Current Projects

Learn more about our ongoing projects here:

 

Advancing Understanding of How Institutional, Professional, and System-Level Factors  Contribute to Physician Burnout.

Investigator: Tania M. Jenkins, PhD

This study builds on previously funded work (FY 20-21) that examined burnout in general pediatricians and trainees in an outpatient clinic located in a low-socioeconomic (SES) neighborhood. The current study will contrast findings from that study with the experiences of general pediatricians and trainees in a high SES neighborhood, as well as compare the experiences of general pediatricians to pediatric surgeons.

 

Are Behavioral Health Providers Co-located with DEA Waivered Buprenorphine Prescribers?

Investigator: Lisa de Saxe Zerden, PhD, MSW; Brianna Lombardi, PhD, MSW; Erica Richman, PhD, MSW; Alex Forte, MSW; Evan Galloway, MPS

To understand the rate of co-location of DEA-waivered providers and behavioral health providers, we will conduct spatial analysis using two publicly available data sources. We will identify the physical location of DEA waivered prescribers through the Substance Abuse and Mental Health Services Administrator Buprenorphine Practitioner Locator and the physical location of social workers and psychologists using the CMS National Plan and Provider Enumeration System (NPPES) downloadable file. These data will provide a national benchmark to assess the degree to which DEA-waivered providers are co-located with behavioral health providers, and thus, implementing best practice models for MOUD. Findings will help identify where co-located MOUD is needed and offer workforce researchers, policy makers, and practitioners more information regarding the workforce distribution needs for treating OUD.

 

Co-location of Pharmacists with Primary Care Providers: An Analysis of NPI vs Other Data Sources

Investigators: Emily M. Hawes, PharmD, BCPS, CPP; Brianna Lombardi, PhD, MSW; Evan Galloway, MPS; Hilary A. Campbell, PharmD, JD; Cristen P. Page, MD, MPH; Mary Roth McClurg, PharmD, MHS

Despite evidence supporting the integration of pharmacists in team-based primary care, current national estimates of the percentage of co-located pharmacists and primary care providers is unknown. Increasing the co-location of pharmacists and primary care providers gives practitioners greater ability to meet the patient’s healthcare needs at the point of care. However, integrated health care delivery models may be less often present in rural and underserved areas and more likely to be located near academic health centers, contributing to unequal access to this model of care.
To understand the degree of co-location of primary care and pharmacists working in integrated primary care settings and the opportunities for collaborative care, we will conduct a geo-spatial analysis to report the rate of physical co-location between primary care providers and pharmacists.

 

Toward a Better Understanding of the Career Trajectories of Physicians from Underrepresented Groups in Medicine.

Investigator: Erin Fraher, PhD, MPP, and William F. Owen, Jr., MD, FACP

The purpose of this study is to use life course theory as a conceptual and methodological framework to investigate how race/ethnicity, age, and gender influence the practice patterns of North Carolina’s primary care physician workforce in different time periods, including whether the physician provides prenatal care, if s/he performs obstetric deliveries, the number of hours worked per week, the type of employment setting in which s/he practices (hospital, group clinic, solo practitioner, medical school etc.) and whether s/he practices in an underserved community. Using data collected on physicians between 2005 and 2019, we will test the following hypotheses:

    1. Between cohort effects: Primary care physicians from URM groups who graduated medical school in different periods will exhibit different practice patterns than their white colleagues.
    2. Intracohort gender effects: Different practice patterns will be observed for male and female primary care physicians of different race/ethnicities within the same medical school cohort.
    3. Age effects: Male and female primary care physicians from URM groups will exhibit different practice patterns at the same age, depending on when they graduated medical school.

 

Interrupted Integrated Health Care: How Primary Care Practices Utilized Tele-Health and Coordinated Team-Based Care in Response to COVID-19

Investigators: Brianna Lombardi, PhD, MSW; Lisa de Saxe Zerden, PhD, MSW; Erica L. Richman, PhD, MSW

This study will investigate how integrated health care (IHC) teams adapted during COVID-19 with a specific focus on their use of tele-health and how they adapted components of IHC such as warm hand-offs between providers and patients, referral linkages, and communication during the pandemic. This study also aims to identify innovative ways IHC practices delivered primary care that addressed patient physical, social, and behavioral health needs during a pandemic and understand areas in which innovation can continue or be reinforced in the post-pandemic period.

 

Developing a GME Policy Toolkit that States Can Use to Evaluate Return on Investment for Public Funds Invested in Training

        Investigators: Erin Fraher, PhD, MPP; Tom Ricketts, PhD, MPH; Ryan Kandrack, PhD

This study will develop and refine a methodology that states can use to evaluate the return on investment for public funds spent on Graduate Medical Education (GME). Armed with data about the outcomes of GME funds invested—in terms of yield of physicians in needed specialties and geographies–states can make more informed decisions about where to target future GME funds to produce the physician workforce needed to meet population health needs and ensure value for their investment.

Manuscript in Health Services Research: A Methodology for Using Workforce Data to Decide Which Specialties and States to Target for Graduate Medical Education Expansion

 

Understanding Registered Nurse Turnover in the U.S.

Investigators:  Cheryl B. Jones, PhD, RN; George Knafl, PhD; Meriel McCollum, BSN, RN, PhD student

While healthcare has changed dramatically over the past decade, the turnover of registered nurses (RNs) remains a recurring challenge. Prior research indicates that nurse turnover is costly, creates an unstable workforce, and affects patient outcomes. Despite this evidence, we know very little about current RN turnover in the U.S., how it varies between different types of health care settings, or among RNs of different backgrounds.

In this study, we will use data collected through the National Sample Survey of Registered Nurses 2018 (NSSRN) to examine nurse turnover (job or employer change) behaviors as a function of sociodemographic, professional, employment, and economic factors. Study findings can be used to develop targeted strategies that will be more effective in addressing nurse turnover behaviors than a one-size-fits-all approach.

 

The demographic, specialty, employment and geographic characteristics of physicians and residents affiliated with ACOs in the United States

Investigators: Erin Fraher PhD and Ryan Kandrack PhD

The transformation toward value is proceeding rapidly and occurring while hospitals and health systems continue to provide health services and train the future workforce. Preliminary analyses suggest that about 4,000 residents-in-training are in OneKey ACO provider roster which will allow us, for the first time we are aware of, to describe the demographic, specialty, employment and geographic characteristics of residents in ACOs. While it is unclear what being in the OneKey ACO file means in terms of the amount and content of training that is occurring in a value-based vs. fee-for-service practice environment, we will use the merged OneKey/MF data to identify the specialty, training institutions and geographic location of these resident physicians.

 

The Impact of COVID-19 on Primary Care Practice

Investigator: Valerie Lewis, PhD

COVID19 has caused dramatic changes to primary care access and delivery that present significant issues to the primary care workforce. First, primary care practices have cancelled large swaths of in person visits while working to rapidly implement telehealth. This is coupled with dramatic declines in revenue that present organizations with difficult financial choices.  The intensity of care under COVID19 likely may be increasing burnout among clinicians. Currently, information on these changes is largely anecdotal. We propose to conduct qualitative interviews with approximately 40 primary care practices in several states, purposively sampled across key dimensions (e.g. size, rurality, ownership).

 


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