Patients' Perspectives on Emergency Department COVID-19 Vaccination and Vaccination Messaging Through Randomized Vignettes.

OBJECTIVES: Emergency departments (EDs) could play an important role in the COVID-19 pandemic response by reaching patients who would otherwise not seek vaccination in the community. Prior to expanding COVID-19 vaccination to the acute care setting, we assessed ED patients' COVID-19 vaccine status, perspectives, and hypothetical receptivity to ED-based vaccination. METHODS: From January 11 through March 31, 2021, we conducted a multisite (Albany Medical Center, Boston Medical Center, Buffalo General Hospital, University of Cincinnati Medical Center, and Upstate Medical Center), cross-sectional survey of ED patients, with embedded randomization for participants to receive 1 of 4 vignette vaccination messages (simple opt-in message, recommendation by the hospital, community-oriented message, and acknowledgment of vaccine hesitancy). Main outcomes included COVID-19 vaccination status, prior intention to be vaccinated, and receptivity to randomized hypothetical vignette messages. RESULTS: Of 610 participants, 122 (20.0%) were vaccinated, 234 (38.4%) had prior intent to be vaccinated, 111 (18.2%) were unsure as to prior intent, and 143 (23.4%) had no prior intent to be vaccinated. Vaccine hesitancy (participants who were vaccine unsure or did not intend to receive the vaccine) was associated with the following: age <45 years, female, non-Hispanic Black, no primary health care, and no prior influenza vaccination. Overall, 364 of 565 (64.4%; 95% CI, 60.3%-68.4%) were willing to accept a hypothetical vaccination in the ED. Among participants with prior vaccine hesitancy, a simple opt-in message resulted in the highest acceptance rates to hypothetical vaccination (39.7%; 95% CI, 27.6%-52.8%). CONCLUSIONS: EDs have appropriate patient populations to initiate COVID-19 vaccination programs as a supplement to community efforts. A simple opt-in approach may offer the best messaging to reach vaccine-hesitant ED patients.

Let's Talk About Breastfeeding: The Importance of Delivering a Message in a Home Visiting Program.

PURPOSE: To examine the potential impact of paraprofessional home visitors in promoting breastfeeding initiation and continuation among a high-risk population. DESIGN: A secondary analysis of program data from a statewide home visitation program. SETTING: Thirty-six Healthy Families New York sites across New York State. SUBJECTS: A total of 3521 pregnant mothers at risk of poor child health and developmental outcomes. INTERVENTION: Home visitors deliver a multifaceted intervention that includes educating high-risk mothers on benefits of breastfeeding, encouraging them to breastfeed and supporting their efforts during prenatal and postnatal periods. MEASURES: Home visitor-reported content and frequency of home visits, participant-reported breastfeeding initiation and duration, and covariates (Kempe Family Stress Index, race and ethnicity, region, nativity, marital status, age, and education). ANALYSIS: Logistic regression. RESULTS: Breastfeeding initiation increased by 1.5% for each 1-point increase in the percentage of prenatal home visits that included breastfeeding discussions. Breastfeeding continuation during the first 6 months also increased with the percentage of earlier home visits that included breastfeeding discussions. Additionally, if a participant receives 1 more home visit during the third month, her likelihood of breastfeeding at 6 months increases by 11%. Effect sizes varied by months postpartum. CONCLUSIONS: Delivering a breastfeeding message consistently during regular home visits is important for increasing breastfeeding rates. Given that home visiting programs target new mothers least likely to breastfeed, a more consistent focus on breastfeeding in this supportive context may reduce breastfeeding disparities.

A statewide assessment of electronic health record adoption and health information exchange among nursing homes.

OBJECTIVE: To determine rates of electronic health record (EHR) adoption and health information exchange (HIE) among New York State (NYS) nursing homes. DATA SOURCES/STUDY SETTING: Primary data collected from a novel survey administered between November 2011 and March 2012 to all NYS nursing homes. STUDY DESIGN: We used a cross-sectional study design to assess level of EHR implementation, automation of key functionalities, participation in HIE, and barriers to adoption. DATA COLLECTION/EXTRACTION METHODS: We used descriptive statistics to characterize rates of EHR adoption and participation in HIE and logistic regression to identify nursing home characteristics associated with EHR adoption and HIE. PRINCIPAL FINDINGS: We received responses from 375 of 632 nursing homes (59.3 percent). Of respondents, almost one in five (n=66, 18.0 percent) reported having a fully implemented and operational EHR and a majority (n=192, 54.4 percent) reported electronically exchanging information. Nursing homes with 100-159 beds were significantly less likely than other facilities to have implemented or be in the process of implementing an EHR (p=.011). CONCLUSIONS: Our findings present an important systematic look at EHR adoption and HIE by NYS nursing homes. Although the nursing home sector has been reported to lag in health information technology adoption, our results are encouraging. However, they suggest much room for growth and highlight the need for targeted initiatives to achieve more widespread adoption in this important health care sector.

United States anesthesiologists over 50: retirement decision making and workforce implications.

BACKGROUND: Anesthesiology is among the medical specialties expected to have physician shortage. With little known about older anesthesiologists' work effort and retirement decision making, the American Society of Anesthesiologists participated in a 2006 national survey of physicians aged 50-79 yr. METHODS: Samples of anesthesiologists and other specialists completed a survey of work activities, professional satisfaction, self-defined health and financial status, retirement plans and perspectives, and demographics. A complex survey design enabled adjustments for sampling and response-rate biases so that respondents' characteristics resembled those in the American Medical Association Physician Masterfile. Retirement decision making was modeled with multivariable ordinal logistic regression. Life-table analysis provided a forecast of likely clinical workforce trends over an ensuing 30 yr. RESULTS: Anesthesiologists (N = 3,222; response rate = 37%) reported a mean work week of 49.4 h and a mean retirement age of 62.7 yr, both values similar to those of other older physicians. Work week decreased with age, and part-time work increased. Women worked a shorter work week (mean, 47.9 vs. 49.7 h, P = 0.024), partly due to greater part-time work (20.2 vs. 13.1%, P value less than 0.001). Relative importance of factors reported among those leaving patient care differed by age cohort, subspecialty, and work status. Poor health was cited by 64% of anesthesiologists retiring in their 50s as compared with 43% of those retiring later (P = 0.039). CONCLUSIONS: This survey lends support for greater attention to potentially modifiable factors, such as workplace wellness and professional satisfaction, to prevent premature retirement. The growing trend in part-time work deserves further study.

Electronic health record adoption and health information exchange among hospitals in New York State.

RATIONALE, AIMS AND OBJECTIVES: Unprecedented national and state initiatives are underway to promote adoption and meaningful use of electronic health records (EHRs) with health information exchange (HIE). New York State leads the nation in state initiatives and is conducting ongoing surveillance of its investments. Lessons learned from studying states like New York can inform federal policies and will be essential to evaluate the effectiveness of these initiatives. We undertook this first in a series of planned surveys to assess EHR adoption and HIE activities by New York State hospitals. METHODS: Between May and December 2009, we surveyed all New York State hospitals to determine rates of EHR adoption, participation in HIE and implementation of functionalities associated with nine core meaningful use criteria. RESULTS: We received responses from 148 (72.2%) of 205 hospitals surveyed and found that 23 (15.5%) had adopted an EHR and 29 (23.2%) were participating in HIE. Two hospitals (1.4%) reported full implementation of the meaningful use functionalities surveyed. Public hospitals were ahead of private hospitals and notable regional differences were found. DISCUSSION: EHR adoption rates and participation in HIE are higher among New York hospitals than hospitals nationwide, suggesting that state initiatives funding community EHR implementation may influence these efforts by hospitals. However, overall rates of adoption and preparedness to meet meaningful use remain low. Direct support for hospitals, such as that provided through the national EHR Incentive Program, will likely be critical for rates of EHR adoption and HIE to significantly rise, even in advanced states.

The effect of local primary care physician supply on the utilization of preventive health services in the United States.

Little research has examined the effect of physician supply on health-related measures at the individual and community level simultaneously. Using telephone survey data from six counties in upstate New York, a commuting radius was constructed between the zip codes of respondents and their primary care physicians. The relationships between local physician supply, the probability of having a primary care physician, and receiving preventive health care checks were analyzed. Both logistic regression and multilevel modeling results indicated the local supply of primary care physicians affects the probability of having a primary care physician, which in turn affects preventive healthcare service utilization.

The certified diabetes educator workforce in New York: findings from a statewide survey.

More than 1.8 million New York residents have diabetes, and diabetes prevalence in the state has doubled in the last decade. As part of its $35 million five-year campaign to reverse the diabetes epidemic in New York, the New York State Health Foundation's Diabetes Policy Center partnered with the Center for Health Workforce Studies at the School of Public Health, University at Albany, State University of New York, to conduct a workforce study of certified diabetes educators (CDEs) in New York and develop recommendations for improving access to diabetes self-management education. The findings from this study suggest that providers of diabetes services must identify new ways to use the existing supply of CDE more effectively. With their small numbers and uneven distribution across New York, creative strategies are needed to maximize the impact of CDEs in helping patients effectively manage diabetes and prevent its occurrence.

Toward a methodology for substate projections of registered nurse supply and demand in New York.

Even as concerns about nursing shortages continue nationwide and for individual states in the United States, there is little information on the impact of nursing shortages at substate levels, such as counties or groups of small counties. National and state level assessments can mask wide geographic variation in the distribution of registered nurses (RNs). The Center for Health Workforce Studies at the School of Public Health, University at Albany, developed a practical approach to projecting RN supply and demand at substate levels. The experimental model used in this research was adapted from a methodology utilized for the RN National Supply Model and National Demand Model developed by the Health Resources and Services Administration in the department of Health and Human Services to make RN supply and demand projections at the broader national and state levels. The Center's research highlighted the value of substate analyses in the identification of RN supply and demand gaps and found that supply and demand gaps vary greatly by region and within regions. This study also provided an in-depth understanding of the dynamics that drive substate labor markets for RNs as well as the need for substate analyses to help policymakers better allocate scarce resources to address nursing shortages.

Cultural similarity, cultural competence, and nurse workforce diversity.

Proponents of health workforce diversity argue that increasing the number of minority health care providers will enhance cultural similarity between patients and providers as well as the health system's capacity to provide culturally competent care. Measuring cultural similarity has been difficult, however, given that current benchmarks of workforce diversity categorize health workers by major racial/ethnic classifications rather than by cultural measures. This study examined the use of national racial/ethnic categories in both patient and registered nurse (RN) populations and found them to be a poor indicator of cultural similarity. Rather, we found that cultural similarity between RN and patient populations needs to be established at the level of local labor markets and broadened to include other cultural parameters such as country of origin, primary language, and self-identified ancestry. Only then can the relationship between cultural similarity and cultural competence be accurately determined and its outcomes measured.

Understanding the supply and distribution of registered nurses: where are the data and what can they tell us?

Health workforce researchers routinely conduct studies to determine whether a profession is currently in short supply and whether future shortages are likely. This is particularly important for registered nursing since the profession has experienced periodic shortages over the past three decades. Registered nurse (RN) forecast studies can be valuable in quantifying supply and demand gaps and identifying the most appropriate strategies to avert future shortages. In order to quantify RN supply/demand gaps, it is important to have accurate data on RNs, including the number of active RNs as well as their demographic, education, and practice characteristics, and work location(s). A lack of relevant and timely data on the nursing workforce is a significant barrier to identifying where nursing shortages exist, where they are most severe, and determining the factors that contribute to them. This lack of understanding impedes the development of effective health workforce programs and policies to mitigate shortages and the ability to evaluate these programs and policies for effectiveness. This study describes the national data sources available to nursing researchers to study the supply and distribution of the RN workforce and assesses the sources' strengths and limitations. This study also explores the potential for using state-level data for nursing workforce research.

Toward a new method for identifying facilities and communities with critical shortages of nurses.

This article summarizes the key findings of a study designed to evaluate the effectiveness of different methods for assessing the severity of nursing shortages in four types of health care facilities in the United States (hospitals, long-term care facilities, home health agencies, and public health agencies). The study involves testing several statistical models using currently available data to assess their accuracy and ease of use as possible bases for estimating and predicting the severity of nursing shortages in individual health care facilities. The assessments are based on criteria developed with the advice of panels of experts knowledgeable about each of the four types of facilities. The results of a "preferred method" for rating the severity of nursing shortages in counties in the United States are presented, along with key findings based on a variety of other models and analyses. Although it requires some refinement and a systematic validation, this method holds promise as a possible basis for targeting federal resources to alleviate the most critical nursing shortages across the country.

An analysis of racial/ethnic pay disparities among hospital nurses in New York City.

Despite growing concern over cultural competence and diversity in the registered nursing (RN) workforce, minority RNs working in hospitals in New York City who were surveyed in 2007 earned less on average than their non-Hispanic White counterparts. Regression decomposition was applied to these data to investigate how much of the differential could be attributed to different characteristics of different racial/ethnic groups and how much could be attributed to differential valuation of characteristics between racial/ethnic groups. The earnings differential between Black/African American and non-Hispanic White RNs was about equally due to different characteristics and differential valuation of characteristics, but the earnings differentials between Hispanic/Latino RNs and non-Hispanic White RNs and between Asian/Pacific Islander RNs and non-Hispanic White RNs were about two-thirds due to different characteristics and one-third due to differential valuation of their characteristics. In particular, years of nursing experience did not translate into the same earnings advantages for minority RNs.

The health services research workforce: current stock.

OBJECTIVE: To examine the size and characteristics of the health services research (HSR) workforce; the job satisfaction, job security, and future plans reported by the workforce; and the future of the HSR workforce supply. DATA SOURCES: (1) AcademyHealth active and lapsed members since 2000 and annual research meeting presenters and interest group participants; (2) principal investigators of research projects listed in the HSRProj database; and (3) authors of articles published in two HSR journals. STUDY DESIGN: Data on investigators conducting HSR in selected venues were collected and compared in order to identify the percentage of the HSR workforce represented in the "core" versus related disciplines and to investigate the extent to which the "core" researchers publish, present, or participate in disciplinary venues. PRINCIPAL FINDINGS: The field appears to have grown dramatically since 1995, from an estimated 5,000 health services researchers to an estimated 11,596 in 2007. This is a broad workforce characterized by various levels of involvement in the field. Some researchers self-identify with the field of HSR, while others are associated primarily with venues related to specific disciplines. Many researchers who identify with HSR also publish in venues related to multiple other disciplines. CONCLUSIONS: The field may face future challenges related to demographic change, such as an aging workforce and an increased need for diversity. International collaboration appears common, and in the future the field may need to be defined internationally rather than nationally. At the same time, there are also many indications that HSR is a good field to work in. Health services researchers reported high levels of satisfaction with their profession and current employer, as well as little desire to change jobs and little concern about job security.

The emerging role of faith community nurses in prevention and management of chronic disease.

Faith community nursing, formerly known as parish nursing, is one model of care that relies heavily on older registered nurses (RNs) to provide population-based and other nonclinical services in community settings. Faith community nursing provides services not commonly available in the traditional health care system (e.g., community case management, community advocacy, community health education). With appropriate support, this model of nursing could be expanded into other settings within the community and has the potential to draw on the skills of experienced RNs to provide communities with services that address unmet health care needs.

Practice patterns of underrepresented minority nurse practitioners in New York state, 2000.

Using data collected from a sample of 1,319 nurse practitioners (NPs) in New York state in 2000, differences in practice patterns by race and ethnicity were identified. NPs from underrepresented minority (URM) groups were more likely than non-URM NPs to work in hospitals, community health centers, and schools but less likely to work in physician offices and NP practices. URM NPs were also more likely to report a specialty certification in women's health. Several different measures of primary care provision were examined, with URM NPs substantially more likely to meet all four measures of primary care practice than non-URM NPs. Finally, URM NPs were more likely than non-URM NPs to practice in federally designated health profession shortage areas.