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​About Us

Established in 2013, the Health Workforce Research Center (HWRC) on Emerging Health Workforce Topics, is part of the Fitzhugh Mullan Institute for Health Workforce Equity. The center’s research portfolio examines how new payment and delivery models, patient centered medical homes, team-based care, telehealth, National Health Service Corps, and other emerging care management strategies impact access and quality of care for rural and underserved populations.

We are committed to advancing the science of workforce analysis by 1) developing cutting edge research methods for documenting how workforce staffing configurations impact patient satisfaction and health outcomes, 2) employing innovative uses of available datasets to identify the workforce caring for patients living in health professional shortage areas, 3) publishing a portfolio of peer-reviewed publications that build off of each other to identify policies for improving care for vulnerable and underserved populations, and 4) training the next generation of health workforce researchers to carry the work forward into the future.

Leadership

Director: Patricia Pittman, PhD
Deputy Director: Clese Erikson, MPAff
PEER-REVIEWED PUBLICATIONS
  1. Chen C, et al. 2021. Coronavirus Disease 2019 Planning and Response: A Tale of 2 Health Workforce Estimator Tools. doi: 10.1097/MLR.0000000000001606.
  2. Han X, Pittman P, Ku L. 2021. The Effect of National Health Service Corps Clinician Staffing on Medical and Behavioral Health Care Costs in Community Health Centers. doi: 10.1097/MLR.0000000000001610.
  3. Markus A, Pillai D. 2021. Mapping the Location of Health Centers in Relation to “Maternity Care Deserts”: Associations With Utilization of Women’s Health Providers and Services. Medical Care. doi: 10.1097/MLR.0000000000001611.
  4. Ziemann M, Erikson C, Krips M. 2021. The Use of Medical Scribes in Primary Care Settings: A Literature Synthesis. doi: 10.1097/MLR.0000000000001605.
  5. Park J, Regenstein M, Chong N, Onyilofor C. 2021. The Use of Community Health Workers in Community Health Centers. Medical Care. doi: 10.1097/MLR.0000000000001607.​
  6. Han X, Pittman P, Barnow B. 2021. Alternative Approaches to Ensuring Adequate Nurse Staffing: The Effect of State Legislation on Hospital Nurse Staffing. Medical Care. doi: 10.1097/MLR.0000000000001614.
  7. Richwine C, Erikson C, Salsberg E. 2021. Does Distance Learning Facilitate Diversity and Access to MSW Education in Rural and Underserved Areas? Journal of Social Work Education. doi:10.1080/10437797.2021.1895929.
  8. Pittman P, Westfall N, Ziemann M, Strasser J. (2021, March 9). Who Is Allowed To Administer COVID-19 Vaccines? The List Is Growing. [Blog]. Retrieved from: www.healthaffairs.org/do/10.1377/forefront.20210303.890600/full/#:~:text=Recommendations%20include%20authorizing%20community%20health,administer%20the%20COVID%2D19%20vaccine.
  9. ​​​Pittman P, Park J, Bass E, Luo Q. 2020. Understanding Why Nurse Practitioner (NP) and Physician Assistant (PA) Productivity Varies Across Community Health Centers (CHCs): A Comparative Analysis. Medical Care Research and Review.
  10. Luo Q, Chong N, Chen C. 2020. Independent Freestanding Emergency Departments and Implications for the Rural Emergency Physician Workforce in Texas. Health Services Research. doi: 10.1111/1475-6773.13587.
  11. Luo Q, Dor A, Pittman P. 2020. Optimal Staffing in Community Health Centers to Improve Quality of Care. Health Services Research. doi: 10.1111/1475-6773.13566.
  12. Delhy R, Dor A, Pittman P. 2020. The Impact of Nursing Staff on Satisfaction Scores for U.S. Hospitals: A Production Function Approach. Medical Care Research and Review. doi: 10.1177/1077558720950572.
  13. Han X, Chen C, Pittman P. 2020. Use of Temporary Providers in Primary Care in Federally Qualified Health Centers. Journal of Rural Health. doi: 10.1111/jrh.12424.
  14. Park J, Dowling N. 2020. Do Nurse Practitioner-Led Medical Homes Differ from Physician-Led Medical Homes? Nursing Outlook, 68(5): 601-610. doi.org/10.1016/j.outlook.2020.05.010.
  15. Han X, Pittman P, Erikson C, Mullan F, Ku L. 2019. The Role of the National Health Service Corps Clinicians in Enhancing Staffing and Patient Care Capacity in Community Health Center. Medical Care, 57(12):1002–1007. doi: 10.1097/MLR.0000000000001209.
  16. Han X, Ku L. 2019. Enhancing Staffing In Rural Community Health Centers Can Help Improve Behavioral Health Care. Health Affairs, 38(12). doi: 10.1377/hlthaff.2019.00823.
  17. Park J, Han X, Pittman P. 2019. Does Expanded State Scope of Practice for Nurse Practitioners and Physician Assistants Increase Primary Care Utilization in Community Health Centers? Journal of the American Association of Nurse Practitioners. doi: 10.1097/JXX.0000000000000263.
  18. Park J, Erikson C, Han X, Iyer P. 2018. Are State Telehealth Policies Associated With the Use of Telehealth Services Among Underserved Populations? Health Affairs, 37(12): 2060-2068.
  19. Park J, Wu X, Frogner B, Pittman P. 2018. Does the Patient-centered Medical Home Model Change Staffing and Utilization in the Community Health Centers? Medical Care. doi: 10.1097/MLR.0000000000000965
  20. Frogner B, Wu X, Park J, Pittman P. 2017. The Association of Electronic Health Record Adoption with Staffing Mix in Community Health Centers. Health Services Research, 52(S1): 407-421.
  21. Frogner B, Wu X, Ku L, Pittman P, Masselink L. 2017. Do Years of Experience With Electronic Health Records Matter for Productivity in Community Health Centers? Journal of Ambulatory Care Management, 40(1): 36–47.
  22. Li S, Pittman P, Han X, Lowe T. 2017. Nurse-Related Clinical Nonlicensed Personnel in U.S. Hospitals and Their Relationship with Nurse Staffing Levels. Health Services Research, 52(S1): 422-436. 
  23. Malcarney M, Pittman P, Quigley L, Horton K, Seiler N. 2017. The Changing Roles of Community Health Workers. Health Services Research, 52(S1): 360-382
  24. ​Pittman P, Li S, Han X, Lowe T. 2017. Clinical Nonlicensed Personnel in U.S. Hospitals: Job Trends from 2010 to 2015. Nursing Outlook, 66(1): 35-45.​
  25. Pittman P, Masselink L, Bade L, Frogner B, Ku L. 2016. Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives. Journal of Healthcare Management, 61(5): 364-377.  
  26. Pittman P, Scully-Russ E. 2016. Workforce Planning and Development in Times of Delivery System Transformation. Human Resources for Health, 14: 56.
  27. Ku L, Frogner B, Steinmetz E, Pittman P. 2015. Community Health Centers Employ Diverse Staffing Patterns, Which Can Provide Productivity Lessons for Medical Practices. Health Affairs, 34(1): 95-103. 

Current Research Studies (2021-2022)

Factors Associated with Providers Billing Medicaid for Medical or Behavioral Health Services in Non-Medical Settings or Via Telehealth
This study will examine provider engagement in offering Medicaid services through telehealth or in non-medical settings such as home, schools, and homeless shelters that may be more accessible to patients with transportation barriers or limited mobility.

Key Questions:
  • What proportion of primary care providers and behavioral health specialists offer services outside the office setting?
  • What provider characteristics and/or state policies are associated with providing care outside office setting?

For questions about this study, contact Clese Erikson at cerikson@gwu.edu.  
Developing Metrics for Six Workforce Equity Domains
The GWMI defines Health Workforce Equity as "a diverse health workforce that has the competencies, opportunities, and courage to ensure everyone can attain their full health potential." We further define six health workforce domains central to determining whether policies and programs facilitate or inhibit this vision of equity. We will build on evidence reviews of these domains to propose a set of measures to track progress.

Key Questions:
  • What are the available data sources for each of the six health workforce equity domains, and what are their availability longitudinally, i.e., to track measures over time?
  • What measures could be used as proxies for each of the six domain (and potentially subdomains)?
  • Should composite measures be developed for each domain, and if so, how?
  • What units of analysis should be prioritized in the context if data feasibility?
  • What does a preliminary landscape report that could be used as a baseline for future tracking look like?​

For questions about this study, contact Patricia Pittman at ppittman@gwu.edu.  
Impact of Hospital Staffing Strategies Responding to COVID-19 in High- and Low-Resource Communities
The purpose of this study is to examine how hospitals in high- and low-resource settings differentially implemented staffing strategies in response to the coronavirus disease 2019 (COVID-19) and subsequently how these responses affected outcomes at the facilities. The COVID-19 pandemic generated an
unprecedented demand for healthcare workers across the country, causing staffing strains on hospitals as they confronted the crisis.

Key Questions:
  • How did facilities respond to COVID-19 hospitalizations with changes in 1) total nurse staffing (FTE and hours), 2) proportion of agency nurses, and 3) proportion of nurses in the intensive care unit that were floated from other units?
  • How did facility resources and community characteristics affect how hospitals employed different staffing strategies?
    a. What facility-level factors are associated with the different staffing strategies, including facilities’ pre-pandemic staffing, capacity, and financial standing?b. To what extent was the impact on low resource communities inequitable?
  • What impact did the changing staffing strategies have on health outcomes? ​

​For questions about this study, contact Patricia Pittman at ppittman@gwu.edu.  
Medicaid Workforce for Specific Populations
The health workforce is a critical component of health care delivery. The number, types, distribution, and practice behaviors of health care workers affect access, quality, and cost of health care. Practice behaviors include populations served (e.g., whether they serve Medicaid patients and how much service they provide). Research demonstrates the health workforce is sensitive to several factors, including education and training, federal and state policies, and developing market incentives. However, the majority of health workforce research has focused on the Medicare population, where data has been more available.

This study builds on our previous work to identify the health workforce serving the Medicaid population to now examine who is providing services to specific segments of the Medicaid population. This study will expand beyond the primary care providers (i.e., the focus of the previous study) and will be conducted at the county level. 

Key Questions:
  • ​What are the different characteristics (e.g. provider type and specialty) of the Medicaid workforce serving different Medicaid populations (e.g., children, pregnant women, Medicaid expansion populations, and dual-eligible)?
  • What are the different types and amount of services provided by the providers to different segments of the Medicaid population? 

For questions about this study, contact Eric Luo at ​qluo@gwu.edu.
Public Health Workforce and Community Health Outcomes 
The need for a robust public health system has become an increasingly important focus due to the COVID-19 pandemic. Public health provides essential services  -  monitoring population health, investigating and addressing health hazards, providing education, partnering with communities, championing and implementing  policies – that protect communities and improve health.

Key Questions:
  • How has the public health workforce changed from 2005 to 2019 in staffing numbers and composition?
  • How are temporal changes in the local health department workforce associated with community-level health outcomes? 
​
For questions about this study, contact Candice Chen at ​cpchen@gwu.edu.
  • Disclaimer
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These projects are supported by the Bureau of Health Workforce (BHW), National Center for Health Workforce Analysis (NCHWA), 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 percent 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.
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