Health Workforce Research e-Library

This article discusses dental hygiene scope of practice regulation and its impacts on oral health outcomes in state populations.

This study examines the trends in H/L dentists’ education and pathways to practice, analyzes practice patterns of H/L dentists by pathway, and describes the licensure and educational environment for foreign-trained dentists (FTDs), with a focus on opportunities to enhance workforce diversity and improve access to care for both underserved and H/L populations.

Trends in consolidation of dental practices and the business, organizational, and workforce models that enable these large practices have not been well researched. One objective of this study was to identify and analyze data describing these organizations, another was to conduct interviews with DSOs to understand the qualitative aspects and benefits of management alliances. This mixed-methods study was exploratory in nature.

Legal scope of practice (SOP) for dental hygienists differs by state. Research suggests that broader SOP laws at the state level can improve oral health outcomes. This infographic illustrates allowable tasks for dental hygienists by each state in the US, to help planners and policymakers understand the differences in legal scope of practice across states, particularly in public health settings.

There are currently too few geriatricians to meet the needs of the geriatric patient population. Therefore, a better understanding of the current roles of geriatricians, how those roles are changing, and how they collaborate with other health professionals is needed. This report describes a literature review that makes up the first stage of a study designed to examine the roles of geriatricians in healthcare teams across a variety of care settings to identify potential solutions to workforce shortages.

This study is intended to inform educators, employers, and policymakers about employer demand for PAs and NPs in the care of older and disabled populations and to guide federal investments in workforce development and planning for these high-growth populations.

Remote monitoring programs are often used to care for patients with chronic conditions and other long-term care needs as such technologies have the potential to reduce costs and improve the accountability of care delivery for these patients. This report describes a study which used a literature review and key informant interviews to examine what factors and strategies are associated with effective remote monitoring programs.

This study explores care coordination staffing in four health systems participating in new payment models, including Medicaid payment reform and Accountable Care Organizations.

This video presentation describes the dementia care specialist workforce in California.

The Affordable Care Act and the Mental Health Parity and Addiction Equity Act have increased demand for behavioral health workers and changed the way policy makers regulate behavioral health scope of practice (SOP) to benefit patient care. Expansion of occupational SOPs is a potential solution for addressing the demand for increased diversity of services. This report describes a study that collected data on SOPs for 10 different behavioral health occupations across all fifty states to compare provider authority and potential barriers to changes in SOPs.

Given the changes to the healthcare environment and this sizable investment, the research team at the Behavioral Health Workforce Research Center investigated how the ACA impacted the behavioral health workforce through the NHSC.

This project identified the varying degrees to which states authorize and reimburse telehealth and how that is related to scope of practice (SOP) regulations within a state.

The use of telehealth has expanded considerably in the 21st century as new technologies have expanded the ways in which patients are able to receive care from their providers. Behavioral health has been no exception to this trend, yet state regulations and scopes of practice to regulate behavioral telehealth are often insufficient and lack uniformity. This lack of clarity can lead to behavioral health providers not providing certain beneficial services for fear of committing license violations or not getting reimbursed. This report describes a study that analyzed state regulations and scopes of practice for 10 different behavioral health professions in 2016 to better understand which telebehavioral health services are authorized and how they are reimbursed by state Medicaid programs.

There is broad consensus that the ubiquity of opioid use disorder (OUD) in the United States constitutes an epidemic. Medication-assisted treatment (MAT), which utilizes medications alongside psychosocial treatments and services, has been shown to be highly effective for treating OUD, but implementation is low. This brief describes a study that utilized geospatial analysis to examine the association between the number of MAT providers and deaths due to OUD, as well as an online survey of behavioral health providers in ten states and virtual focus groups to investigate provider roles and barriers to MAT implementation.

The supply of behavioral health providers has struggled in recent years to keep up with increased access to and demand for services. A Minimum Data Set (MDS) is a potential data collection solution for improved workforce planning needed to address the shortage. However, more information is needed about the efficacy and feasibility of using MDS to collect information about behavioral health providers. This report describes 3 studies conducted for the purpose of testing 3 different kinds of MDS implementation methods, 1 for each of 3 different specialties of behavioral health providers (a mix of behavioral health occupations, social workers, and marriage and family therapists), to collect workforce data and to evaluate respondents’ willingness to disclose certain kinds of information to certain groups.

Studies show that a diverse health workforce is important for ensuring patient satisfaction and meeting the needs of underserved populations. However, white providers continue to be overrepresented in the behavioral health workforce compared to the populations they serve. Developing a diverse behavioral health workforce can be challenging due to recruitment and retention issues as well as other factors. This report describes a study that utilized a survey of underrepresented minority behavioral health providers to identify barriers to recruiting and retaining a diverse behavioral health workforce.

As the number of behavioral health professionals increases to meet the increasing demand, professional competency statements are important for organizations to ensure that their behavioral health professionals are able to meet a wide variety of support needs. However, these competency statements are not standardized across organizations and their content has not been comprehensively studied. This report describes a comprehensive analysis of behavioral health competency statements to investigate gaps and overlaps in competency statements across organizations and professions, examine the extent to which statements cover a full range of needed skills, and identify potential barriers to change.

Professional and legal scopes of practice (SOPs) guide the roles and responsibilities for these workers, however, there is some question as to whether SOPs accurately reflect their increasing daily responsibilities. This study included a survey of 108 NAADAC Level I Addiction Counselors, Community Health Workers, Peer Recovery Specialists, Case Managers, and Health Navigators in 10 states to investigate the alignment of job responsibilities with SOPs.

First, through partnership with the American Association for Marriage and Family Therapy (AAMFT), a membership organization for MFTs, this pilot study was developed to test the effectiveness of the MDS as a data collection tool for this segment of the behavioral health workforce. Second, we sought to understand the feasibility of reaching a survey population through AAMFT to obtain worker data.

Social workers comprise the largest segment of the behavioral health workforce. As demand for behavioral health services continues to increase, more information about social workers and the development of better data collection methods will be needed. This brief describes a study that utilized a minimum data set (MDS) designed to collect data on social workers to test the effectiveness of the dataset and to gauge the feasibility of using this method to collect data from a variety of different sources.

Many organizations have called for increased transparency and accountability for public funds invested in graduate medical education (GME) but federal efforts have stalled. In the absence of federal GME reform, states are increasingly exploring ways to leverage Medicaid funds to shape the size, specialty mix, and geographic distribution of their workforce. This policy brief investigates how states are reforming Medicaid GME with the goal of identifying innovations and challenges at the state level.

There is a distinct need for a flexible ambulatory care workforce that possesses core clinical and practice management competencies, but is also nimble in its ability to adapt to new innovations. This requires programs that can facilitate continuous learning of new skill sets needed to keep pace with emerging federal and state policies that are shaping healthcare and the health care workforce of the future. This research brief assesses the role practice facilitators have played in helping rural practices adopt health information technology (HIT) systems such as electronic medical records (EMR).

This study outlined a methodology for allocating graduate medical education (GME) training positions based on data from a workforce projection model.

The objective of this study was to understand factors affecting specialty heterogeneity in physician migration.

Accountable care communities form as health care entities partner with communities to more fully address population health. This partnership requires an adaptable, boundary spanning, and diverse workforce, as well as flexible regulatory and governing structures that adapt to changing payment models, task shifting, and new roles in health care.

While federal graduate medical education (GME) reform efforts have stalled, states have become increasingly active in determining ways to target Medicaid and state appropriations toward producing the workforce needed to meet population health needs. However, states have voiced the need for better data to determine where to target these funds and evaluate their return on investment (ROI). This policy brief examines the DocFlows web app developed by the Carolina Health Workforce, which allows users to query, download, and share maps/graphs of interstate moves by residents and actively practicing physicians in 35 specialties.

New healthcare delivery and payment models demand that primary care physicians (PCPs) deliver coordinated, integrated, team-based care to promote population health. Physical therapists (PTs) are part of this team-based care for the treatment of musculoskeletal, neurological, and other conditions seen in primary care. Limited evidence exists on the extent to which PCPs engage PTs in patient care. This policy brief outlines PCP referrals to PT, compares PCP referrals to other physicians, and identifies factors associated with referrals to PT. Findings include: 1) PCP referral to PT has declined while other physicians increase, 2) the possibility of under or over-referral to PT, and 3) age and physician characteristics reason as factors associated with PCP referral to PT.

Little is known about why LPNs transition to become an RN. Do they face personal barriers that support or prohibit transitions? Do academic programs and employers foster LPN-to-RN transitions? This transition could be a natural pathway for LPNs to gain greater autonomy and income, yet, data are not available to help us understand why LPNs might choose to advance their education or not, and whether support is needed from academic programs and health care systems to foster such a transition. Evidence is also needed to aid policymakers in developing and targeting incentives that support LPN-to-RN transitions to ensure an adequate overall supply of nurses in the future.

This study examines 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 registered nurse (RN) and licensed practical nurse (LPN) staffing.

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. This brief helps 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.

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. This report helps 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.

To begin to understand the extent to which the spread of telehealth has included primary care settings in HPSAs, this study explores whether and to what extent NHSC-approved sites, which are by definition located in HPSAs, are utilizing telehealth.

An Accountable Care Organization (ACO) refers to a group of physician and other healthcare providers and suppliers of services, notably hospitals that form a collaborative network in order to reduce costs while improving quality of inpatient care, and thereby meet contractual requirements and targets set by third-party payers. Although the number of ACOs nationwide has been growing rapidly since they were first recognized in Medicare regulations in 2011, little is known about the way delivery systems adjusted to the change, and specifically about how those changes affect the health care workforce in hospitals). The purpose of this report is to provide a descriptive analysis of workforce differences between hospitals that participate in an ACO and those that do not.

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 nonphysician-led PCMHs (Cassidy, 2010). Currently there are almost 300 nurse practitioner (NP)-led PCMHs recognized by the national accreditation body such as the National Committee for Quality Assurance (NCQA). However, little is known about current status of NP-led PCMHs. The overall goal of this study is to understand whether and the extent to which NP-led PCMHs differ from other PCMHs that are primarily run by physicians.

New payment incentives are encouraging an increasing number of primary care practices to take the steps necessary to be certified as patient-centered medical homes (PCMH). Despite this growing interest in team-based care, little is known about how leaders of primary care facilities decide on the types of providers and support staff to hire, and how they organize their roles to best serve patients. This article explores perceptions of CEOs of community health centers (CHCs) with a variety of staff configurations, and identifies a typology of factors they consider when deciding how to staff their centers.

As implementation of the US 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 is to explore the dynamic processes and interactions by which workforce planning and development (WFPD) is evolving in this new environment.

Data visualization can be a powerful tool for detecting patterns in data and for sharing data accessibly with a wide audience. This webinar introduces the basics of data visualization with an eye towards practice, including simple tips and tricks to help create effective visualizations. The webinar also discusses the major tools available to create static or web-based interactive visualizations.

HRSA’s web-based nursing model is a powerful new tool for health workforce planners and researchers to better understand future nursing supply and demand. The new web-based application allows states to examine the future supply of RNs and LPNs by practice setting in relation to demand for their services, and to explore alternative scenarios by modifying key parameters such as the graduation and retirement rate. This webinar discusses HRSA’s new model and demonstrates the user interface.

The local supply of physicians in any community, especially smaller and rural communities, depends on a flow of physicians into those communities from the places where they train or from more populous places that may have more than enough physicians to meet population needs. The factors that influence whether a physician will move from one place to another depends on their personal characteristics, the places from and to which they move, and the programs that support or inhibit those moves. In this webinar, Tom Ricketts describes his work on physician diffusion, and helps explain its effects and policy implications on underserved areas.

Learn about the issues involved in developing a state health workforce monitoring system and identify potential strategies to engage licensing bodies in collecting health workforce data.

Whether your state is just beginning a data system or already has one established, learn about common challenges facing states interested in using health workforce data to inform state policy decisions.

Quality Improvement, as defined by the Health Resources and Services Administration (HRSA), consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. Rapid Cycle Quality Improvement (RCQI) is a simple yet powerful tool used to achieve improved outcomes by health care professionals and educators around the world. By allowing the application of several tests over time, the RCQI model can identify the most successful ideas: those that have the largest impact on the overall program outcomes. The RCQI Resource Guide is designed for HRSA grantees and explains in detail the Model for Improvement, how to compose an aim statement, how to measure changes, and provides relevant examples.

Project Officers (POs) at HRSA work with grantees who operate grant funded programs designed to support HRSA’s mission of improving health and achieving health equity. This webinar describes the steps in the process of conducting a policy analysis as well as strategies for disseminating results of these analyses. Understanding the process of policy analysis allows POs to work more effectively with grantees in assessing their effectiveness in achieving program goals and objectives. It also provides opportunities to assess the effectiveness of HRSA policies related to grantees.

There is a growing body of evidence documenting the relationship between physical and oral health, increasing interest in expanding access to basic oral health services, particularly for underserved populations. This webinar discusses key access barriers in oral health and describes findings from research studies conducted by the Oral Health Workforce Research Center that highlights innovative oral health service delivery models and workforce strategies aimed at increasing access to oral health services.

This webinar focuses on how HRSA Project Officers (POs) are working with grantees to implement Rapid Cycle Quality Improvement (RCQI) activities. It includes a discussion with a PO to understand what is going well in working with grantees and what obstacles tend to be encountered.

Developed for health workforce planners, policymakers, and researchers, this guide provides a better understanding of available health workforce data and how to use these data to conduct health workforce research. The guide covers a wide array of topics, including basic health workforce research terminology and methods and special challenges associated with conducting health workforce research. The guide also provides examples of research that aim to clarify key workforce-related concepts, methods, data interpretations, and policy challenges.

HWTAC is conducting an ongoing survey of states to learn more about their health workforce data collection and analysis efforts. This report describes findings to date from the 2016 survey, and includes information about data collection on health workforce supply and demand, and the educational pipeline in specific US states.

The 2016 edition of the Health Workforce Analysis Guide was developed by the Health Workforce Technical Assistance Center to provide an updated framework for health workforce planners, policymakers, and researchers interested in health workforce data and analysis. This webinar, the first of a 2-part series, provides an overview of the guide, with attention to the special challenges associated with conducting health workforce research.

Most states that collect health workforce supply data follow Minimum Data Set (MDS) guidelines on the questions they ask. However, some states collect additional data on their health workforce. This brief summarizes state health workforce data collection efforts that go beyond the MDS.

The 2016 edition of the Health Workforce Analysis Guide was developed by the Health Workforce Technical Assistance Center to provide an updated framework for health workforce planners, policymakers, and researchers interested in health workforce data and analysis. This webinar, the second in a 2-part series, provides an overview of secondary data sources available to health workforce researchers, highlights strengths and weaknesses and provides examples of how these data can be used.