The rapidly changing U.S. health care system and other forces continue to create a tremendous demand for an innovative and flexible health work force. Yet there are concerns that the United States does not and will not have the workforce it needs to meet this demand without significant changes. New research published this month in a special issue of the journal Health Services Research (HSR) focuses on some of the novel ways that health care workers can be trained and deployed to improve the delivery, quality and cost of U.S. health care.
Four of the 9 original research articles were authored by researchers at the George Washington University Health Workforce Institute (GWHWI), which together with the Health Resources & Services Administration (HRSA) funded the special issue, "The Evolving U.S. Health Workforce."
"A key driver of the increased need for healthcare has been, and will continue to be, the aging population," says Patricia Pittman, PhD, co-director of the GWHWI and an associate professor of health policy and management at Milken Institute School of Public Health at the George Washington University (GW). "In this special issue of HSR researchers demonstrate that the evolving U.S. health workforce is central to the ongoing search for ways to ensure access and quality of care, especially in rural and underserved communities."
The articles in this special issue of HSR touch on four themes:
The Changing Role of Providers: A team led by GW's Mary-Beth Malcarney finds that more and more hospitals and health systems are hiring community health workers. These health workers previously had been primarily employed by community based organizations. The new study says such workers often need new skills to go along with the shift. Researchers from the University of California-San Francisco document the expanded role of medical assistants and describe on the job training and career advancement programs that could be adopted by more health systems.
The Changing Mix of Providers: Two additional GW teams explore changes in skill mix for health care professionals. Bianca Frogner and her colleagues assess the effects of electronic health record (EHR) adoption on staffing patterns in community health centers and find greater variation in the mix of providers in centers that have EHRs. Suhui Li and co-authors examine trends in nursing and support staffing levels over time, and find that while nursing is holding steady there is a slight decline in support staff hours. While this could increase nurse workloads, this study does not find evidence of job substitution.
Access and Quality of Care: GW's Ellen Kurtzman and colleagues evaluate the effect of nurse practitioner scope of practice laws on the ability to deliver high quality care, and find that despite variations in laws, quality outcomes appear to be similar across states. Researchers from HRSA examine access to care for veterans and find that 24 percent of veterans live in provider shortage areas.
Advances in Methods: A second HRSA team describes advances in the new microsimulation model used by this agency to project the primary care workforce supply and demand. University of North Carolina (UNC) Chapel Hill researchers offer an alternative approach for allocating General Medical Education (GME) training positions by specialty and location based on workforce projections. Lastly, another research team at UNC identifies variables driving physician relocation, and shows how different specialties may be responsive to different factors.
Access reports at: http://onlinelibrary.wiley.com/doi/10.1111/hesr.2017.52.issue-S1/issuetoc
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