Program on Health Professions and Primary Care

Projects

Current Projects

• North Carolina Health Professions Data System more info... – One of the most comprehensive and few continuously maintained state-level data systems available to track the supply and distribution of health professionals in the nation, this up-to-date inventory of all licensed health professionals in the State has been used continuously for the past 29 years for planning and evaluation of health professions distribution. Each year, the Sheps Center has produced an annual publication entitled A Special Report on Health Care Resources in North Carolina: North Carolina Health Professions Data Book. In recent years a companion publication, Health Professions Supply by County Pocket Guide, has been released in tandem with the annual databook. These publications are widely used by state policymakers, researchers, media, and professionals in the health care industry as the official source of health professions statistics in North Carolina.

  Project Director: Erin P. Fraher, M.P.P.

  Funding Source: NC Area Health Education Centers Program and UNC-CH Office of the Provost (Health Affairs)

  Total Program Period: 10/74 – on-going
  
  

• Access to Pediatric Subspecialty Care in the United States – The specific aims of this project are to: 1) depict the practice location of pediatric and adult subspecialists; 2) explore the relationship between county characteristics and access to pediatric subspecialty care; 3) ascertain the extent to which adult subspecialists expand access to care for children with rheumatic diseases; 4) describe the practice patterns of subspecialists, their comfort with treating a variety of pediatric conditions, and the practice, provider, and market characteristics that influence their decisions to treat pediatric patients; and 5) determine the independent effects of selected training, personal, and practice characteristics on the likelihood that an adult subspecialist treats pediatric patients. In addition, two pilot studies are being conducted that explore the role of general pediatricians in treating children with rheumatic conditions and compare care received across physician management types for children with juvenile rheumatoid arthritis.

  Principal Investigator: Michelle L. Mayer, R.N., M.P.H., Ph.D.

  Funding Source: Agency for Healthcare Research and Quality (K02 Award)

  Total Project Period: 09/03 – 08/07
  
  

• Development of a New Methodology for Mental Health Professional Shortage Designation – The purpose of this project is to develop a new methodology for designation of mental health professional shortage areas (MHPSAs) throughout the United States. The new methodology will be based on the proposed new methodology that was developed for primary care with criteria specific to mental health. The goal is to improve the way that underserved areas and populations are designated as MHPSAs by incorporating current measures of mental health and access barriers.

  Principal Investigator: Joseph P. Morrissey, Ph.D.

  Funding Source: Health Resources and Services Administration (HRSA)

  Total Project Period: 09/05 – 08/07
  
  

• Study of Primary Care and Specialty Supply – The study of the primary care and specialty workforce in North Carolina is a collaborative effort of the NC Institute of Medicine, NC AHEC program, and the Sheps Center’s Southeast Regional Workforce Center, described under the Program on Primary Care and the Health Professions. Current data from the NC Health Professional Data System indicate that physician growth is no longer keeping pace with the population growth in North Carolina. The goal of this study is to identify likely provider shortages, both in terms of provider specialty (e.g., OB-GYN, surgeons, psychiatrists, geriatricians, pediatric subspecialists, primary care), or areas of the state experiencing persistent shortages, and to address these potential problems before the state is in the midst of a full-blown crisis. This initiative also includes the needs of underserved population groups (e.g., uninsured, immigrants, frail and elderly) in determining the types of providers needed in the future. The study evaluates the state’s past efforts to recruit and retain health professionals both in and out-of-state; the use of international medical graduates; whether the growth in nurse practitioners, physicians’ assistants and certified nurse midwives will offset the likely shortfall in primary care physicians; and professional quality of life issues. The goal of this study is to develop public and private policy options to ensure that North Carolina has an adequate supply of providers distributed throughout the state.

  Principal Investigator: Pam C. Silberman, J.D., Dr.P.H.

  Funding Source: Kate B. Reynolds Charitable Trust

  Total Project Period: 09/05 – 09/06 (extended)
  
  

• Analysis of Confidential Data Describing Licensees of the North Carolina Medical Board – This project provides assistance to the NC Medical Board in examining their physician licensee records to improve their ability to monitor quality of care.

  Principal Investigator: Thomas C. Ricketts, III, M.P.H., Ph.D.

  Funding Source: North Carolina Medical Board

  Total Project Period: 09/06 – 06/08 (extended)
  
  

• Generalist-Specialist Interface in the Care of Children With Special Health Care Needs – Project will assistance with the instrument development, resaerch design, data collection, and analysis in a stucy of the generalist-specialist interface in the care of children with special health care needs.

  Principal Investigator: Michelle L. Mayer, R.N., M.P.H., Ph.D.

  Funding Source: AccessCare

  Total Project Period: 10/06 – 09/07
  
  

• GeographicAccess to Pediatric Surgical Care in the United States – Using the 2005 American Medical Association Physician Masterfile and zip code level data from Claritas, specialty-specific estimates will be generated and provider maps will be drawn for: 1) the population weighted average distance to a provider and 2) the percent of children who live within a relatively short driving distance to a providers. Additional analyses will be done as part of the preiously described K02 award on Access to Pediatric Subspecialty Care in the United States.

  Principal Investigator: Michelle L. Mayer, R.N., M.P.H., Ph.D.

  Funding Source: University of North Carolina at Chapel Hill University Research Council

  Total Project Period: 12/06 – 11/07
  
  

• Documentation of the Activities and Contributions of the NC Medical Society’s Community Practitioner Program (CPP): The First 17 Years (1989-2006) – The primary focus of the CPP is to help medical practices in physician shortage areas of North Carolina recruit and retain physicians, physician assistants, and nurse practitioners, using loan repayment incentives to attract practitioners. This project will link administrative data from the program with data from secondary sources (e.g., medical licensure files, U.S. Census) to provide in-depth descriptions of the practitioners who have participated in the program, including their backgrounds, disciplines, and careers prior to and after participating. The report will also describe the practices, towns and counties where participants have served, and the patient populations for whom they provided care.

  Co-Principal Investigators: Donald E. Pathman, M.D., M.P.H.

  Funding Source: North Carolina Medical Society Foundation

  Total Project Period: 04/07 – 03/08
  
  

• TheReauthorization of Children’s Hospitals Graduate Medical Education (CHGME) Payment Program: Data Collection Instruments and Analysis Plan – There have been major changes occurring in Pediatric resident education in the last half-decade. The initiation of the Children's Hospital Graduate Medical Education Payment Program (CHGME), structured to provide funds for graduate medical education to free-standing children's teaching hospitals, has most likely enabled Pediatric residency programs to stay current with the above-mentioned changes and implement new training regimens. Congress now requires documentation of the progress and accomplishments of the CHGME program. This project is to develop, pilot test, and finalize the survey for administration to recipients of the CHGME program to document the impact of this program.

  Principal Investigator: Michelle L. Mayer, R.N., M.P.H., Ph.D.

  Funding Source: Bureau of Health Professions, HRSA (subcontract with Quality Resource Systems, Inc.)

  Total Project Period: 04/02/07 – 10/01//07
  
  

• Primary Care-Practice Based Research Network (PBRN) – This is a master task order contract that brings together five North Carolina-based PBRNs, three based at UNC-CH, one based at Duke University, and one based at Carolinas HealthCare System. Although no core funds are allocated, it places UNC on a “short list” for contract work from AHRQ over the next 3-5 years, and multiple research projects will result.

  Principal Investigator: Philip D. Sloane, M.D., M.P.H.

  Funding Source: Agency for HealthCare Policy and Research (AHRQ)

  Total Project Period: 01/29/07 – 01/28/10
  
  

• Initiative to Identify and Eliminate Racial Ethnic Disparities within UNC Health Care – Disparities in the health and health care of racial and ethnic minorities in the U.S. are well recognized and their causes are known to be many, but there are few tested models for reducing disparities, particularly for patients within a particular practice organization. This project aims to 1) use analyses of a wide variety of available health care system data to identify differences in access to care, use of health care services and care experiences for African American, Hispanic and non-Hispanic white patients of UNC Health Care; 2) use analysis of health system data and the methods of continuous quality improvement (CQI) to help clinical departments identify the causes for identified racial-ethnic disparities in care and design, implement and monitor interventions to reduce the disparities; and 3) to formally evaluate the usefulness of these approaches in identifying and reducing racial-ethnic disparities in care within UNC Health Care and to broadly disseminate the findings.

  Co-Principal Investigators: Donald E. Pathman, M.D., M.P.H.

  Funding Source: UNC School of Medicine, Investments in the Future

  Total Project Period: 07/07 – 06/10
  
  

• North Carolina Center for Health Workforce Studies – The Sheps Center has had a continuous research focus on the supply and distribution of health care professionals in North Carolina from the time of its founding in 1968. In 2007, a separately identified Center for Health Workforce Studies was created to bring together many of the distributed elements of health workforce research in the Sheps Center and across the University. The Center includes the work of the North Carolina Health Professions Data System (described above). The goals of the Center are to 1) monitor trends in health professional supply and distribution; 2) provide policy makers with timely, objective and data-driven analyses to inform policy debates; and 3) identify emerging issues in the supply of unlicensed health professionals that are important to health care delivery as well as the health of the state's economy. The Center produces peer-reviewed papers, policy briefs, white papers and presentations that are disseminated to state and national policy makers. It also provides technical assistance to states wanting to conduct their own health workforce analyses.

  Center Director: Erin P. Fraher, M.P.P.

  Funding Source: Permanent funding being sought, start-up funds are an internal use of UNC State appropriation

  Total Project Period: 07/06 – 06/08 (renewable)
  

• Improving the Integration of Evidenced-Based Clinical and Community Services to Support Healthy Behaviors – This is a randomized trial within a primary care practice-based research network (PBRN) evaluating two different interventions compared to usual practice to improve linkages with community resources addressing tobacco use, unhealthy diets, and physical inactivity. The first intervention uses an evidence-based quality improvement learning collaborative and the second uses a more informal practice strategy in which practices will receive written material (brochures, fax referral forms, and “information” prescription pads) to facilitate referral to community resources that address the selected unhealthy behaviors. Quantitative and qualitative analyses will be used to understand the impact of the interventions at the practice, provider, patient, and community resource level. The main outcome measure is the probability that a patient with an unhealthy behavior is referred to a community resource. [This is the first Primary Care-Practice Based Research Network (PBRN) project.]

  Principal Investigator: Philip D. Sloane, M.D., M.P.H.

  Funding Source: Agency for HealthCare Policy and Research (AHRQ)

  Total Project Period: 07/07 – 12/08
  

• Understanding the Direct and Indirect Costs of Quality Measurement Data Collection and Reporting in Primary Care Practice –. The purpose of this study is to estimate both direct and indirect costs incurred by primary care practices related to being required to collect and report quality performance measurement data. A diverse sample of eight practices will participate in the study. Direct and indirect costs of the following scenarios will be estimated: 1) total costs absorbed by practices who are reporting 1-2 measures; 2) costs involved with reporting a small group of measures (2-8 measures); and 3) costs of reporting 2-8 (or more) measures to several different stakeholders. Cost estimates will be generated for practices that use Health Information Technologies (HIT, e.g. electronic health records, registries) and for those that do not. In addition, the project seeks to determine: 1) what factors influence primary care practices to collect and report quality measures; 2) the actual strategies used by practices to implement and maintain reporting, and to improve the cost-efficiency of this reporting; and 3) the justification of these costs. [This is the second Primary Care-Practice Based Research Network (PBRN) project.]

  Principal Investigator: Philip D. Sloane, M.D., M.P.H.

  Funding Source: Agency for HealthCare Policy and Research (AHRQ)

  Total Project Period: 09/07 – 10/08

Recently Completed Project

• Southern Rural Access Evaluation Project more info... – This is a comprehensive evaluation and monitoring system for the Robert Wood Johnson Foundation Southern Rural Access Program, a long-term effort to improve access to basic health care in eight of the most rural and medically-underserved states in the country. With guidance from the Foundation, the evaluation team is basing its evaluation efforts on three types of data: 1) information from periodic progress reports submitted by state grantees documenting completion of implementation and outcome targets specified early in their efforts; 2) telephone survey data from 4,800 rural inhabitants assessing their use of health services, satisfaction with the care they receive, perceived barriers to care, and related indicators of access; and 3) data on practitioner counts, characteristics, and locations drawn from national, state licensure, and other state sources.

  Co-Principal Investigators: Donald E. Pathman, M.D., M.P.H. and Thomas C. Ricketts, III, M.P.H., Ph.D.

  Funding Source: Robert Wood Johnson Foundation

  Total Project Period: 05/00 – 09/06 (extended)
  
  

• Southeast Regional Center for Health Workforce Studies – The Workforce Center’s mission is to conduct a structured agenda of research and technical assistance to support the development of an effective health workforce for the State of North Carolina, for states in U.S. DHHS Region IV, and for the nation. This is being accomplished by building on the substantial resources in place within the Sheps Center and available through cooperating academic units on the campus of the University of North Carolina, especially the Schools of Nursing (principal partner), Pharmacy, Public Health, Dentistry and Medicine and the North Carolina Area Health Education Centers (AHEC) Program. The Workforce Center also works closely with the North Carolina Institute of Medicine (NC•IOM) and the North Carolina Center for Nursing. The initial goals of the Center are to: 1) coordinate, expand and intensify the impact of the work already underway at the Sheps Center and to develop strong relationships with regional partners in the health workforce policy-making process; 2) initiate a series of projects funded by the federal government under this cooperative agreement that address federal workforce policy issues of diversity, distribution and geriatrics; and 3) develop a network of contacts and cooperative projects with states in Region IV to provide support to their workforce analysis needs. In addition, a strong, cooperative, policy-relevant network of interested analysts and institutions from the states of the Southeast Region is being developed and local, state, and regional studies of the need for health care professionals, their distribution, productivity and training is being developed.

  Principal Investigator: Thomas C. Ricketts, III, M.P.H., Ph.D.

  Funding Source: Bureau of Health Professions, HRSA

  Total Project Period: 09/03 – 02/07 (extended)
  
  

• A Primary Health Care Management Support Package for People With Developmental Disabilities – This project is conducting and evaluating a two-year demonstration project in four counties (Duplin, Sampson, Lenoir, and Pitt) in eastern North Carolina to assess its impact on the access to primary care for persons with developmental disabilities. The demonstration project provides a “care management support package” to local primary care providers intended to increase their ability and willingness to provide services to persons with developmental disabilities. During the third year, the knowledge gained during the demonstration period will be transferred to other communities in NC through training, technical assistance, and consultation.

  Principal Investigator: Kathryn Moss, Ph.D.

  Funding Source: North Carolina Council on Developmental Disabilities

  Total Project Period: 07/04 – 06/07