Regional Variations in Maternal Mortality and Health Workforce Availability in the United States.

BACKGROUND: Skilled, high-quality health providers and birth attendants are important for reducing maternal mortality. OBJECTIVE: To assess whether U.S. regional variations in maternal mortality rates relate to health workforce availability. DESIGN: Comparison of regional variations in maternal mortality rates and women's health provider rates per population and identification of a relationship between these measures. SETTING: U.S. health system. PARTICIPANTS: Women of child-bearing age and women's health providers, as captured in federal data sources from the Centers for Disease Control and Prevention, Census Bureau, and Health Resources and Services Administration. MEASUREMENTS: Regional-to-national rate ratios for maternal mortality and women's health provider availability, calculated per population for women of reproductive age. Provider availability was examined across occupations (obstetrician-gynecologists, internal medicine physicians, family medicine physicians, certified nurse-midwives), in service-based categories (birth-attending and primary care providers), and across the entire women's health workforce (all studied occupations). RESULTS: Maternal deaths per population increased nationally from 2009 to 2017 and, in 2017, were significantly higher in the South and lower in the Northeast (P < 0.001) than nationally. The occupational composition and per-population availability patterns of the women's health workforce varied regionally in 2017. The South had the lowest availability in the nation for nearly every health occupation and category studied, and the Northeast had the highest. This exploratory analysis suggests that subnational levels of provider availability across a region may be associated with higher maternal mortality rates. LIMITATIONS: No causal relationship was established. Nationally representative maternal mortality and health workforce data sources have well-known limitations. Low numbers of observations limit statistical analyses. CONCLUSION: Regional variations in maternal mortality rates may relate to the availability of birth-attending and primary care providers. PRIMARY FUNDING SOURCE: None.

The geographic alignment of primary care Health Professional Shortage Areas with markers for social determinants of health.

BACKGROUND: The Health Resources and Services Administration (HRSA), an agency within the U.S. Department of Health and Human Services (HHS), works to ensure accessible, quality, health care for the nation's underserved populations, especially those who are medically, economically, or geographically vulnerable. HRSA-designated primary care Health Professional Shortage Areas (pcHPSAs) provide a vital measure by which to identify underserved populations and prioritize locations and populations lacking access to adequate primary and preventive health care-the foundation for advancing health equity and maintaining health and wellness for individuals and populations. However, access to care is a complex, multifactorial issue that involves more than just the number of health care providers available, and pcHPSAs alone cannot fully characterize the distribution of medically, economically, and geographically vulnerable populations. METHODS AND FINDINGS: In this county-level analysis, we used descriptive statistics and multiple correspondence analysis to assess how HRSA's pcHPSA designations align geographically with other established markers of medical, economic, and geographic vulnerability. Reflecting recognized social determinants of health (SDOH), markers included demographic characteristics, race and ethnicity, rates of low birth weight births, median household income, poverty, educational attainment, and rurality. Nationally, 96 percent of U.S. counties were either classified as whole county or partial county pcHPSAs or had one or more established markers of medical, economic, or geographic vulnerability in 2017, suggesting that at-risk populations were nearly ubiquitous throughout the nation. Primary care HPSA counties in HHS Regions 4 and 6 (largely lying within the southeastern and south central United States) had the most pervasive and complex patterns in population risk. CONCLUSION: HHS Regions displayed unique signatures with respect to SDOH markers. Descriptive and analytic findings from our work may help inform health workforce and health care planning at all levels, and, by illustrating both the complexity of and differences in county-level population characteristics in pcHPSA counties, our findings may have relevance for strengthening the delivery of primary care and addressing social determinants of health in areas beset by provider shortages.

Impact of the Health Resources and Services Administration's state oral health workforce grant program on dental workforce density and access to oral health care.

BACKGROUND: The Health Resources and Services Administration's Grants to States to Support Oral Health Workforce Activities, otherwise known as the State Oral Health Workforce Program (SOHWP), help states develop and implement innovations that address the workforce needs of dental Health Professional Shortage Areas in a manner appropriate to the states' individual needs. AIM: This cross-sectional study explores the broad impact of the SOHWP by comparing measures of dental workforce density and access to oral health care in states with multiple years of funding versus states with few or no years of funding. METHODS: We used data for 2006-2016 SOHWP awardees together with data from the 2016-2017 Area Health Resources Files and the 2016 Behavioral Risk Factor Surveillance System to compare numbers of dentists per 100,000 population and age-adjusted prevalence of annual dental visits among adults for long-term SOHWP-funded states versus states with few or no years of funding. RESULTS: Multi-year SOHWP funding is associated with higher workforce density and greater access to oral health care, especially in the Midwest and West. CONCLUSION: Allowing states funding utilization flexibility may result in improved outcomes. This finding can help inform planning and policy about whether and how to scale future training and workforce programs to achieve greater impact.

Where do physicians train? Investigating public and private institutional pipelines.

Where a physician is educated-in a public or a private institution-affects his or her practice choices, including the likelihood of choosing a career in primary care. It is important to monitor the educational pipeline for physicians to ensure that a robust cadre of professionals is entering the health care workforce from public-sector institutions to meet the growing demand for primary care providers.

Accelerating the translation of research into practice in long term services and supports: a critical need for federal infrastructure at the nexus of aging and disability.

The nexus of aging and disability, characterized by the phenomenon of aging with a disability, will become more visible as the population ages and the number of people with disabilities surviving to midlife increases. This article addresses 3 interrelated issues critical to the fields of aging and disability: increasing demand for community-based long-term services and supports, a paucity of evidence-based programs demonstrating effectiveness in facilitating independence for those aging with a disability, and lack of a federal infrastructure to support coordinated investments in research-to-practice for this population. Suggestions for federal interagency collaborations are given, along with roles for key stakeholders.

Title V of the Older Americans Act, the Senior Community Service Employment Program: participant demographics and service to racially/ethnically diverse populations.

Title V of the Older Americans Act, the Senior Community Service Employment Program (SCSEP), is a 40+-year-old federal program providing subsidized community service and employment training to low-income, unemployed individuals aged 55 and older. It is the only nationally mandated workforce training program for seniors. Because of SCSEP's dual mission, participants added 48 million hours of community service (valued at almost $1 billion) to the U.S. economy in 2008. Almost half (48.9%) of the participants are racial or ethnic minorities, which makes it crucial to understand the program experience of these individuals. Participation, program duration, and employment placement of minorities are examined. Findings show successful enrollment rates, an interactive effect of age and education on program duration, and no indication of a minority disadvantage in employment placement. Recommendations include funding for innovative grants, leveraging of federal partnerships, and targeted technical assistance.

Development and pilot testing of four desired health outcomes scales.

PURPOSE/OBJECTIVES: To develop and pilot test scales to measure desired health outcomes hypothesized to result from high-quality cancer nursing care: Fortitude Scale, Trust in Nurses Scale, Cancer Patient Optimism Scale, and Authentic Self-Representation Scale. DESIGN: Instrument development. SETTING: Community cancer support organization. SAMPLE: 66 recently treated patients with cancer who attended a cancer support organization workshop. The sample was predominately white, middle-aged, well-educated females. METHODS: Items for each scale were generated from qualitative data and the literature. The scales properties were evaluated using expert panel assessment of content validity, cognitive interviews of patients with cancer, and reliability and validity testing of each scale with the Multitrait/Multi-Item Analysis Program Revised (MAP-R) statistical program. FINDINGS: Participant responses to the four scales did not include the lowest possible score. Responses yielded evidence of adequate Cronbachs alpha internal consistency reliability for each scale: 0.81 for the Fortitude Scale; 0.81 for Trust in Nurses Scale, 0.75 for Cancer Patient Optimism Scale, and 0.71 for Authentic Self-Representation Scale. The MAP-R statistics yielded evidence of acceptable convergent validity and discriminant validity. CONCLUSIONS: The data provided preliminary evidence of acceptable psychometric properties for four scales designed to measure desired outcomes of cancer nursing care. Support was found for careful use of scales. Further psychometric testing with large samples is recommended. IMPLICATIONS FOR NURSING: These scales represent an initial effort toward providing measures of the desired health outcomes that patients with cancer attributed to high-quality cancer nursing care.