Healthcare Workforce

The mix and distribution of health care providers. LDI Senior Fellows study how to transform health care delivery through the optimal training, mix, and placement of health care professionals and allied health workers to deliver cost-effective care.

Tracking a Trend: Nursing Home Specialists

Apr. 12, 2019

The world of health care is divided into many areas of specialization. At one point or another, we may have seen a podiatrist for a foot problem or a dermatologist for skin issues. Not all of us realize that – in addition to specializing in, say, the lungs – clinicians can devote their practice to providing general care to patients in a specific setting. For example, some physicians, called ‘hospitalists,’ see all or most of their patients in a hospital environment.

Assessing First Visits By Physicians To Medicare Patients Discharged To Skilled Nursing Facilities

Research Brief
Kira Rysinka, MD
Apr. 1, 2019

In this study of postacute care, more than 10% of Medicare skilled nursing facility (SNF) stays included no visit from
a physician or advanced practitioner. Of stays with visits, about half of initial assessments occurred within a day of
admission, and nearly 80% occurred within four days. Patients who did not receive a visit from a physician or advanced
practitioner were nearly twice as likely to be readmitted to a hospital (28%) or to die (14%) within 30 days of SNF
admission than patients who had an initial visit.

Do Longer Shifts Affect Residents’ Sleep or Patient Safety?

Mar. 25, 2019

Do residents need more sleep? Two new studies in the New England Journal of Medicine compare the effects of standard versus flexible duty-hours on residents’ sleep and patient safety.

The iCOMPARE trial randomized 63 internal medicine residency programs, consisting of over 5,000 trainees, to standard duty-hour policies or flexible policies. All programs were held to an 80-hour work week, but flexible policies had no limits on shift lengths and did not mandate time off between shifts.

Association of Nurse Engagement and Nurse Staffing on Patient Safety

Feb. 14, 2019

J. Brooks Carthon, Linda Hatfield, Colin Plover, Andrew Dierkes, Lawrence Davis, Taylor Hedgeland, Anne Sanders, Frank Visco, Sara Holland, Jim Ballinghoff, Mary Del Guidice, Linda Aiken

ABSTRACT [from journal]

Background: Nurse engagement is a modifiable element of the work environment and has shown promise as a potential safety intervention.

Purpose: Our study examined the relationship between the level of engagement, staffing, and assessments of patient safety among nurses working in hospital settings.

Methods: A secondary analysis of linked cross-sectional data was conducted using survey data of 26 960 nurses across 599 hospitals in 4 states. Logistic regression models were used to examine the...

Improving End of Life Care – Ask the Nurses

Dec. 7, 2018

Everyone wants a dignified death – yet few actually experience one. Despite preferring to remain at home, most older adults spend their final days in hospitals, where they often undergo medical care that neither improves survival, quality of life, nor satisfaction and is often incongruent with their wishes and goals. A new study in the Journal of the American Geriatrics Society describes these problems in end of life care in nearly 500 U.S.

Cost Impact of The Transitional Care Model for Hospitalized Cognitively Impaired Older Adults

Research Brief
Nov. 19, 2018

Using advanced practice nurses to support high risk patients and their families to transition from hospital to home can reduce postacute care use and costs. A study comparing three evidence-based care management interventions for a population of hospitalized older adults with cognitive impairment found that the Transitional Care Model, which relies on advanced practice nurses to deliver services from hospital to home, was associated with lower postacute care costs when compared to two “hospital only” interventions.

Nurses' and Patients' Appraisals Show Patient Safety in Hospitals Remains a Concern

Research Brief
Nov. 5, 2018

In the report To Err is Human (1999), the National Academy of Medicine called for national action to improve patient safety in hospitals. The report concluded that improving nurse work environments—assuring adequate nurse staffing and supporting nurses’ ability to care for patients—was critical to these efforts. Two decades later, have nurse work environments improved, and has that had a noticeable impact on patient safety? To find out, a research team led by LDI Senior Fellow Linda Aiken, PhD, RN surveyed more than 800,000 patients and 53,000 nurses in 535 hospitals in 2005, and again in 2016.

Reimagining Care to Support Families and Workers

Nov. 5, 2018

At some point in our lives, each of us will need care, or be asked to provide or arrange care for a loved one. Historically, we have relied on unpaid or poorly paid labor, largely delivered by women and minorities, to fill these needs; however, current arrangements are neither fair nor feasible.

A Policy Analysis of Legally Required Supervision of Nurse Practitioners and Other Health Professionals

Sep. 5, 2018

Ashley Z. Ritter, Kathryn H. Bowles, Ann L. O'Sullivan, ...

Abstract [from journal]

The use of legally required supervision occurs across health professionals who provide similar services. Legally required supervision has the potential to disrupt the production of high-quality, cost-efficient, accessible health services across disciplines.

This paper examines the effects of nurse practitioner collaborative practice agreements and similar

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