FAQs: CHC Workforce Investment Simulator
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Frequently Asked Questions
What were the data sources, sample size, and time period of the original production function analyses?
The two main data sources were the Uniform Data System (UDS) and Internal Revenue Service Form 990 nonprofit tax returns (for revenue and capital). We used three years of data from 2014-2016 for a total of 3,139 observations from 1,178 CHCs.
How was the causal relationship between workforce and outcomes (control of hypertension and diabetes) established?
In the production function analysis that is the basis for this tool, we first explored the relationship of all the process and outcome measures reported in UDS. We found statistically significant association of many process measures with workforce variables, i.e., more or less of a given staffing category changed the frequency of a process measure, like vaccine delivery. Just two health outcome measures had a strong association with workforce after controlling for other factors.
What exactly are the outcome measures?
For diabetes, a well-controlled condition means that the patient's A1C (blood sugar) level is lower than 9 percent for a given year (as defined by the UDS data). For patients with hypertension, a well-controlled condition means that the patient's blood pressure is less than 140/90 mm Hg. These outcome measures were calculated in UDS as the average of the proportion of patients with diabetes whose A1C level was under control, and the proportion of patients with hypertension whose blood pressure was under control. The final outcome measure used, namely the percentage of diabetic or hypertensive patients under control, had a mean of 63.91 percent during the study period.
How are the many contextual variables across CHCs, such as rurality, taken into account in the simulator?
In the original production function analysis, patient and community demographics, as well as rural, suburban and urban variables were considered as control variables. In addition, fixed effects estimators were used to determine unobservable differences. We used instrumental variables to rule out the endogeneity between quality and volume of services.
What does Capital mean?
Capital is not a particularly actionable variable in our simulator. It measures the directionality of changes in infrastructure investments, e.g., space, equipment. It is included in the simulator as a way of recognizing that workforce is not the only possible investment. As a reminder, the purpose of the tool is estimate whether workforce investments would help improve quality, and if so, what types.
Are community health workers accounted for?
Community health workers during 2014-2016 were reported in UDS as part of the Enabling staff. Because enabling staff did not have a positive contribution to quality in our analyses, they have been combined with administrative staff, which similarly must be considered as a baseline configuration but did not have a positive contribution either. Starting in 2016 community health workers were reported separately, and this will allow us to consider adding these important workers as an independent group.
Will the simulator be updated with newer data
Yes, the simulator will be updated once a year with newer data.
ACKNOWLEDGMENT: The Community Health Center Workforce Investment Simulation Tool is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $450,000 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov.