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.

Pennsylvania Scope of Practice Policy Brief

Jan. 28, 2021

Pennsylvania is one of 28 states that has not expanded the scope of practice in its licensure laws for certified registered nurse practitioners (NPs), who must maintain formal collaborative agreements with physicians to practice. For many years, proposals to update licensure and adapt it to make it more compatible with current models of collaborative care could not overcome legislative logjams. Recognizing an opportunity to break the logjam, the University of Pennsylvania held a virtual workshop on November 20, 2020, bringing together researchers, health professionals, and consumers to chart a new path forward. This policy brief summarizes their recommendations to update scope of practice regulation to better meet the primary care needs of Pennsylvanians.

Bringing Gynecologic Cancer Care Closer to Patients

Jan. 13, 2021

For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist.

Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons

Research Brief
Dec. 10, 2020

Despite concerns that duty hour reform might adversely affect the performance of new surgeons, this national study found no impact on patient outcomes, including 30-day mortality rates, failure-to-rescue, length of stay, and use of intensive care units. These findings should allay fears that reduced work hours during residency would produce surgeons less prepared for practice than their more experienced colleagues.

Evaluation of Hospital Nurse-to-Patient Staffing Ratios and Sepsis Bundles on Patient Outcomes

Dec. 9, 2020

Karen B. Lasater, Douglas M. Sloane, Matthew D. McHugh, Jeannie P. Cimiotti, Kathryn A. Riman, Brendan Martin, Maryann Alexander, Linda H. Aiken

Abstract [from journal]

Background: Despite nurses’ responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis.

Methods: Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/...

Expanding Therapeutic Jurisprudence Across the Federal Judiciary

Nov. 24, 2020

Benjamin A. Barsky, Heather Ellis Cucolo, Dominic A. Sisti

Abstract [from journal]

A patchwork of drug courts and other problem-solving courts currently exists to divert individuals with mental illness and substance use disorders away from the criminal justice system. We call for a broader implementation of problem-solving courts, particularly at the federal level, that would operate according to the principles of therapeutic jurisprudence (i.e., a framework that aims to maximize the health benefits of judicial and legislative policies and practices). Expanding federal problem-solving courts will better serve


Alzheimer’s Dementia After Exposure to Anesthesia and Surgery in the Elderly: A Matched Natural Experiment Using Appendicitis

Jeffrey H. Silber, MD, PhD
Nov. 17, 2020

Jeffrey H. SilberPaul R. Rosenbaum, Joseph G. Reiter, Alexander S. Hill, Siddharth Jain, David A. Wolk, Dylan S. Small, Sean Hashemi, Bijan A. Niknam, Mark D. NeumanLee A. Fleisher, Roderic...

Abstract [from journal]

Objective: To determine if surgery and anesthesia in the elderly may promote Alzheimer's Disease and Related Dementias (ADRD).

Background: There is a substantial conflicting literature concerning the hypothesis that surgery and anesthesia promotes ADRD. Much of the literature is confounded by indications for surgery or has small sample size. This study examines elderly patients with appendicitis, a common condition that strikes mostly at random after controlling for some known associations.


Using Nationally Representative Percentiles to Interpret PROMIS Pediatric Measures

Christopher B. Forrest, MD, PhD
Nov. 17, 2020

Adam C. Carle, Katherine B. Bevans, Carole A. Tucker, Christopher B. Forrest 

Abstract [from journal]

Purpose: This study's aim was to use a representative sample of the US pediatric population to estimate percentiles for several PROMIS pediatric measures: Anger, Anxiety, Depressive Symptoms, Family Relationships, Fatigue, Global Health, Life Satisfaction, Meaning and Purpose, Pain Behavior, Pain Interference, Physical Activity, Physical Function Mobility, Physical Function Upper Extremity, Physical Stress Experiences, Positive Affect, Psychological Stress Experiences, Sleep Disturbance, Sleep Impairment, and Peer


Are There Enough Experienced Physicians to Treat Patients Hospitalized With COVID?

Research Brief
Kira Rysinka, MD
Nov. 16, 2020

In this national study of 438,895 physicians, 45% provided care to hospitalized patients and 7% provided critical care. At the high estimate of patients requiring hospitalization at the projected peak of the pandemic, 18 states and Washington, DC would have patient to physician ratios greater than 15:1 (a level associated with poor outcomes among hospitalized patients). There was considerable geographic variation in the availability of physicians: 41% of hospital service areas did not have a physician with critical care experience.

Expectations and Experiences With Physician Care Among Patients Receiving Post-Acute Care in U.S. Skilled Nursing Facilities

Kira Rysinka, MD
Nov. 10, 2020

Kira L. Ryskina, Kierra A. Foley, Jason H. Karlawish, Joshua D. Uy, Briana Lott, Erica Goldberg, Nancy A. Hodgson

Abstract [from journal]

Background: In the US, post-acute care in skilled nursing facilities (SNFs) is common and outcomes vary greatly across facilities. Little is known about the expectations of patients and their caregivers about physician care during the hospital to SNF transition. Our objectives were to (1) describe the experiences and expectations of patients and their caregivers with SNF physicians in SNFs, and (2) identify patterns that differed between patients with vs. without cognitive impairment.



When A Family Seeks To Exclude Residents From Their Child's Care

Nov. 5, 2020

Emily A. Largent, Ross Newman, Christopher E. Gaw, John D. Lantos

Abstract [from journal]

A primary goal of our medical education system is to produce physicians qualified to promote health, prevent and treat disease, and relieve suffering. Although some aspects of the practice of medicine can be learned in classrooms, from textbooks, or with simulators, other aspects can only be learned through the direct provision of patient care. Residency programs therefore offer essential educational experiences that support residents' acquisition of knowledge, skills, and professional judgment through the assumption of progressive


Assessment of Perceptions of Professionalism Among Faculty, Trainees, Staff, and Students in a Large University-Based Health System

Nov. 2, 2020

Dominique A. Alexis, Matthew D. Kearney, J. Corey Williams, Chang Xu, Eve J. Higginbotham, Jaya Aysola

Abstract [from journal]

Importance: With a renewed focus on medical professionalism, an opportunity exists to better define its standards and application to meet the needs of an increasingly diverse workforce given the important association between interprofessional behavior and patient care.

Objective: To examine the context of how professionalism is operationalized and perceived in diverse health care work and learning environments.

Design, setting, and participants: A qualitative mixed-