Health Resources Services Administration Research Articles

REPORTING MERIT-BASED INCENTIVE PAYMENT SYSTEM LIKE DATA IN A UNIQUE AGE-FRIENDLY HEALTH CARE SETTING

Abstract The Richmond Health and Wellness Program (RHWP) offers screening, education, care coordination, and resources as an enhancement to primary care for older adults in five low-income apartment buildings and in a community center. Participants may receive primary care through multiple healthcare systems in the region that do not have a common electronic medical record (EMR). To track age-friendly workflows to the Health Resources Services Administration (HRSA) in the domains of advance care planning, falls prevention, and high-risk medication use, case note documentation in a REDCap database is used to generate Merit-based Incentive Payment System (MIPS)-like data. We report on advance care plans developed, fall risk screenings and risk reduction interventions implemented, high-risk medications screened, and referrals to primary care for high-risk medication deprescribing, including risk reduction with opioid use. When reporting MIPS data to HRSA, we include a disclaimer for RHWP data defining the numerator and denominator used for the MIPS-like measure calculation. For example, when reporting advance care plan completion, we include “RHWP is a care coordination site and care is not provided at the site. The population includes adults aged 55+ or people (of any age) with disabilities in low-income congregate living facilities and all adults participating in RHWP at the Virginia Commonwealth University Health Hub.” The numerator indicates the number of clients with advanced care plans created, and the denominator indicates the total number of clients seen during the reporting period. This presentation will provide strategies to meet reporting requirements when EMR records are not available.

Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018

It is unclear whether center-level factors are associated with racial equity in living donor kidney transplant (LDKT). To evaluate center-level factors and racial equity in LDKT during an 11-year time period. A retrospective cohort longitudinal study was completed in February 2023, of US transplant centers with at least 12 annual LDKTs from January 1, 2008, to December 31, 2018, identified in the Health Resources Services Administration database and linked to the US Renal Data System and the Scientific Registry of Transplant Recipients. Observed and model-based estimated Black-White mean LDKT rate ratios (RRs), where an RR of 1 indicates racial equity and values less than 1 indicate a lower rate of LDKT of Black patients compared with White patients. Estimated yearly best-case center-specific LDKT RRs between Black and White individuals, where modifiable center characteristics were set to values that would facilitate access to LDKT. The final cohorts of patients included 394 625 waitlisted adults, of whom 33.1% were Black and 66.9% were White, and 57 222 adult LDKT recipients, of whom 14.1% were Black and 85.9% were White. Among 89 transplant centers, estimated yearly center-level RRs between Black and White individuals accounting for center and population characteristics ranged from 0.0557 in 2008 to 0.771 in 2018. The yearly median RRs ranged from 0.216 in 2016 to 0.285 in 2010. Model-based estimations for the hypothetical best-case scenario resulted in little change in the minimum RR (from 0.0557 to 0.0549), but a greater positive shift in the maximum RR from 0.771 to 0.895. Relative to the observed 582 LDKT in Black patients and 3837 in White patients, the 2018 hypothetical model estimated an increase of 423 (a 72.7% increase) LDKTs for Black patients and of 1838 (a 47.9% increase) LDKTs for White patients. In this cohort study of patients with kidney failure, no substantial improvement occurred over time either in the observed or the covariate-adjusted estimated RRs. Under the best-case hypothetical estimations, modifying centers' participation in the paired exchange and voucher programs and increased access to public insurance may contribute to improved racial equity in LDKT. Additional work is needed to identify center-level and program-specific strategies to improve racial equity in access to LDKT.

Future Directions for HIV/HCV Care: Lessons Learned From Local Evaluation Projects in Texas and Connecticut and Implications for Practice and Health Promotion.

The Health Resources Service Administration (HRSA) Special Projects of National Significance (SPNS) project titled "Curing Hepatitis C among People of Color Living with HIV," funded two sites, University of Texas (TX) San Antonio and Yale University School of Medicine in Connecticut (CT) to explore barriers and facilitators towards achieving HCV cure in the era of curative DAAs for HCV in different local contexts. Through individualized approaches that study patient, provider and system level barriers, the nine articles in this Focus Issue highlight key themes that are important in designing local implementation strategies that will enable achievement of HCV elimination goals in priority populations.

Staffing transformation following Patient-Centered Medical Home recognition among Health Resources & Services Administration-funded health centers.

Patient-Centered Medical Home (PCMH) recognition is designed to promote whole-person team-based and integrated care. Our goal was to assess changes in staffing infrastructure that promoted team-based and integrated care delivery before and after PCMH recognition in Health Resources & Services Administration (HRSA)-funded health centers (HCs). We identified changes in staffing 2 years before and 3 years after PCMH recognition using 2010-2019 Uniform Data System data among three cohorts of HCs that received PCMH recognition in 2013 ( n = 346), 2014 ( n = 207), and 2015 ( n = 115). Our outcomes were team-based ratio (full-time equivalent medical and nonmedical providers and staff to one primary care physician) and a multidisciplinary staff ratio (allied medical and nonmedical staff to 1,000 patients). We used mixed-effects Poisson regression models. The earlier cohorts served fewer complex patients and were larger before PCMH recognition. Three years following recognition, the 2013 and 2014 cohorts had significantly larger team-based ratios, and all three cohorts had significantly larger multidisciplinary staff ratios. Cohorts varied, however, in the type of staff that drove this change. Both ratios increased in the longer term. Our study suggests that growth in team-based and multidisciplinary staff ratios in each cohort may have been due to a combination of HCs' perceptions of need for specific services, HRSA funding, and technical assistance opportunities. Further research is needed to understand barriers such as costs of employing a multidisciplinary staff, particularly those that cannot directly bill for services as well as whether such changes lead to practice transformation and improved quality of care.

Black maternal health scholars on fire: Building a network for collaboration and activism.

Black maternal health scholars on fire: Building a network for collaboration and activism.

2022 Zellmer lecturer Krista Pedley reflects on pharmacy as the foundation for public service.

Rear Admiral Krista M. Pedley, assistant surgeon general and director of the Health Resources & Services Administration (HRSA) Office of Special Health Initiatives (OSHI), says the training she received as a pharmacist was the perfect launch pad for her 22-year career in public service. “We are unique,” Pedley told her pharmacy audience September 13 as she delivered ASHP’s William A. Zellmer Lecture in Bethesda, MD. “No matter what role we play, we use our training and foundational values to rise to every occasion.” The William A. Zellmer Lecture Award was established in 2010 to recognize leadership in advancing public policy that improves medication use through the efforts of pharmacists. The annual lecture takes place during Policy Week, when members of ASHP’s policy-recommending councils and the Commission on Affiliate Relations travel to Capitol Hill to advocate for issues important to the pharmacy profession. Policy Week participants also drive the development of ASHP’s professional policies and lay the foundation for ASHP’s advocacy efforts.

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

A Season for PALTC: Improving Quality, Increasing Transparency, and Strengthening Our Workforce

Geriatric Workforce Enhancement Programs' Participation in the Nursing Home COVID Action Network

In late September, 2020, the Geriatric Workforce Enhancement Program’s (GWEP) Program Officer, at the Health Resources Services Administration (HRSA), alerted the 48 GWEPs about a nationwide initiative focusing specifically on the pandemic’s effect in nursing facilities. The ECHO Institute at the University of New Mexico negotiated a national contract with the Agency for Healthcare Research and Quality (AHRQ) to provide a nationwide educational intervention via the CARES Act Provider Relief Fund. The ECHO Institute recruited over 100 Training Centers as educational coordinators for the Project ECHO Nursing Home National COVID Action Network. Our Project Officer suggested that individual GWEPs participate in this effort and take the lead or provide geriatric educators for these Training Centers. Project ECHO (Extension for Community Healthcare Outcomes) is an innovative telementoring program that creates virtual learning communities, bringing together healthcare providers and subject matter experts using videoconference technology for brief presentations, and case-based learning, fostering an “all learn, all teach” approach. This symposium will describe the journeys that five GWEPs experienced becoming Training Centers, rapidly deploying a nursing home ECHO project, to support nursing home staff on best practices for protecting patients, staff, and visitors from coronavirus infection and spread. GWEPs from The University of Louisville, the University of North Carolina, the University of North Texas, the University of Rochester and The Virginia Geriatric Education Center’s two ECHO Hubs, joined the National COVID Action Network. This presentation will provide an overview of why GWEPs are well positioned to address emergent needs with short notice.

Moving toward health equity: A journey

Moving toward health equity: A journey

Predictors of student veterans progression and graduation in Veteran to Bachelor of Science in Nursing (VBSN) Programs: A multisite study.

Capitalizing on the veteran's extensive service experience, values, and norms, Health Resources Services Administration (HRSA) proposed Nurse Education, Practice, Quality and Retention - Veterans' Bachelor of Science (VBSN) Program grants (2016-2019). The purpose was to identify predictors of student veterans' (SV) progression and graduation rates in VBSN programs. A descriptive correlational retrospective design was used. Two hundred and eighty-two (282) SV records were examined. One hundred and forty (140) SVs graduated (49.6%) and 107 (37.9%) were still enrolled. Only program delivery mode (hybrid) was significantly associated with completion and confirmed by logistic regression modeling. An increased representation of SVs' gender, race/ethnicity was present; however, gender, age, race, ethnicity, and veteran status did not significantly predict progression nor graduation. Hybrid program delivery became the single predictor influencing VBSN progression and graduation. As non-traditional students in higher education with a history of social isolation and help-seeking stigma, this delivery mode may have assisted SV retention and persistence. With a registered nurse shortage and workforce calls for increased gender, race, and ethnic diversity, the findings suggest nursing education programs designed for veterans are a viable solution.

Empowered by Cultural Identity and Catalyzed by Resilience: A Path to Support American Indian Nursing Student Success.

Since the early 1990s, the Institute of Medicine has identified the need to increase the number of ethnic minority nurses to improve access to care and eliminate health disparities in these populations (Institute of Medicine, 1994, 2011). American Indians (AI) and Alaska Natives endure the highest rates of poverty, depression, addiction, suicide, domestic violence, and diabetes in the United States (Sarche & Spicer, 2008). With the disadvantages AIs face, nursing schools have difficulty recruiting, retaining, and graduating AI nursing students. Based on the guidance needed by AI nursing students, a program called Niganawenimaanaanig was specifically designed to provide holistic support for these students to improve their chances of successfully completing the baccalaureate nursing program. This program, funded through a Health Resource Services Administration Nursing Workforce Diversity grant, was begun at Bemidji State University in Minnesota, proximal to three of the largest Ojibwe reservations in the state. Once enrolled in Niganawenimaanaanig, students are provided comprehensive care within a unique cultural, academic, and social support framework. Tuition scholarships and monthly stipends provide crucial financial relief to students once they are accepted into the 4-year prelicensure or RN-to-BS nursing programs. In Niganawenimaanaanig's first 2 years, the number of AI students declaring nursing as a major increased by over 600%, and the program has retained 100% of their prenursing freshmen. At the heart of Niganawenimaanaanig is a grounding in AI culture that empowers and fosters resilience among nursing students, which is a relevant and recreatable concept for schools seeking to recruit and retain ethnic minority nursing students.

Developing an interprofessional transition course to improve team-based HIV care for sub-Saharan Africa

BackgroundWith funding from the United States Health Resources Service Administration (HRSA), a consortium of health professional training institutions from Africa developed HIV-specific, interprofessional, team-based educational resources to better support trainees during the transition period between pre-service training and professional practice.MethodsTen faculty members representing nine medical and nursing schools in sub-Saharan Africa (SSA) developed a training package of modules focused on core clinical, public health, interprofessional education (IPE), and quality improvement (QI) domains related to HIV service delivery. Curriculum development was informed by a rapid needs assessment of existing tools and future needs for HIV education across 27 SSA health professions training institutions. A total of 17 modules were developed, targeted at newly qualified health care professionals to be taught in a series of two-day workshops meant to complement existing institution specific HIV-curricula.ResultsBetween April and July 2019, a comprehensive case-based HIV training package was developed to support trainees in transition from pre-service training to independent professional practice. Each module, addressing different elements of interprofessional practice, was intended to be delivered in an interprofessional format. Thus far, 70 health professions training institutions in 14 countries have implemented the program; 547 educators facilitated STRIPE workshops, with a total of 5027 learners trained between September 2019 and September 2020.ConclusionsTo our knowledge this is the first IPE HIV-specific curriculum explicitly focused on enhancing the quality of training provided to graduating health care professionals working in SSA. The collaborative, cross-institutional, interprofessional approach to curriculum development provides a benchmark for how best-practice approaches to education can be disseminated in SSA.

Age Related Satisfaction of Telemedicine

Telehealth or more specifically telemedicine has been rapidly adopted recently. The “Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications”.1

Treatment for Opioid Use Disorder in Primary Care: Opportunities and Challenges for Sustainable Training Programs.

Drug overdose death rates from opioid use have risen steadily since 1999 and reached epidemic levels, slowing for the first time in 2018, though not for many forms of opioid use. Yet evidence-based approaches to combating OUD, such as medication-assisted treatment for OUD (MT-OUD), are still inaccessible to many. Primary care providers are well-positioned to offer these services; however, training and education in OUD care remains inadequate. The National Center for Integrated Behavioral Health interviewed the Health Resources Service Administration (HRSA) awardees of federal funding to implement an MT-OUD curriculum in their primary care residency training programs to identify barriers and facilitators to implementation. Awardees were interviewed at program launch and one year later. Results showed the importance of leadership willingness to participate, effective treatment integration into existing workflow, curriculum and clinical flexibility, and supportive interdisciplinary and community partnerships. Recommendations for best practices of MT-OUD training in primary care are identified.

Integrated care workforce development: university-community collaboration

ABSTRACTBehavioral health workforce shortages to provide quality care services for children, adolescents, and transitional age youth are well established. This paper highlights the workforce shortage and the need to infuse interprofessional education to engage in integrated care for children, adolescents and transitional age youth with behavioral health needs. A specialized training curriculum to build behavioral health workforce in Nevada was conceptualized and delivered through 10 workshops under the auspices of the Health Resources & Services Administration (HRSA) funded Behavioral Health Workforce Education and Training (BHWET) grant funded in 2014. To train existing workforce and in alignment with the spirit of the grant to build behavioral health workforce and existing workforce, workshops were extended to social service providers in the community. In an effort to enhance university-community collaboration, workshop presenters were invited from various units in the University and from social service agencies in the community. Implications of such training are addressed from a policy, practice, research, and university-community collaboration perspective.

Development of an Innovative Endocrinology Training Program for Nurse Practitioners

Nurse practitioners (NPs) have a critical role in meeting the growing demand for health care in the current complex health care system. The use of NPs in both primary care and specialty settings is expected to rise significantly by 2025 in response to increased demands and a shortage of physician providers. The Duke University School of Nursing, with funding from the Health Resource Services Administration, has implemented the first endocrinology specialty training program for primary care NP students. The first in the country, this innovative, hybrid training program prepares primary care NP students to manage complex diabetes mellitus and general endocrine conditions. Well-trained NPs can help meet the increased demands in primary care. This subspecialty certificate program provides a framework for other graduate nursing schools that are considering adding specialty content as a supplement to primary care training. [J Nurs Educ. 2018;57(8):506-509.].

Assessing MSW Students’ Integrated Behavioral Health Skills Using an Objective Structured Clinical Examination

ABSTRACTWithin the last decade, there has been a significant shift in the field of social work toward competency-based education. This article details the use of the Objective Structured Clinical Examination (OSCE) Adapted for Social Work Performance Rating Scale. We used the measure to evaluate specific practice competencies among students (n=33) participating in a professional workforce development program, funded by the Health Resources Services Administration Behavioral Health Workforce Education and Training for Professionals. We report on students’ performance and their views of the OSCE as an assessment measure and learning experience, and on the interrater reliability and consistency of the OSCE. Results can be used by other social work programs to inform the use of OSCEs to facilitate competency-based assessment.

Helping Smokers Quit: New Partners and New Strategies from the University of California, San Francisco Smoking Cessation Leadership Center

ABSTRACTThe Smoking Cessation Leadership Center (SCLC) was established in 2003 to increase the rate of smoking cessation attempts and the likelihood those efforts would succeed. Although smoking remains the number one cause of preventable death and disability, clinicians underperform in smoking cessation. Furthermore, many clinical organizations, governmental agencies, and advocacy groups put little effort into smoking cessation. Initially targeted at increasing the efforts of primary care physicians, SCLC efforts expanded to include many other medical and non-physician disciplines, ultimately engaging 21 separate specialties. Most clinicians and their organizations are daunted by efforts required to become cessation experts. A compromise solution, Ask, Advise, Refer (to telephone quitlines), was crafted. SCLC also stimulated smoking cessation projects in governmental, not-for-profit, and industry groups, including the Veterans Administration, the Health Resources Services Administration, Los Angeles County, and the Joint Commission. SCLC helped CVS pharmacies to stop selling tobacco products and other pharmacies to increase smoking cessation efforts, provided multiple educational offerings, and distributed $6.4 million in industry-supported smoking cessation grants to 55 organizations plus $4 million in direct SCLC grants. Nevertheless, smoking still causes 540,000 annual deaths in the US. SCLC’s work in the field of behavioral health is described in a companion article.

Review of U.S. Health Resources and Services Administration’s Find a Health Center Locator

ABSTRACTIn addition to questions about diagnoses, wellness guidelines, and treatment concerns, librarians are sometimes confronted with questions about access to care from uninsured clients. The U.S. Health Resources & Services Administration (HRSA) provides an easy-to-use online “Locator” service for its network of Federally Qualified Health Centers serving low income and/or uninsured individuals across the country. This Locator tool is an important resource for consumer health librarians serving uninsured individuals.

Patient-Centered Homes and Integrated Behavioral Health Care: Reclaiming the Role of “Consultant” for Psychiatric-Mental Health Nurse Practitioner

The notion of patient-centered care has long been linked with nursing practice since Florence Nightingale. The discipline of nursing is focused on the holistic care of individuals, families, and communities in times of sickness and/or health. However, in psychiatric-mental health nursing, the concepts of mental health and psychiatric illness still remain marginalized in our health care delivery systems, as well as in nursing education, knowledge development, and practice. Even with the concept of patient-centered homes, acute and primary care providers are reluctant to embrace care of those with psychiatric illness in their respective settings. Psychiatric illness was and continues to be in the shadows, hidden and often ignored by the larger community as well as by health care providers. This paper describes a Health Resources Services Administration (HRSA) Advanced Nursing Education (ANE) training grant's objective of reintegrating psychiatric-mental health practice into ALL health care delivery systems using the concept of patient-centered nursing care as a foundation for, and promotion of, the Psychiatric-Mental Health Nurse Practitioner (PMH-NP) as the “navigator” for not only the patients and their families, but also for their acute and primary care colleagues using an Interprofessional Education Model. The major barriers and lessons learned from this project as well as the need for psychiatric-mental health nurses to reclaim their role as a consultant/liaison in acute, primary, and long-term care settings will be discussed. The PMHNP as a consultant/liaison is being revitalized as an innovative advanced practice nursing health care model in North Carolina.