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.

Networks in ACA Marketplaces are Narrower for Mental Health Care Than for Primary Care

Research Brief
Sep. 5, 2017

In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans.

Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study

Aug. 28, 2017

Jane E. Ball, Luk Bruyneel, Linda H. Aiken, Walter Sermeus, Douglas M. Sloane, Anne Marie Rafferty, Rikard Lindqvist, Carol Tishelman, Peter Griffiths, RN4CAST Consortium

In International Journal of Nursing Studies, Jane Ball and colleagues, including Linda Aiken, examine if missed nursing care explains the observed association between nurse staffing levels and mortality. Previous research has shown that higher postoperative mortality rates are associated with lower nurse staffing levels. When nurse staffing levels are lower, there is a higher incidence of necessary but missed nursing care. The authors collected data from 422,730 patients from 300 general acute hospitals, and administered surveys to 26,516 registered nurses to understand staffing...

Community Health Worker Support For Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial

Research Brief
Aug. 21, 2017

Community health worker interventions hold promise for improving outcomes of low-income patients with multiple chronic diseases.

Development and Validation of the Primary Care Team Dynamics Survey

Jul. 19, 2017

Hummy Song, Alyna T. Chien, Josephine Fisher, Julia Martin, Antoinette S. Peters, Karen Hacker, Meredith B. Rosenthal, Sara J. Singer

In Health Services Research, Hummy Song and colleagues develop and validate a survey instrument designed to measure team dynamics in primary care. The authors study 1,080 physician and non-physician health care professionals at 18 primary care practices participating in a learning collaborative to improve team-based care. They administer a cross-sectional survey addressing team dynamics, and assessed reliability and discriminant validity of survey factors, as well as the overall survey’s goodness-of-fit. They find that this model demonstrated adequate fit, scale reliability, and...

Components of Comprehensive and Effective Transitional Care

Jul. 10, 2017

Mary D. Naylor, Elizabeth C. Shaid, Deborah Carpenter, Brianna Gass, Carol Levine, Jing Li, Ann Malley, Kathleen Mccauley, Huong Q. Nguyen, Heather Watson, Jane Brock, Brian Mittman, Brian Jack, Suzanne Mitchell, Becky Callicoatte, John Schall, Mark V. Williams

In Journal of the American Geriatrics Society, Mary Naylor and colleagues identify components of the Transitional Care model that provide the desired patient and caregiver outcomes. For decades, the Transitional Care (TC) model has worked to prevent re-hospitalizations and their associated costs, however little is known about the specific factors that make TC effective. The authors formed a workgroup to identify a preliminary set of components. The workgroup conducted focus groups and interviews with patients and caregivers, and created an advisory group comprised of patient and...

Nurses’ Perceptions of In-Hospital Versus Telephone Availability of an Intensivist at Night in an Intensive Care Unit

Jul. 10, 2017

Emily S. Stanton, Cary Hilbert, Stephanie Maillie, Jessica Dine, Scott D. Halpern, and Meeta Prasad Kerlin

In American Journal of Critical Care, Emily Stanton and colleagues, including Jessica Dine, Scott Halpern, and Meeta Prasad Kerlin, investigate nurses' perceptions about nighttime intensivist staffing. The authors conducted semi-structured interviews of 13 night-shift nurses in an academic medical intensive care unit to elicit perceptions of nighttime staffing with attending intensivists, versus residents with attending intensivists on call remotely. Eight themes emerged from these interviews: efficiency, communication, job place comfort, quality of patient care, procedures,...

Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care

Jul. 10, 2017

Linda H. Aiken, Douglas Sloane, Peter Griffiths, Anne Marie Rafferty, Luk Bruyneel, Matthew McHugh, Claudia B. Maier, Teresa Moreno-Casbas, Jane E. Ball, Dietmar Ausserhofer, Walter Sermeus

In BMJ Quality & Safety, Linda Aiken and colleagues, including Matthew McHugh examine the association of hospital nursing skill mix with patient mortality, patient ratings of care, and indicators of quality care among European hospitals. As policymakers around the world seek to reduce health spending, a popular target in Europe has been to transition from more professional nurses to fewer high-cost nurses supported by more lower-wage assistants. The authors analyzed how nursing skill mix affects indicators of quality patient care. The authors utilized cross-sectional patient...

Bringing Rounds Back to the Patient: A One-Year Evaluation of the Chiefs’ Service Model for Inpatient Teaching

Jul. 5, 2017

Nadia L. Bennett, Judd D. Flesch, Peter Cronholm, James B. Reilly, Jack Ende

In Academic Medicine, Nadia Bennett and colleagues, including Peter Cronholm and Jack Ende, evaluate the impact of a new approach to inpatient teaching on both patient care and resident education. This model, called the Chiefs’ Service (CS), is a structured approach to inpatient teaching rounds, and has five key elements: morning huddles, bedside rounds, diagnostic “time-outs”, day-of-discharge rounds, and postdischarge follow-up rounds. The authors conducted end-of-rotation evaluation questionnaires among 183 residents after the program’s first year, and compared residents’...

Training social work students to recognize later-life depression: Is standardized patient simulation effective?

Jul. 5, 2017

Zvi D. Gellis and Eunhae Grace Kim

In Gerontology & Geriatrics Education, Zvi Gellis and Eunhae Grace Kim assess the affect of an educational intervention on social work students' understanding of later-life depression. The authors note that, although social workers are the largest provider of mental health services in the nation, they receive little coursework or clinical training in late-life depression unless they are in a gerontology specialization. The authors developed and completed a Standardized Patient Simulation course with 104 students, and assessed whether the simulation improved student knowledge...

An Assessment of Global Oral Health Education in U.S Dental Schools

Jul. 5, 2017

Janet Sung and Joan I. Gluch

In Journal of Dental Education, Janet Sung and Joan Gluch assess how global health education is currently incorporated into pre-doctoral dental training in the U.S.  In 2015-2016, the authors surveyed 64 accredited U.S dental schools regarding their global health education and competencies, and received responses from 52 of those schools. Most dental school curricula covered social determinants of oral diseases and conditions, how to identify barriers to use of oral health services, and how to work with patients who have limited dental health literacy. But other key areas of...

Association of Provider Specialty and Multidisciplinary Care With Hepatocellular Carcinoma Treatment and Mortality

Jun. 28, 2017

Marina Serper, Tamar H. Taddei, Rajni Mehta, Kathryn D'Addeo, Feng Dei, Ayse Ayatman, Michelle Baytarian, Rena Fox, Kristel Hunt, David S. Goldberg, Adriana Valderrama

In Gastroenterology, Marina Serper and colleagues, including David Goldberg, assess how various health care system factors affect survival rates in hepatocellular carcinoma (HCC). These factors included uptake of historically underutilized curative therapies, access to a hepatologist, and presentation of the case to a multidisciplinary tumor board. The authors found that, while curative treatments of HCC increased survival rates, only 25% of newly diagnosed HCC patients received treatment intended to cure the disease. Additionally, those who received care from only...

Pages