting edge research methods for documenting how workforce staffing configurations impact patient satisfaction and health outcomes, (2) employing innovative uses of available datasets to identify the workforce caring for patients living in health professional shortage areas, (3) publishing a portfolio of peer-reviewed publications that build off of each other to identify policies for improving care for vulnerable and underserved populations, and (4) training the next generation of health workforce researchers to carry the work forward into the future.

Current Research Studies (2025-2026)

The Health Professional Shortage Area (HPSA) scoring system incorporates several domain-specific indicators, including low birth weight and infant mortality rates, to assess population health needs. While such indicators are informative at larger geographic or population scales, their use in smaller areas—such as rural census tracts or specific demographic subgroups—poses significant challenges due to low event counts. This limitation disproportionately affects rural communities and other small population subgroups, where health needs may be high, but data are sparse. This study aims to develop and apply statistical methods that explicitly model and communicate uncertainty in outcome indicators used in HPSA scoring.

Key Questions:

  • How can we improve the accuracy of estimates of rare health outcomes (e.g., infant mortality, low birth weight) in small geographic areas or low-population subgroups using hierarchical or spatio-temporal modeling approaches?
  • How should statistical uncertainty in these estimates be quantified and incorporated into HPSA scoring to reduce misclassification and better guide resource allocation?

For questions about this study, contact Eric Luo. 

Accurate data on the primary care workforce is essential for reliable calculation of provider-to-population ratios and effective designation of Health Professional Shortage Areas (HPSAs). While self-reported specialty information from sources like NPPES and PECOS is available for physicians, it may not reflect their current clinical activity. This classification challenge is even more pronounced for Nurse Practitioners (NPs) and Physician Assistants (PAs).

This study proposes moving beyond self-reported data and developing an activity-based classification methodology using machine learning (ML) to identify all providers—physicians, NPs, and PAs—who are actively functioning in primary care.

Key Questions:

  • How can supervised and unsupervised machine learning models, trained on physician practice patterns (claims data), be used to accurately classify the specialty of Physicians, NPs, and PAs as primary care versus non-primary care?
  • How can provider affiliation and collaboration data be integrated into classification models to improve specialty prediction, particularly for providers with low billing volume or ambiguous practice patterns?


For questions about this study, contact Eric Luo.

The Health Professional Shortage Area (HPSA) designations are critical for allocating federal resources to communities with high health needs. The scoring methodology relies heavily on provider-to-population ratios to determine the severity of a shortage. However, current HPSA scoring methodologies typically count all providers within a given area, regardless of their funding source or affiliation with federal support programs.

The goal of this study is to distinguish federally supported clinicians from the general provider population. We will then simulate the impact of excluding these providers from provider-count calculations to assess how provider-to-population ratios might change if federal market incentives are removed. This project will also deliver a dynamic simulation tool to help HRSA model various policy scenarios and methodological assumptions related to provider counts.

Key Questions:

  • How can we accurately identify and compile a comprehensive list of federally supported clinicians (including physicians, Nurse Practitioners, and Physician Assistants) participating in CHC, RHC, and NHSC programs, and geocode them to current HPSAs
  • How would provider-to-population ratios change under simulations that exclude these federally supported clinicians, and how can a modular tool be developed to help HRSA explore the impact of various exclusion scenarios and methodological assumptions on these ratios? 


For questions about this study, contact Eric Luo.

Under the current HPSA methodology, the provider-to-population thresholds used to define a shortage are inconsistent. They are subject to optional state-level adjustments and are based on a longstanding 1:3,500 ratio that dates to the 1970s. This benchmark is widely considered outdated and does not reflect modern primary care panel sizes, which recent studies suggest may be closer to 750-1,500 patients per provider. Furthermore, the contributions of Nurse Practitioners (NPs) and Physician Assistants (PAs) to primary care productivity are not consistently accounted for when examining the relationship between provider supply and outcomes.1 This study proposes moving beyond historical benchmarks to develop new, empirically derived thresholds and, at the same time, address prior limitations in how NPs/PAs have been — and have not been — included.

Key Questions:

  • What is the empirical relationship between primary care provider-to-population ratios (including weighted contributions of NPs/PAs) and key population health outcomes (e.g., avoidable hospitalizations, low birth weight)?
  • Can we identify a data-driven inflection point, or threshold, where further increases in provider density yield diminishing or plateauing returns on population health improvements?
  • How can NP and PA productivity be appropriately weighted in these ratios to account for contributions to care and variations in state-level scope of practice (SOP) laws?


For questions about this study, contact Eric Luo.

Peer-Reviewed Publications

  1. Erikson C, Tiunn H, Herring J, Luo E, Pittman P. 2025. Medicaid Billing for Community Health Worker Services Growing, but Remains Low, 2016-2020. Health Affairs Scholar. doi.org/10.1093/haschl/qxae164.
  2. Williams G, Ziemann M, Chen C, Forman R, Sagan A, Pittman P. 2024. Global Health Workforce Strategies to Address the COVID-19 Pandemic: Learning Lessons for the Future. The International Journal of Health Planning and Management. doi.org/10.1002/hpm.3762.
  3. Forrest C, Chen C, Perrin E, Stille C, Cooper R, Harris K, Luo Q, Maltenfort M, Parlett L. 2024. Pediatric Medical Subspecialist Use in Outpatient Settings. JAMA Network Open. doi: 10.1001/jamanetworkopen.2023.50379.
  4. Luo Q, Erikson C. Changes in Waivered Clinicians Prescribing Buprenorphine and Prescription Volume by Patient Limit. JAMA. doi: 10.1001/jama.2023.5038
  5. Erikson C, Park Y, Felida N, Dill M. 2023. Telehealth Use and Access to Care for Underserved Populations Before and During the COVID-19 Pandemic. Journal of Health Care for the Poor and Underserved. doi:10.1353/hpu.2023.0009.
  6. Regenstein M, Park YH, Krips M. 2023. The Use of Interpreters in Health Centers: A Mixed-Methods Analysis. J Health Care Poor Underserved. doi: 10.1353/hpu.2023.0015.
  7. Erikson C, Herring J, Park JH, Luo Q, Burke G. 2022. Association between State Payment Parity Policies and Telehealth Usage at Community Health Centers During COVID-19. Journal of the American Medical Informatics Association. doi: 10.1093/jamia/ocac104.
  8. Chen C, et al. 2021. Coronavirus Disease 2019 Planning and Response: A Tale of 2 Health Workforce Estimator Tools. doi: 10.1097/MLR.0000000000001606.
  9. Han X, Pittman P, Ku L. 2021. The Effect of National Health Service Corps Clinician Staffing on Medical and Behavioral Health Care Costs in Community Health Centers. Medical Care. doi: 10.1097/MLR.0000000000001610.
  10. Markus A, Pillai D. 2021. Mapping the Location of Health Centers in Relation to “Maternity Care Deserts”: Associations With Utilization of Women’s Health Providers and Services. Medical Care. doi: 10.1097/MLR.0000000000001611.
  11. Ziemann M, Erikson C, Krips M. 2021. The Use of Medical Scribes in Primary Care Settings: A Literature Synthesis. Medical Care. doi: 10.1097/MLR.0000000000001605.
  12. Park J, Regenstein M, Chong N, Onyilofor C. 2021. The Use of Community Health Workers in Community Health Centers. Medical Care. doi: 10.1097/MLR.0000000000001607.
  13. Han X, Pittman P, Barnow B. 2021. Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing. Medical Care. doi: 10.1097/MLR.0000000000001614.
  14. Richwine C, Erikson C, Salsberg E. 2021. Does Distance Learning Facilitate Diversity and Access to MSW Education in Rural and Underserved Areas? Journal of Social Work Education. doi: 10.1080/10437797.2021.1895929.
  15. Pittman P, Westfall N, Ziemann M, Strasser J. 2021. Who Is Allowed To Administer COVID-19 Vaccines? The List Is Growing. Health Affairs. doi: 10.1377/forefront.20210303.890600.
  16. Pittman P, Park J, Bass E, Luo Q. 2020. Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Analysis. Medical Care Research and Review.
  17. Luo Q, Chong N, Chen C. 2020. Independent Freestanding Emergency Departments and Implications for the Rural Emergency Physician Workforce in Texas. Health Services Research. doi: 10.1111/1475-6773.13587.
  18. Luo Q, Dor A, Pittman P. 2020. Optimal Staffing in Community Health Centers to Improve Quality of Care. Health Services Research. doi: 10.1111/1475-6773.13566.
  19. Delhy R, Dor A, Pittman P. 2020. The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach. Medical Care Research and Review. doi: 10.1177/1077558720950572.
  20. Han X, Chen C, Pittman P. 2020. Use of Temporary Providers in Primary Care in Federally Qualified Health Centers. Journal of Rural Health. doi: 10.1111/jrh.12424.
  21. Park J, Dowling N. 2020. Do Nurse Practitioner-Led Medical Homes Differ from Physician-Led Medical Homes? Nursing Outlook, 68(5): 601-610. doi.org/10.1016/j.outlook.2020.05.010.
  1. Han X, Pittman P, Erikson C, Mullan F, Ku L. 2019. The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Center. Medical Care, 57(12):1002–1007. doi: 10.1097/MLR.0000000000001209.
  2. Han X, Ku L. 2019. Enhancing Staffing In Rural Community Health Centers Can Help Improve Behavioral Health Care. Health Affairs, 38(12). doi: 10.1377/hlthaff.2019.00823.
  3. Park J, Han X, Pittman P. 2019. Does Expanded State Scope of Practice for Nurse Practitioners and Physician Assistants Increase Primary Care Utilization in Community Health Centers? Journal of the American Association of Nurse Practitioners. doi: 10.1097/JXX.0000000000000263.
  4. Park J, Erikson C, Han X, Iyer P. 2018. Are State Telehealth Policies Associated With the Use of Telehealth Services Among Underserved Populations? Health Affairs, 37(12): 2060-2068.
  5. Park J, Wu X, Frogner B, Pittman P. 2018. Does the Patient-centered Medical Home Model Change Staffing and Utilization in the Community Health Centers? Medical Care. doi: 10.1097/MLR.0000000000000965.
  6. Frogner B, Wu X, Park J, Pittman P. 2017. The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers. Health Services Research, 52(S1): 407-421. https://doi.org/10.1111/1475-6773.12648.
  7. Frogner B, Wu X, Ku L, Pittman P, Masselink L. 2017. Do Years of Experience With Electronic Health Records Matter for Productivity in Community Health Centers? Journal of Ambulatory Care Management, 40(1): 36–47. doi: 10.1097/JAC.0000000000000171.
  8. Li S, Pittman P, Han X, Lowe T. 2017. Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels. Health Services Research, 52(S1): 422-436. https://doi.org/10.1111/1475-6773.12655. 
  9. Malcarney M, Pittman P, Quigley L, Horton K, Seiler N. 2017. The Changing Roles of Community Health Workers. Health Services Research, 52(S1): 360-382.
  10. Pittman P, Li S, Han X, Lowe T. 2017. Clinical Nonlicensed Personnel in U.S. Hospitals: Job Trends from 2010 to 2015. Nursing Outlook, 66(1): 35-45. https://doi.org/10.1016/j.outlook.2017.06.014.
  11. Pittman P, Masselink L, Bade L, Frogner B, Ku L. 2016. Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives. Journal of Healthcare Management, 61(5): 364-377.  
  12. Pittman P, Scully-Russ E. 2016. Workforce Planning and Development in Times of Delivery System Transformation. Human Resources for Health, 14: 56.
  13. Ku L, Frogner B, Steinmetz E, Pittman P. 2015. Community Health Centers Employ Diverse Staffing Patterns, Which can Provide Productivity Lessons for Medical Practices. Health Affairs, 34(1): 95-103. doi: 10.1377/hlthaff.2014.0098.

Previous HWRC Studies

As of 2022, approximately 39% of children in the U.S. were covered by Medicaid/CHIP, but many face transportation barriers and other challenges with seeking medical care. This study examined differences in health care access and service utilization between Medicaid/CHIP-enrolled children who receive care from providers in school settings and those who do not, and by beneficiary race/ethnicity and rurality.

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Project Contact: Clese Erikson

Funder: Health Resources and Services Administration

Demand for nurses is expected to slightly exceed supply in the United States over the next ten years. Many healthcare organizations face severe recruitment and retention challenges, and geographic distribution remains inequitable. One strategy that has grown in popularity is the use of the Nurse Licensure Compact (NLC), which reduces administrative obstacles in licensing if nurses wish to either move to another state or practice outside their primary state of residence in another NLC participating state.

This study builds on DePasquale and Strange’s work by examining more recent periods that allow us to study the “enhanced” NLC that began in 2018, and by using different data sources (the CPS and the NSSRN).

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Project Contact: Patricia Pittman

Funder: Health Resources and Services Administration

In recent years, the primary care landscape in the United States has seen significant shifts due to the emergence of alternative practice models such as concierge medicine and Direct Primary Care (DPC). These models have attracted attention as potential solutions to the growing challenges in traditional primary care, including high administrative burdens, clinician burnout, and barriers to patient access. This project was among the first studies to examine the potential downstream effects of these models on the primary care workforce in underserved communities (e.g., workforce loss).

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Project Contact: Eric Luo

Funder: Health Resources and Services Administration

The availability of primary care providers (PCPs) is a key factor affecting access to care for Medicaid enrollees. Prior analysis by the Mullan Institute suggests that in 2019, about 87% of PCPs participated in Medicaid in the U.S., but participation varied considerably across states and by PCP specialty. This study examined office visit panels of Medicaid-engaged PCPs using national-level claims data and compared them with their commercial patient office visit panels.

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Project Contact: Mandar Bodas

Funder: Health Resources and Services Administration

Study Year: 2024

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. ​​

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Study Year: 2024

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 ​

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​For questions about this study, contact Mandar Bodas.

Study Year: 2024

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.

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Study Year: 2024

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.

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​For questions about this study, contact Eric Luo.

Study Year: 2024

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.

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For questions about this study, contact Mandar Bodas.

Study Year: 2023

To examine whether increasing reliance on overtime and agency nurses affects patient safety, we used a proprietary database from Premier, Inc. that reports on inpatient staffing based on payroll, as well as patient utilization and safety metrics from 75 hospitals across the nation. These findings suggest important implications for hospital management, as well as, potentially, state and federal regulators concerned about promoting patient safety.

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For questions about this study, contact Patricia Pittman.

Study Year: 2023

Given the importance of Community Health Centers (CHCs) in providing care for underserved populations, it is critical to understand the trends in vertical integration and its impact on these outcomes. One of the most important challenges in studying vertical integration among CHCs is measuring integration. This study provides a novel method to identify different forms of vertical integration among CHCs by combining publicly available data sources and assessing vertical integration’s impact on CHC staffing patterns.

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For questions about this study, contact Eric Luo.

Study Year: 2023

This study uses Medicare Provider Enrollment Chain and Ownership System (PECOS) data to develop methods that permit the tracking of movements of healthcare providers as close to “real-time” as possible. It demonstrates that existing datasets can be used to better track healthcare provider movement, and movement appears to be increased post-COVID, although not consistently between specialties and professions.

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For questions about this study, contact Stephen Petterson​.

Study Year: 2023

Diversity at an organizational level may have several benefits, including improved provider cultural sensitivity and cultural competency. This study assesses the organizational (i.e., practice-level) diversity of primary care physicians who care for Medicaid patients using a unique score of practice diversity.

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For questions about this study, contact Anushree Vichare.

Study Year: 2023

Community Health Workers (CHWs) gained prominence as crucial healthcare providers in the United States by leveraging their unique understanding of local communities to improve patient access, quality of care, and outcomes. Acknowledged by the American Public Health Association as trusted community members, CHWs are bridges between healthcare and social services, particularly adept at addressing cultural disparities. We reviewed state Medicaid policies to identify states that authorize CHW billing by CHW authorization type (SPA, 1115 or 1915 waiver, MCO contract, or health home) and reimbursement method (direct fee-for-service (FFS) or MCO care cost versus indirect funding such as per-member-per month (PMPM) payments, administrative fees, or grants) and identified 12 states that reimbursed for peer support services between 2016 and 2019. ​

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For questions about this study, contact Clese Erikson.

Study Year: 2023

Poor access to prenatal care is a key driver of high maternal mortality and morbidity in the U.S. Telehealth could help address this issue and enhance prenatal care. This study examined telehealth use during pregnancy during the COVID-19 pandemic.

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​For questions about this study, contact Anushree Vichare.

Study Year: 2022

The health workforce is a critical component of health care delivery. The number, types, distribution, and practice behaviors of health care workers affect access, quality, and cost of health care. Practice behaviors include populations served (e.g., whether they serve Medicaid patients and how much service they provide). Research demonstrates the health workforce is sensitive to several factors, including education and training, federal and state policies, and developing market incentives. However, the majority of health workforce research has focused on the Medicare population, where data has been more available.

This study built on our previous work to identify the health workforce serving the Medicaid population to now examine who is providing services to specific segments of the Medicaid population.

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For questions about this study, contact Eric Luo.

Study Year: 2022

The need for a robust public health system has become an increasingly important focus due to the COVID-19 pandemic. Public health provides essential services  –  monitoring population health, investigating and addressing health hazards, providing education, partnering with communities, championing and implementing  policies – that protect communities and improve health. This study examined the change in local health department (LHD) staffing between 2013 and 2019 across U.S. counties, as well as the association between public health workforce staffing and community-level health outcomes.

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Study Year: 2022

This study examined how hospitals in high- and low-resource settings differentially implemented staffing strategies in response to COVID-19 and subsequently how these responses affected outcomes at the facilities. The COVID-19 pandemic generated an unprecedented demand for healthcare workers across the country, causing staffing strains on hospitals as they confronted the crisis.

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For questions about this study, contact Patricia Pittman.

Study Year: 2022

This study examined provider engagement in offering Medicaid services through telehealth or in non-medical settings such as home, schools, and homeless shelters that may be more accessible to patients with transportation barriers or limited mobility.

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For questions about this study, contact Clese Erikson.

Study Year: 2022

The GWMI defines Health Workforce Equity as “a diverse health workforce that has the competencies, opportunities, and courage to ensure everyone can attain their full health potential.” We further define six health workforce domains central to determining whether policies and programs facilitate or inhibit this vision of equity. We built on evidence reviews of these domains to propose a set of measures to track progress.

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For questions about this study, contact Patricia Pittman.

Study Year: 2021

The purpose of this study was to assess the availability and use of language services in CHCs. About one in five health center patients indicate a preference to receive care in a language other than English, which means that over 5.8 million patients, collectively visiting health centers approximately 19 million times over a year, may require the use of an interpreter or some other language service.

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For questions about this study, contact Marsha Regenstein.

Study Year: 2021

This study aimed to identify the health workforce serving the Medicaid population – acceptance (yes/no) and amount of service, and examine variation in service based on provider profession and specialty. The goal of this initial analysis is additional studies examining the patient, provider, and policy characteristics associated with provider Medicaid  service, as well as, the development of a Medicaid Tracker tool that allows users to explore the characteristics of the Medicaid providers in their communities (e.g., county-level characteristics and outcomes).

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Study Year: 2021

The purpose of this research was to inventory and categorize governors’ executive orders (EOs) that address four categories of workforce flexibility during the pandemic: SOP laws for APRNs, PAs, and pharmacists; and out-of-state licensing for all health care practitioners.

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​For questions about this study, contact Patricia Pittman. ​

Study Year: 2021

The purpose of this study was to examine national primary care workforce attrition through the end of 2020.

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Study Year: 2021

To improve health workforce equity, the GW Fitzhugh Mullan Institute for Health Workforce Equity (GWMI) tracks who is providing services, what services, where, and for whom. This allows us to approximate the adequacy of the health workforce supply for specific populations, using alternative measures of population needs. Researchers, policymakers, and advocates can use these interactive trackers to select variables depending on their own priorities.

​For questions about this study, contact Candice Chen.

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Study Year: 2021

Amid the COVID-19 pandemic, accessing care can be challenging and risky, given social  distancing restrictions and concerns about exposure to the virus. This study examined the extent to which consumers are experiencing increased difficulty with accessing care when needed during the pandemic with a specific focus on how COVID-19 is affecting underserved populations.

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For questions about this study, contact Clese Erikson.

Study Year: 2021

As the third wave of COVID-19 was tapering off in the United States, we obtained new data that enabled us to revise our state-level hospital workforce estimator to provide county-level estimates of workforce need related to COVID-19 outbreaks.

 

For questions about this study, contact Clese Erikson.

Study Year: 2021

Amid the COVID-19 pandemic, health care providers, including community health centers (CHCs), are rescheduling non-urgent care and exploring options to increase telehealth use to reduce the risk of spreading the virus. This study examined the extent to which CHCs are offering telehealth visits as an option for maintaining services during the pandemic.

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For questions about this study, contact Clese Erikson.

Study Year: 2020

Until 2016, community health centers (CHCs) reported community health workers (CHWs) as part of their overall enabling services workforce, making analyses of CHW use over time infeasible in the annual Uniform Data System (UDS). This study examined changes in the CHW workforce among CHCs from 2016 to 2018 and factors associated with use of CHWs.

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​For questions about this study, contact Marsha Regenstein. ​

Study Year: 2020

Under a fee-for-service payment system, the logic of human resource planning is based mainly on labor costs and the ability of a clinician to bill. However, there are trends toward more health care organizations, including community health centers (CHCs), engaging in alternative payment models in which providers are reimbursed based on achieving specific quality outcomes. Though this has the potential to change the way CHC leadership thinks about workforce planning fundamentally, evidence on the effect of workforce configurations on quality outcomes is still sparse. This project aimed to develop tools for CHCs to use simulated data as they make decisions about staffing.

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​For questions about this study, contact Eric Luo. ​

Study Year: 2020

We hypothesized that health centers close to a desert versus those that were not would provide higher numbers of family physician and nurse practitioner visits compared to obstetrician-gynecologist and nurse-midwife visits. We based our hypothesis on prior research that shows that: (1) obstetrician-gynecologists tend to establish their practice in higher resourced, urban areas; (2) family physicians, who are trained in obstetrics, are more likely to perform deliveries the closer they are to a rural area; and (3) nurse practitioners, who are trained women’s health providers and licensed to provide prenatal care, more often staff and even lead clinics where permitted by state law, which is in harder to reach areas of the country.

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For questions about this study, contact Anne Markus.

Study Year: 2020

Independent freestanding emergency departments (IFEDs) have increased over the last decade, mainly in Texas. We examined the IFED physician workforce composition and changes in emergency physician workforce supply across states and in rural Texas throughout IFED proliferation.

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Study Year: 2020

Clerical burdens have strained primary care providers already facing a shifting healthcare landscape and workforce shortages. These pressures may cause burnout and job dissatisfaction, with negative implications for patient care. Medical scribes perform real-time EHR documentation and are posited as a solution to relieve clerical burdens, thus improving provider satisfaction and other outcomes. The purpose of this study was to identify and describe the published research on medical scribe utilization in primary care and safety net settings.

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For questions about this study, contact Clese Erikson.

Study Year: 2019

The use of temporary health care providers, such as locum tenens and on-call providers, has increased in the US in recent years, but data is lacking on their use in federally qualified health centers (FQHCs) that often face extreme difficulties and delays in recruiting staff. Temporary providers might be an important staffing solution for FQHCs, both to bridge to permanent hires and to maintain patient service in more challenging health professional shortage and recruitment areas, including rural areas. However, an important question remains on whether temporary providers were generally used to fill vacancies in FQHCs, especially rural FQHCs that face more severe staffing problems. This study provides a landscape of temporary provider usage in FQHCs and identifies factors associated with their use.

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​​For questions about this study, contact Patricia Pittman. ​

Study Year: 2019

The growth of nurse practitioners (NPs) and physician assistants (PAs), or Advanced Practitioner Clinicians (APCs) in the primary care workforce has far exceeded the growth of primary care physicians (PCP) in community health centers (CHCs) over the last decade, yet their productivity varies dramatically across organizations. In this study, we asked what organizational characteristics are causing this variation to occur.

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For questions about this study, contact Patricia Pittman.

Study Year: 2019

The National Health Service Corps (NHSC) is an important source of clinician staffing for community health centers (CHCs). In Year 5, researchers from our team compared the marginal productivity (measured as visits per additional staff) for NHSC and non-NHSC clinicians in CHCs, and found that productivity for NHSC clinicians is similar to that of non-NHSC clinicians in primary care, but is higher for NHSC clinicians in mental health care. However, whether NHSC staffing reduces total costs of care in CHCs remains unknown. This study compared the marginal effect of NHSC and non-NHSC clinician staffing on medical and mental health care costs and administrative costs in CHCs.

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​​For questions about this study, contact Patricia Pittman. ​

Study Year: 2019

The shortage of clinicians that have received waivers under the Drug Addiction Treatment Act (DATA) of 2000 to provide medication-assisted treatment (MAT) for opioid use disorder is becoming more salient with the ongoing opioid epidemic. While studies have shown a substantial number of DATA-waived physicians never begin prescribing buprenorphine, little is known about how many continue to prescribe buprenorphine once they start. This study provides new insights on retention and attrition of buprenorphine providers.

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For questions about this study, contact Clese Erikson.

Study Year: 2019

Distance learning in social work has proliferated in recent years to meet student demand for flexible learning opportunities. Online and blended programs are increasingly promoted as a strategy for diversifying the social work workforce and expanding access to graduate education for individuals in rural and under-served communities. This study assesses the accuracy of these claims by analyzing survey data on recent Master of Social Work (MSW) graduates.  Controlling for educational and personal characteristics, we evaluate whether participation in an online or blended MSW program (1) is associated with practice in rural or underserved areas and (2) increases diversity in the field.

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​​For questions about this study, contact Edward Salsberg. ​

Study Year: 2018

This study examined the effects of health workforce on quality of care delivered in CHCs, measured by percent of patients with diabetes and hypertension who have their chronic conditions under control.

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​​For questions about this study, contact Eric Luo.

Study Year: 2018

The National Health Service Corps (NHSC) is a principal federal program to increase the supply of primary care medical, dental and mental health clinicians in underserved areas, but there has been little research examining the extent to which NHSC clinicians expand patient care capacity of federally qualified health centers. This study examines whether NHSC clinicians substitute for non-NHSC clinicians and to estimate the extent to which they increase clinic visit volumes at health centers.

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​​For questions about this study, contact Patricia Pittman.

Study Year: 2018

Medicare beneficiaries are increasingly seeking care at community health centers and other health professional shortage areas (HPSAs) that can be challenging to adequately staff. The National Health Service Corps (NHSC) is a primary federal strategy to increase the supply of primary care providers in HPSAs. This study uses Medicare Part D provider billing data to document the role that NHSC participants and recent alumni play in caring for Medicare patients, including dual eligible Medicare and Medicaid beneficiaries, in HPSAs.

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​​For questions about this study, contact Patricia Pittman.

Study Year: 2018

This study examined trends in telehealth usage over time, as well as the role state telehealth policies play in telehealth use when controlling for population characteristics.

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​​For questions about this study, contact Clese Erikson.

Study Year: 2017

The purpose of this study was to explore key workforce strategies in Next Generation Accountable Care Organizations (Next Gen ACOs), the latest evolution in Medicare ACOs. We conducted semi-structured interviews with leaders from seven of the initial 18 Next Gen ACOs to better understand their perceptions regarding how workforce roles are changing to support the Next Gen ACO model.

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​​For questions about this study, contact Clese Erikson.

Study Year: 2017

Building on a robust literature on the relationship of nurse staffing levels to outcomes in hospitals, this study examines the effects of changes in the level of both nurse’s (RN and LPNs) and their support staff’s (assistive personnel) hours on six measures of patient satisfaction outcomes. Higher patient satisfaction scores are now rewarded as part of the Medicare reimbursement policies. The aim of the study was to identify optimal levels of staffing for maximizing these outcomes, and to better understand the interaction of these two groups of healthcare workers with regard to these outcomes of interest.   ​​

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For questions about this study, contact Patricia Pittman.

Study Year: 2017

Over the last two decades, community health centers (CHCs) have grown in number and capacity to meet the needs of the uninsured and Medicaid populations. This growth was been accelerated by the Affordable Care Act (ACA), which extended Medicaid eligibility beginning January 1, 2014 to include those with family incomes of less than 138% of the federal poverty level. Despite this shift, the workforce impacts have not been measured. This study examines the effects of state Medicaid expansion on community health center staffing.

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For questions about this study, contact Patricia Pittman.

Study Year: 2017

This study examines the effects of expanded nurse practitioner (NP) scope of practice (SOP) laws on the composition and productivity of key primary care providers in community health centers (CHCs), including NPs, primary care physicians, and physician assistants (PAs).

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​​For questions about this study, contact Patricia Pittman.

Study Year: 2016

This study explored whether and to what extent the National Health Service Corps (NHSC) grantee sites are utilizing telehealth.

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​​For questions about this study, contact Patricia Pittman.

Study Year: 2016

Significant Federal investments have motivated many community health centers (CHCs) to implement electronic health records (EHRs) in recent years. Because CHCs are known to use flexible and innovative staffing models, their uptake of EHRs creates a unique opportunity to study how new technology intersects with staffing changes to influence care delivery. The goals of the project are to understand how CHCs’ implementation of EHRs has changed staffing models, staff roles, and workflow, and the mechanisms by which EHRs influence staff productivity and coordination between providers and quality of care.

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​​For questions about this study, contact Clese Erikson.

Study Year: 2016

This study examined the nurse-related clinical non-licensed personnel (CNLP) staffing in U.S. hospitals between 2010 and 2014, in terms of their job categories, staffing trends, and relationship with hospital registered nurse (RN) and licensed practical nurse (LPN) staffing.

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For questions about this study, contact Patricia Pittman.

Study Year: 2016

​​The patient-centered medical home (PCMH) is an enhanced model of primary care and has grown substantially over time. Although initially established as a physician-centric model, the model has evolved to emphasize team-based care and in some cases, the development of non-physician-led PCMHs. Currently there are almost 300 nurse-led PCMH practices recognized by the national accreditation body, the National Committee for Quality Assurance (NCQA). However, little is known about whether and to what extent nurse-led PCMHs differ from physician-led PMCHs in terms of patient populations they serve, staff composition as well as roles and responsibilities of each team member, and the services they provide.

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For questions about this study, contact Jeongyoung Park.

Study Year: 2016

The purpose of this report was to provide a descriptive analysis of workforce differences between hospitals that participate in some form of an ACO and those that do not. In particular, the study examines whether care coordination activities are higher in ACO hospitals and whether nurse staffing and staffing of care coordination jobs are higher.

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​​For questions about this study, contact Patricia Pittman.

Study Year: 2015

As implementation of the U.S. Affordable Care Act (ACA) advances, many domestic health systems are considering major changes in how the healthcare workforce is organized. The purpose of this study was to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment.​​

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For questions about this study, contact Patricia Pittman.

Study Year: 2015

The purpose of this study was to fill this gap by developing a new evidence-based health workforce innovation research framework and applying the model to compare health workforce innovations at community health centers and other ambulatory care settings.

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​For questions about this study, contact Patricia Pittman.

Study Year: 2015

The purpose of this study was to understand the workforce transformation occurring in community health centers (CHCs) that have achieved patient-centered medical home (PCMH) recognition, and to assess the relationship of those changes to productivity.

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​For questions about this study, contact Jeongyoung Park.

Study Year: 2015

The purpose of this study was to examine what different types of employers value in hiring Community Health Workers (CHWs), and determine what new competencies CHWs might need to meet workforce demands in the context of an evolving payment landscape and substantial literature suggesting that CHWs are uniquely qualified to address health disparities.

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​​For questions about this study, contact Patricia Pittman.

Study Year: 2015

This study describes the changes in the workforce of community health centers (CHCs) from 2007 to 2013.

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For questions about this study, contact Leighton Ku.

Study Year: 2015

The purpose of this study was to assess how the medical staffing mix changed over time with the adoption of electronic health records (EHRs) in community health centers (CHCs).

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For questions about this study, contact Patricia Pittman.

Study Year: 2015

The aging population coupled with expanded health insurance coverage creates an increasing demand for medical services in the United States. The purpose of this analysis was to better understand how hospitals are using Clinical Support Personnel (CSP), and to explore changes that may have occurred since the 2010 passage of the Affordable Care Act.

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​​For questions about this study, contact Patricia Pittman.

Study Year: 2014

Community health centers’ (CHCs) patient panels are expected to increase in the coming years. This study investigated to what the years of experience with an electronic health record (EHR) was related to the productivity of CHCs.

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For questions about this study, contact Patricia Pittman.

Study Year: 2014

Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different types of staff to productivity, and the factors associated with staffing at community health centers across the United States.

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For questions about this study, contact Leighton Ku.

Study Year: 2014

While financial incentives to adopt team-based care are mounting, little is known about how leaders of primary care organizations make decisions regarding medical staff configurations. This study explored perceptions of CEOs of community health centers (CHCs) that have a variety of staff configurations.

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​​For questions about this study, contact Patricia Pittman.