Cecil G. Sheps Center for Health Services Research,
The University of North Carolina at Chapel Hill

February 2017
In this time of uncertainty about the future direction of health policy, we continue to be actively engaged in producing timely, objective and evidence-based research to inform policy. In this newsletter, we share some examples of our recent work, but invite you to visit our website http://www.shepscenter.unc.edu/programs-projects/workforce/ to learn more about the exciting projects underway in our Center. 
Carolina Health Workforce Research Center

Created in 2013, the CHWRC is one of six national Health Workforce Research Centers funded through cooperative agreements with the National Center for Health Workforce Analysis in the Bureau of Health Workforce in the Health Resources and Services Administration (HRSA). The mission of the CHWRC is to conduct and disseminate timely, policy-relevant research on the flexible use of healthcare workers to improve the quality and efficiency of health care.  

Feature: Medicaid GME
State-Based Approaches to Reforming Medicaid-Funded Graduate Medical Education
In the absence of federal Graduate Medical Education (GME) reform, states are increasingly exploring ways to leverage Medicaid funds to shape the size, specialty mix and geographic distribution of their workforce. We investigated how states are reforming Medicaid GME, with the goal of identifying innovations and challenges confronted at the state level. While there is broad interest in reforming GME, at present, more states are in the discussion phases of GME reform than in implementation phases. States called for more tracking of workforce outcomes, accountability, and transparency.

Erin Fraher presented t his study at the GME Initiative 2017 Summit in Albuquerque, NM on January 23. Look for her again at the 13th Annual AAMC Health Workforce Research Conference in Arlington, VA, May 3-5.
Authors: Erin Fraher, Julie Spero, Tom Bacon
Date: January 2017

New Carolina HWRC research briefs

The Role of Practice Facilitators in Meeting the HIT Needs of Rural Practices
This case study evaluated the skills, knowledge and effectiveness of practice facilitators in helping small, rural practices meet the requirements of meaningful use. We found that small, rural ambulatory care practices often lack resources to hire new staff or develop new skills in their existing staff to meet the demands of increasing use of health information technology. A model that builds upon the practice facilitator's experience in a healthcare profession and allows them to access continuous learning opportunities enables practices to retrain members of their existing workforce who can assist in training other providers and staff in small, rural practices.
Authors: Ann Lefebvre, Mary McCaskill, Kristin Reiter, Jason Mose, Erin Fraher, Warren Newton
Date: January 2017
Predicting Transitions in the Nursing Workforce: Professional Transitions from LPN-to-RN
This study examined the career trajectories of LPNs in North Carolina (NC) to identify predictors of LPN transitions to the RN role. The authors identified several characteristics of LPNs at the time of their licensure that were associated with a greater likelihood of a LPN to RN transition, including obtaining LPN licensure between 1996-2013 (and particularly between 1996 and 2004); obtaining licensure at younger ages; obtaining nursing education in the US; being employed in a hospital setting; being employed part-time; and specializing in medical/surgical nursing.
Authors: Cheryl Jones, Mark Toles, George Knafl, Anna Beeber
Date: November 2016
Read the brief. 
Determining the Role of the Nurse with a Doctor of Nursing Practice Degree
The role of the DNP outside of academic settings has not been explored and the value that DNP-prepared nurses bring to employment settings is largely unknown. This study surveyed DNP programs to identify the non-academic settings in which their graduates are employed and the roles DNP nurses fill in non-academic settings. We found that the role of the DNP-prepared nurse in non-academic settings is not clearly defined. These nurses appear to typically function as APNs in clinical care or as health care system leaders. However, the number of DNPs in these settings is still limited, making it challenging to clearly articulate the role of DNPs in various settings
Authors: Anna Beeber, Cheryl Jones, Carrie Palmer, Julee Waldrop, Mary Lynn
Date: September 2016
Social Work in Integrated Primary Care: A Systematic Review
Social workers are increasingly being deployed in integrated behavioral health and primary care settings to address social determinants of health that impede treatment uptake and adherence. We conducted a systematic review of RCTs in which social workers were one of the intervention agents providing integrated healthcare. We found that that social workers were serving as behavioral health specialists, care managers or in a referral role that connected patients with community-based services.
Authors: Mark Fraser, Brianna Lombardi, Shiyou Wu, Lisa de Saxe Zerden, Erica Richman, Erin Fraher
Date: September 2016
New Manuscripts and Presentations

HSR special issue on "The Evolving US Health Workforce", www.hsr.org

The latest issue of Health Services Research is a special issue funded by The George Washington University Health Workforce Institute
and HRSA that focuses on the evolving US Health Workforce. The issue includes two articles from the Carolina HWRC. The special issue of HSR can be accessed at no charge through the end of February 2017.
Just in time for the HWTAC's upcoming webinar on using nursing workforce data to inform state policy, Erin Fraher published an article on how North Carolina has used state licensure data to inform discussions about access to care, evaluate progress on increasing the number of baccalaureate nurses, monitor how well the ethnic and racial diversity in the nursing workforce match the population and investigate the educational and career trajectories of licensed practical nurses and registered nurses.
Fraher EP. " Workforce Planning in a Rapidly Changing Healthcare System." South Carolina Health Care Workforce Forum. Columbia, SC. February 13, 2017.  
Fraher EP, Spero J, Bacon T. "State-Based Approaches to Reforming Medicaid-Funded Graduate Medical Education." Graduate Medical Education Initiative Summit. Albuquerque, NM. January 23, 2017.

Fraser M, Lombardi B, Wu S, Zerden L, Richman E, Fraher E. "Social Work in Integrated Primary Care: A Systematic Review." Society for Social Work and Research 21st Annual Meeting. New Orleans, L. January 2017.
Gaul K, Arney K. "MDS: The Tool a Regulator Can Use." Federation of State Boards of Physical Therapy Annual Meeting. Columbus, OH. November 5, 2016.
Using Data to Inform Policy in North Carolina

New series of briefs highlights North Carolina's success in using data to shape state workforce policy decisions

The Program on Health Workforce Research and Policy released a series of four briefs on North Carolina's experience collecting and using health workforce data to answer policy questions, inform decisions, and determine the need for health professions education programs. The series demonstrates the value of investing in systems that gather routine health workforce data to inform policymaking. 
Health Workforce Data and Policy: A North Carolina Overview
Authors: Tom Bacon, Katie Gaul, Erin Fraher 
Date: February 2017   
Read the brief.  

Health Workforce Data and Policy: Reports Used to Inform Policy in North Carolina 
Authors: Katie Gaul, Tom Bacon, Erin Fraher
Date: February 2017  
Read the brief.
Health Workforce Data and Policy: How Stakeholders Use Data in North Carolina
Authors: Tom Bacon, Katie Gaul, Erin Fraher

Date: February 2017 
Read the brief.

Health Workforce Data and Policy: Using Data to Evaluate the Need for New Educational Programs
Authors: Tom Bacon, Katie Gaul, Erin Fraher

Date: February 2017 
Read the brief.
Erin Fraher appointed to COGME
Erin Fraher was appointed to the Council on Graduate Medical Education (COGME), which provides advice and recommendations to the HHS Secretary and Congress on issues regarding physician supply, distribution, shortages, education and financing.
Tom Ricketts featured on local, national news
In addition to being active on Twitter (@ThomasCRicketts), Tom Ricketts has been featured recently in a discussion on health insurance exchanges and the US health care system on our local news station, and was quoted in an article in Politico (1/31/17) discussing the effect of the immigration and travel ban on foreign-born physicians training and practicing in the US.  
Carolina Seminar on Health Workforce Research and Policy
Josh Dobson, Graig Meyer and Julie Spero at the December 6 seminar.
With funding from Carolina Seminars at UNC-Chapel Hill, the Program hosts six seminars per academic year, which cover a range of topics relating to health workforce research and policy.

Recent seminars included a discussion in December with NC House Representatives Josh Dobson and Graig Meyer about the role of evidence in policymaking and how researchers can better communicate with legislators. In January, Chris Collins, the former director of the North Carolina Office of Rural Health, and Warren Newton, director of the NC AHEC Program, spoke about a pilot method for assessing state level GME workforce outcomes and implementing pay for performance for publicly funded GME programs.

Upcoming seminars:
February 21, 2017, 1:00-2:30 pm
Lew Lampiris, UNC School of Dentistry, and
Rumay Alexander, UNC School of Nursing and UNC-CH Chief Diversity Officer
Do Poverty Simulations Change How Dental and Nursing Students Understand Patients?

May 1, 2017, TBD
Des Gorman, Executive Chair, Health Workforce New Zealand; and Professor of Medicine and Associate Dean, Faculty of Medical and Health Sciences, University of Auckland. 

Emily Tierney part of third place team in national case competition
Emily Tierney, a Graduate Research Assistant with the Program, has been a key team member on our Physicians Foundation FutureDocs Forecasting Tool. In October, she and two other MHA students from the Department of Health Policy and Management at the Gillings School of Global Public Health, placed third in the annual Everett V. Fox Student Case Analysis and Presentation Competition, hosted by the National Association of Health Services Executives (NAHSE). Congratulations, Emily! Read the full story.

Erin Fraher appointed new Deputy Director for Policy at the Sheps Center
Erin has joined the Sheps Center leadership team as the Deputy Director for Policy. She will help the Center and investigators better connect their work to policy and develop ways to more effectively communicate and engage with policy stakeholders.
Read the announcement.

Growing the next generation of health workforce researchers
A key part of our Program is to train and mentor the next generation of health workforce researchers and policy analysts. Our team takes this seriously, and produced three brand new people in 2016. Congratulations to Julie Spero, Erica Richman, and Evan Galloway on the new additions to their families!
Share the FutureDocs Forecasting Tool on social media
We have added the ability to share graphics from The FutureDocs Forecasting Tool on social media, and we will soon have a Twitter account dedicated to the model. We invite you to create custom maps, charts and population pyramids, and share them with the world. Let's get the conversation started.

The Program on Health Workforce Research and Policy is now on social media
Follow us on Twitter @UNC-PHWRP and find us on Facebook at https://www.facebook.com/uncworkforce.
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The Program on Health Workforce Research and Policy is now on Twitter and Facebook.