Health Workforce Research e-Library

During the COVID-19 pandemic, numerous concerns about the nursing workforce have been reported. With a shortage of registered nurses (RNs) likely underway now, employers need to ramp up their efforts to retain RNs and develop career paths for newly-graduated RNs. They also need to rapidly develop and implement strategies to mitigate the potential harm of shortages over the next 5 years. This report reviews the supply and demand of RNs in California and how the COVID-19 pandemic is affecting the nursing workforce.

We investigated if Electronic Visit Verification (EVV), in representative states, acted as a barrier, facilitator, or a promising practice in terms of supporting and advancing choice, control, community living, and participation for disabled individuals who received Medicaid-Funded Personal Care Services (PCS).

Despite considerable research on nursing turnover, few studies have considered turnover among nurses working in home health care. Between 2016 and 2019, the average annual separation rate of home health nurses was over 30%, with most separations occurring voluntarily. Schedule volatility and turnover were positively associated for full-time nurses, but not for part-time nurses. This article examines turnover among home health nurses, focusing on the role of schedule volatility.

This study examined the impact of nursing home medical staffing organization (NHMSO) dimensions on the quality of care in U.S. nursing homes.

Several states and cities established alternate care sites in locations such as convention centers and dormitories to provide sub-acute care for people with SARS-Cov2 infection. This policy brief examines the roles of these sites, their staffing mix, their recruitment and deployment strategies, and their training approaches.

This study examines unemployment and re-employment patterns during the COVID-19 period to develop new understanding about how to recruit new workers into direct care jobs, where they are acutely needed.

This study seeks to measure wage differences between registered nurses (RNs) working in long-term care (LTC) (e.g., nursing homes, home health) and non-LTC settings (e.g., hospitals, ambulatory care) and whether differences are associated with the characteristics of the RN workforce between and within settings.

This second year of a two-year study, conducted jointly by the Behavioral Health Workforce Research Center (BHWRC) at the University of Michigan and University of California-San Francisco Health Workforce Research Center on Long-Term Care (UCSF-HWRC), sought to assess the effectiveness of peers in helping behavioral health clients achieve and maintain recovery. Findings of this study build on a 2020 systematic review of literature on the efficacy of peers in behavioral health treatment.

Marriage and family therapists (MFTs) are a key component of behavioral health, but little is known about their job functions, practice settings, or demographic characteristics on a broad scale. This brief describes a pilot study that was conducted to test the effectiveness of a minimum data set (MDS) designed to collect MFT workforce data.

This study aims to describe the variation in paraprofessional accreditation standards by state and to analyze whether states follow national models, their own models, or a mixture of both.

This study aims to describe the variation in paraprofessional accreditation standards by state and to analyze whether states follow national models, their own models, or a mixture of both.

To better understand behavioral health workforce development opportunities for telebehavioral health and the impact of COVID-19, the BHWRC research team conducted a mixed methods study of data from behavioral health provider organizations nationwide. This brief provides a summary of findings related to telebehavioral health workforce development opportunities and the impact of the COVID-19 pandemic.

To better understand behavioral health workforce development opportunities for telebehavioral health and the impact of COVID-19, the BHWRC research team conducted a mixed methods study of data from behavioral health provider organizations nationwide. This report provides a summary of findings related to telebehavioral health workforce development opportunities and the impact of the COVID-19 pandemic.

Buprenorphine is shown to be an effective medication for the treatment of opioid use disorder. It promotes long-term recovery and decreases the risk of mortality. Although Medicaid programs largely cover buprenorphine products, many continue to apply prior authorization (PA) requirements. This brief studies how state Medicaid programs apply PA requirements to buprenorphine products.

Buprenorphine is shown to be an effective medication for the treatment of opioid use disorder. It promotes long-term recovery and decreases the risk of mortality. Although Medicaid programs largely cover buprenorphine products, many continue to apply prior authorization (PA) requirements. This report studies how state Medicaid programs apply PA requirements to buprenorphine products.

The behavioral health workforce is currently experiencing a shortage of providers across the United States. This workforce shortfall has likely been affected by the COVID-19 pandemic, though it is currently unclear how policy changes and systems-level factors within behavioral health care will impact workforce capacity. This report investigates systems-level factors and service delivery following COVID-19-related state and federal regulatory changes and their impact on behavioral health workforce capacity. Results of this study can inform future behavioral health workforce planning efforts, specifically around identifying and removing barriers to maximizing workforce capacity.

Prior research to assess the supply of clinical child and adolescent subspecializations among behavioral health providers may underestimate the number of psychologists without a child and adolescent specialty credential who primarily treat these populations. This second year of a two-year study adds to estimates of the health service psychologist workforce that provides services to children and adolescents.

Distance learning in social work has proliferated in recent years. It is 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. Findings indicate that online and blended education is associated with practice in rural and underserved areas. This article examines the effects of distance learning in social work education.

Hospitals have increasingly relied on nurse assistants to support nurses in the provision of patient care, yet knowledge about their contributions to the patient experience in U.S. hospitals is limited. We address this issue by exploring the impact of nurse assistants and registered nurses on an array of patient satisfaction measures from the Medicare Hospital Consumer Assessment of Healthcare Providers and Systems.

The patient-centered medical home (PCMH) is an enhanced model of primary care. This study examined to what extent nurse practitioner (NP)-led PCMHs differed from traditional physician-led PCMHs.

Expanding state scope of practice (SOP) for nurse practitioners (NPs) and physician assistants (PAs) can boost productivity and improve access to health care services. Existing analyses on regulatory policies in NP or PA SOP have primarily focused on the direct effects on their own professions but have not fully considered the potential cross-professional effects. This study examines the impact of expanded state SOP for NPs and PAs on primary care utilization by NP, PA, and primary care physician (PCP) in community health centers (CHCs).

As health workforce shortages become more common in the United States, the use of temporary health care providers has increased. Federally qualified health centers (FQHCs) often experience staffing shortages and barriers to recruitment, but their use of temporary health care providers is not well understood. This article describes a study that analyzed data from 2013-2017 to investigate trends in the use of temporary health care providers at FQHCs and what factors were associated with their use.

Independent freestanding emergency departments (IFEDs) have proliferated over the last decade, largely in Texas. We examined the IFED physician workforce composition and changes in emergency physician workforce supply across states and in rural Texas over the period of IFED proliferation following a 2009 legislation allowing the licensing of these sites.

The objective of this study was explore optimal workforce configurations in the production of care quality in community health centers (CHCs), accounting for interactions among occupational categories, as well as contributions to the volume of services.

This study asks how much and why the productivity of advanced practice clinicians (APCs, nurse practitioners, and physician assistants) varies across community health centers (CHCs), as measured in their marginal contribution to overall patient visits.

This study examines whether characteristics of dental education, practice characteristics and state Medicaid policies are associated with dentists’ pediatric Medicaid participation.

This webinar will cover the basics of using IPUMS for studying the health workforce. It will review the guiding principles for understanding how IPUMS data can aid research. The webinar will open with options for defining the health workforce using IPUMS industry, occupation, and education codes. The webinar will also cover 5 specific topics: 1) Measuring the characteristics of the US health workforce, 2) Accessing data on health care utilization and expenditures by characteristics of the health workforce, 3) Understanding the geographic levels at which these data are available, 4) Describing the time periods for which these data are available, and 5) Describing the international data available via IPUMS on the health workforce.

A community health needs assessment is a collaborative analysis of the population, resources, services, health care statuses, health care outcomes, and other data in a defined community or service area that helps identify potential health issues for improvement. Certain federal and state funders require periodic community health needs assessments, including federal grants for primary care offices and maternal and child health programs.

The inaugural Health Workforce Research Centers (HWRCs’) Annual Report highlights the work from the Health Resources and Services Administration (HRSA) funded centers throughout the country. This report introduces each center, their work, the conference season, and more.

This webinar is a discussion with leaders of Health Workforce Research Centers (HWRCs) to get their perspectives on COVID-19 impacts on the health workforce. Webinar participants will: gain insight into state responses to quickly build health workforce surge capacity, learn about COVID-19 workforce resources available on the Health Workforce Technical Assistance Center website, and hear about plans for current and future studies by the HWRCs related to COVID-19.

Small Area Analysis (SAA) is a research technique used to analyze variations in health service utilization and resource allocation among neighboring communities. SAA focuses on specific areas or populations to identify significant differences and needs among well-defined small areas within a larger geographic boundary. This web page provides answers to common questions about SAA through a series of podcasts. It also provides access to helpful SAA tools, resources, and related articles.

Between 2010 and 2016, the proportion of women working in dentistry increased from 24.5% to 29.8%. Overall, female dentists were more racially/ethnically diverse, more likely to be foreign-trained, and more likely to work in pediatric dentistry than male dentists. Gender diversification in dentistry and other factors, including generational differences and changes in public policy, continue to reshape the delivery of oral health services. This study analyzed gender differences in dental practice using the American Dental Association’s 2010-2016 Masterfile and the 2017 Survey of Dental Practice.

The objectives of this study were to highlight unique access barriers for children, including specific barriers for underserved children living in rural or other underserved geographic areas, underrepresented minorities, and children with special health care needs. The ultimate goal of this research was to provide scientific evidence to support the development of effective policy strategies to address access barriers and oral health disparities among children.

Oral health providers across the country that work in the safety net have used a variety of innovative strategies to expand access to oral health services in community-based settings, including federally qualified health centers, schools and nursing homes, among others. This compendium summarizes best practices in innovative oral health service delivery programs drawn from over 40 case studies conducted by the OHWRC in recent years. Organizations included were early initiators of service integration, mobile/portable dentistry, and/or teledentistry. Brief summaries of each organization include infographics as well as detail the problem, solution, facilitators, barriers, and benefits that the organization encountered in its efforts to expand access to care for underserved populations.

The scope of practice for dental hygienists has rapidly expanded and evolved over the past decade. These changes have brought about new career growth opportunities for providers and have improved access to care for patients. This article explores some of the most important changes in scope of practice for dental hygienists and how these changes have impacted the industry.

The objective of this research project was to obtain baseline data on dental school curricular content related to pharmacological pain management and on patient screening, identification, intervention, and referral for substance use disorders to better understand the extent to which dental students might be prepared to address substance use among patients in clinical practice.

This study assesses the contributions of general and specialty dentists to care for people with special needs. Another goal is to describe sources of training for dentists relative to treating people with special needs. Study findings are useful to many oral health stakeholders interested in expanding access to oral health services for these populations. This report will henceforth refer to “special needs” consistent with conventional terminology and recognizable by our survey respondents

Access to oral healthcare remains a significant problem in the United States. One solution that has gained momentum over the past decade is the expansion of the oral health workforce through the addition of a new member: the dental therapist (DT).

The objective of this study was to evaluate factors influencing utilisation of follow-up oral-health services in general dentistry clinics among children subsequent to a teledentistry consultation and treatment with a paediatric dental specialist.

This study examines the alignment of policy and infrastructure with evidence-based workforce strategies to increase access to oral health services for rural populations. We examine how and where best practices are employed across US states, the strength of the evidence on outcomes, and the policy factors that enable success in bringing access to oral health services for rural populations.

Dental therapists (DTs) are primary dental care practitioners that have been deployed in many countries around the world. There is increasingly strong evidence supporting the safety and effectiveness of DTs, including their ability to promote community-based services and enhance oral health equity. Following the approval of education standards by the Commission on Dental Accreditation (CODA) in 2015, dental therapy gained increasing acceptance in the United States with states and tribal nations authorizing dental therapy. Dental therapy is rapidly becoming an established, growing profession in the US, although there is variation in legal authority across states and jurisdictions. This interactive infographic describes the status of dental therapy in the US and details the specific requirements in state laws and regulations that define dental therapy practice.

This interactive infographic describes specific requirements in state laws and regulation that impact the ability of dental hygienists to apply silver diamine fluoride (SDF).

The objective of this study was to explore how home care workers and the agencies that employ them interact with their state’s nurse practice act in the provision of care.

A key component of addressing ongoing elder abuse and the likelihood that its prevalence will increase as a result of a rapidly growing older adult population is the network of local and state agencies that form the country’s system of community Adult Protective Services (APS). At the earliest stage in the development of APS, several key issues were identified that continue to be relevant today. These include the need for well-trained APS personnel and the need to offer competitive salaries to attract and retain a high quality workforce, the importance of effective inter-agency coordination and cooperation among teams of interdisciplinary professionals, and federal financial and administrative support to ensure effective service delivery. This report summarizes the current state of affairs with respect to these issues, highlights efforts being made to address them, and recommends actions that would further support these efforts to improve community APS in the US.

The aim of this study was to examine the relationship of nurse staffing in California nursing homes and compare homes with and without COVID-19 residents.

Over 1.5 million new jobs for medical assistants, nursing aides, and home care aides need to be filled by 2026. Many of these providers will work in the long-term services and supports (LTSS) sector. This article discusses a study that utilized 16 years of data from the American Time Use Survey, which examines the financial vulnerability of high-skill and low-skill LTSS workers in comparison with other health care workers, and provides insight into their well-being by measuring time spent on work and non-work activities.

Personal care, home health, and nursing aides provide the majority of care to chronically ill and disabled older adults. This workforce faces challenging working conditions, resulting in high turnover and workforce instability that affect the quality of care for older adults. This study adds to the literature by examining racial and ethnic disparities in well-being among direct care workers, workers who are especially vulnerable to struggles at work and at home. This article examines financial security, work–life balance, and quality of life of Black, Hispanic, and workers of other race/ethnicity compared to White workers among the direct care workforce.

The delivery of medical care services in U.S. nursing homes (NHs) is dependent on a workforce that comprises physicians, nurse practitioners, and physician assistants. Each of these disciplines operates under a unique regulatory framework while adhering to common standards of care. NH provider characteristics and their roles in NH care can illuminate potential links to clinical outcomes and overall quality of care with important policy and cost implications. This perspective provides an overview of what is currently known about medical provider practice in NH and organizational models of practice. Links to quality, both conceptual and established, are presented as is a research and policy agenda that addresses the gaps in the evidence base within the context of our ever-changing health care landscape.

This report aims to determine the variation in behavioral health provider reimbursement rates per unit of service under fee-for-service (FFS) and MCO in states with Medicaid waivers for behavioral health, and in non-waiver states, determine if there are fewer behavioral health providers available in Medicaid FFS and MCO programs.

By working with state rural health and health workforce offices, this study determined the current recruitment practices to both build the provider pipeline in a given state and incentivize practice in areas suffering from maldistribution of workers. This brief describes state incentives for behavioral health provider recruitment, particularly in rural areas.