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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. Erikson C, Herrng J, Park JH, Luo Q, Burke G. 2022. Association between State Payment Parity Policies and Telehealth Usage at Community Health Centers During COVID-19. Journal of the American Medical Informatics Association. doi: 10.1093/jamia/ocac104.
  2. Chen C, et al. 2021. Coronavirus Disease 2019 Planning and Response: A Tale of 2 Health Workforce Estimator Tools. doi: 10.1097/MLR.0000000000001606.
  3. 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. Medical Care. doi: 10.1097/MLR.0000000000001610.
  4. 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.
  5. Ziemann M, Erikson C, Krips M. 2021. The Use of Medical Scribes in Primary Care Settings: A Literature Synthesis. Medical Care. doi: 10.1097/MLR.0000000000001605
  6. 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.​
  7. 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.
  8. 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.
  9. Pittman P, Westfall N, Ziemann M, Strasser J. (2021, March 9). Who Is Allowed To Administer COVID-19 Vaccines? The List Is Growing. [Blog]. 10.1377/forefront.20210303.890600​.
  10. ​​​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.
  11. 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.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 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.
  17. 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.
  18. 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.
  19. 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.
  20. 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
  21. 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.
  22. 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.
  23. 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. 
  24. 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
  25. ​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.​
  26. 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.  
  27. Pittman P, Scully-Russ E. 2016. Workforce Planning and Development in Times of Delivery System Transformation. Human Resources for Health, 14: 56.
  28. 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 (2022-2023)

Does Diversity of Primary Care Practices Improve Outcomes for Medicaid Beneficiaries?
Diversity at an organizational level may have several benefits, including improved provider cultural sensitivity and cultural competency. This study assesses the organizational (i.e., practice-level) diversity of primary care physicians (PCPs) that care for Medicaid patients using a unique score of practice diversity. 
​
Key Questions:
  • What is the overall racial and ethnic diversity of the primary care physician workforce that cares for Medicaid patients? 
  • What is the average diversity of a practice’s physician workforce relative to the diversity of its patient panel among practices that serve Medicaid patients?
  • How does the diversity score compare across provider settings, e.g., CHCs and other primary care practices, and by practice integration? 

For questions about this study, contact Anushree Vichare at avichare@gwu.edu.  
Policies Associated with Community Health Worker (CHW) Participation in Medicaid Billing 
This study will examine how variations in state Medicaid policies are associated with participation by community health workers (CHWs) in Medicaid billing and the breadth and volume of CHWs services billed by Community Health Centers compared to other settings. 

Key Questions:
  • What is the level and distribution by state of CHW participation in Medicaid, and what are their practice patterns – e.g., geographic locations, types and volume of services provided, and the demographics of patients served?
  • Are CHCs more likely to bill for CHW services than other primary care settings in a state that allow billing? How do the volume and breadth of services compare? 
  • Are different types of state Medicaid policies associated with participation and the level of service provided by CHWs in Medicaid? 

For questions about this study, contact Clese Erikson at cerikson@gwu.edu. 
Telehealth Use for Prenatal Visits before, during, and after the covid-19 Pandemic
Poor access to prenatal care is a key driver of high maternal mortality and morbidity in the U.S., and telehealth could help enhance prenatal care. This study will examine the uptake of telehealth use for prenatal care among disadvantaged pregnant people during the COVID-19 pandemic and explore its potential for improving access and maternal health outcomes.

Key Questions:
  • How was telehealth used for prenatal care at the start, during, and latter periods of the COVID-19 pandemic? 
  • What types of prenatal services were delivered via telehealth? What types of telehealth services (audio/digital) were utilized? 
  • What patient and provider characteristics were associated with telehealth use for prenatal care? What was the uptake among those with high-risk pregnancies?
  • Did telehealth utilization for prenatal care differ among the general population and disadvantaged groups, such as those living in rural areas and seeking care in CHCs?

For questions about this study, contact Anushree Vichare at avichare@gwu.edu. 
The Impact of COVID-19 on Health Care Provider Mobility and Turnover
This research study will use Medicare Provider Enrollment, Chain, and Ownership System (PECOS) data matched with other workforce data to examine the movement of healthcare providers across organizations during different stages of the pandemic. The findings will inform policy efforts to anticipate and model the flow of providers to provide more coherent responses to shocks to the health care system.​

Key Questions:
  • How has the COVID-19 pandemic impacted provider turnover at different stages, including switching the job and attrition from practice?
  • What was this impact across different practices and organizations—by size, specialty composition, hospital or office-based?
  • What were the differences in mobility by provider characteristics, including provider type, gender, and race/ethnicity of physicians? 

For questions about this study, contact Stephen Petterson at spetterson72@gwu.edu​.  
Trends and Impact of Vertical Integration of CHCs on Workforce
This study will assess the degree of vertical integration among federally funded community health centers (CHCs) and the resulting variation in workforce configuration. In year two, if selected, we propose to build on this landscape to analyze the impact of vertical integration on CHC productivity and access to care for patients. 

Key Questions:
  • What are the different vertical integration structures between CHCs and hospitals and health systems?
  • How many CHCs are now vertically integrated?
  • What is the trend of vertical integration among CHCs?
  • What is the impact of vertical integration on the workforce configuration of CHCs?

For questions about this study, contact Eric Luo at qluo@gwu.edu​.  
What is the Effect of Increased Dependence on Travel Nurses on Patient Safety and Quality
This study will examine the effects of substituting staff nurses with travel nurses on patient safety in different types of hospital units before and during the COVID-19 pandemic. Using Premier Inc. data from 2019 through the end of 2022, we will identify the minimum and maximum marginal effect of travel nurses’ productivity, beyond which additional travel nurses have a negative impact on patient safety and quality.  

Key Question:
  • What is the marginal effect of travel nurses, as a proportion of total nurse staff, on patient outcomes by type of hospital unit? 

For questions about this study, contact Patricia Pittman at ppittmano@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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