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Nurse Practitioner and Physician Assistant Waivers to Prescribe Buprenorphine and State Scope of Practice Restrictions
04-10-19
There is a shortage of clinicians authorized to prescribe medications to treat opioid use disorder. Nurse practitioners (NPs) and physician assistants (PAs) were allowed to obtain waivers to prescribe buprenorphine beginning in 2016. They investigated the proportions of NPs and PAs with waivers in...
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CIN Toolkit: Three Strategies to Help Primary Care Teams Treat Substance Use Disorders
01-31-19
This document is a guide for primary care organizations and care teams working to integrate substance use disorder (SUD) treatment services. It provides proven strategies, best practices, and tools used by organizations within California to expand the capability of primary care teams in commercial...
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CIN Connections, Fall 2018: Integrating Primary Care and Substance Use Disorder Treatment
10-18-18
Ensuring that Californians have timely access to substance use disorder (SUD) treatment that is appropriately linked to their physical health care represents a huge challenge and opportunity for health leaders, providers, and care teams throughout the state. This issue of CIN Connections features...
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Medication Adherence, Costs, and ER Visits of Nurse Practitioner and Primary Care Physician Patients
10-03-18
Objective
To compare medication adherence, cost, and utilization in Medicare beneficiaries attributed to nurse practitioners (NP) and primary care physicians (PCP).
Data
Medicare Part A, B, and D claims and beneficiary summary file data, years 2009‐2013.
Study Design
We used propensity score‐...
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California’s Physician Assistants: How Scope of Practice Laws Impact Care
09-25-18
Physician assistants (PAs) — state-licensed health professionals who practice medicine in collaboration with physicians and other providers — provide high-quality care, and are more likely to work in rural areas and with underserved populations than are physicians. Their training enables them to...
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California’s Nurse Practitioners: How Scope of Practice Laws Impact Care
09-07-18
Nurse practitioners (NPs) are registered nurses who have completed additional education to prepare them to deliver a broad range of services including the diagnosis and treatment of acute and chronic illnesses. They are one of four categories of advanced practice registered nurses, with the others...
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Breaking Barriers for Underrepresented Minorities in the Health Professions
07-30-18
In spite of the United States’ racial and ethnic diversity, the health care workforce remains predominately white, particularly in professions that require doctoral degrees. This has a real and negative impact on both patients and health professionals. Diversity in the classroom can translate into...
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California’s Physicians: Headed for a Drought?
06-25-18
The people in California’s communities rely on physicians — primary care providers and specialists alike — to keep them healthy. This report, compiled using data from surveys completed by doctors renewing their medical licenses in 2015, provides a snapshot of who those physicians are, where they...
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Solutions to Reduce Imminent Primary Care Shortage in California
06-12-18
California needs a comprehensive strategy for primary care workforce development to alleviate a statewide shortfall of primary care providers that is projected to occur within the next 15 years. According to a report released June 12 by Healthforce Center, this comprehensive strategy should include...
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CIN Connections, Spring 2018: Healing the Healers
04-20-18
The California Improvement Network’s report, CIN Connections: Healing the Healers, features actionable information to tackle provider burnout and promote well-being at health care organizations. It includes an interview with Mickey Trockel, MD, PhD, from Stanford Medicine WellMD Center, who...
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2017 Survey of Nurse Practitioners and Certified Nurse Midwives
04-11-18
This study of California nurse practitioners (NPs) and certified nurse-midwives (CNMs) was conducted in early 2017. In November 2016, there were 20,337 NPs living in California, of whom 569 also were CNMs (“dual certified”). Another 582 people had CNM-only certification. Surveys were mailed to 2,...
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Federally Qualified Health Centers Reduce the Primary Care Provider Gap in Health Professional Shortage Counties
02-13-18
Federally qualified health centers (FQHCs) were designed to provide care in medically underserved areas and substantial and sustained federal funding has accelerated FQHC growth. This report examines changes over time in primary care provider supply and whether FQHCs have been successful in...
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The Roles and Value of Geriatricians in Healthcare Teams: A Landscape Analysis
12-21-17
While it is difficult to know the true number of practicing geriatricians, the supply has been negatively affected by tightening certification requirements, relatively low income and negative return on investment. There appears to be consensus that clinical care by geriatricians should be reserved...
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California's Primary Care Workforce: Forecasted Supply, Demand, and Pipeline of Trainees, 2016-2030
08-15-17
This second report in a series of three Healthforce Center reports on primary care in California, unveils projections of a statewide primary care clinician shortfall in the next 15 years, with the most severe shortages in the Central Valley, Central Coast and Southern Border areas.
Key Findings...
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Physician Participation in Medi-Cal: Is Supply Meeting Demand?
06-29-17
Enrollment in Medi-Cal, California's Medicaid program, surged with the implementation of the Affordable Care Act (ACA), from 8.6 million in September 2013 to 13.4 million three years later. Medi-Cal now covers nearly one in three Californians. These Medi-Cal enrollees benefit from no- or low-cost...
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Dementia-Capable Care Coordination
05-25-17
This study describes the program requirements, workforce competencies, and barriers for dementia capable care coordination within health plans from seven states participating in the Center for Medicare and Medicaid Services demonstration programs for dually-eligible Medicare and Medicaid...
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How do Stakeholders Perceive Labor Nurses' Influence on Birth Outcomes?
04-21-17
Background
Childbirth is a leading reason for hospital admission in the USA, and most labor care is provided by registered nurses under physician or midwife supervision in a nurse-managed care model. Yet, there are no validated quality measures for maternity care that are thoughtful about the role...
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Prescribing Practices by Nurse Practitioners and Primary Care Physicians: A Descriptive Analysis of Medicare Beneficiaries
04-01-17
Introduction
Nurse practitioner (NP) prescribing continues to be a contentious policy issue, and studies systematically examining NP prescribing are lacking. The aim of this study was to conduct a descriptive analysis comparing the prescribing services of NPs with those of primary care physicians (...
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California's Primary Care Workforce: Supply, Characteristics and Pipeline
02-16-17
Is California prepared to meet growing demand for primary care?
This report is the first in a series of three Healthforce Center at UCSF reports that will provide information to help policymakers, consumers and leaders of health care delivery organizations and educational institutions understand...
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Few Hospital Palliative Care Programs Meet National Staffing Recommendations
09-07-16
This study, which was published in Health Affairs, was the first major data analysis of hospital palliative care programs’ workforce. The growing field of palliative care, which affects nearly all Americans, focuses on improving quality of life for patients with serious illnesses – including...
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Issue Brief: California's Teaching Health Centers
08-17-16
The Teaching Health Center Graduate Medical Education program was established as part of the Affordable Care Act (ACA) to increase the number of primary care physicians serving people in medically underserved areas of the US. The Health Resources and Services Administration (HRSA) has awarded...
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How Could Nurse Practitioners and Physician Assistants Be Deployed to Provide Rural Primary Care?
03-15-16
The Affordable Care Act is projected to result in nearly three-quarters of a million additional insured people in rural regions of the U.S. These newly insured are expected to generate 1.39 million rural primary care office visits. At a national level it would require 345 full-time equivalent...
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Defining Competencies for Education in Health Care Value: Recommendations from the University of California, San Francisco Center for Healthcare Value Training Initiative
04-11-15
Leaders in medical education have increasingly called for the incorporation of cost awareness and health care value into health professions curricula. Emerging efforts have thus far focused on physicians, but foundational competencies need to be defined related to health care value that span all...
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Reflections and Responses: Six Models for Understanding How Families Experience the System of Care for Children with Special Health Care Needs
11-13-14
During the spring and summer of 2013, some 61 stakeholders—including 52 parents of children with special heath care needs and nine providers and policymakers—were systematically interviewed for their responses to and reflections on six ethnographic models produced for the Lucile Packard Foundation...
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Electronic Health Record Availability Among Advanced Practice Registered Nurses and Physicians
11-01-14
OBJECTIVES: To characterize availability of electronic health records (EHRs) at the primary practice locations of certified nurse midwives (CNMs), nurse practitioners (NPs), and physicians in California prior to the implementation of the state's Medicaid EHR incentive program.
STUDY DESIGN AND...
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Physician Participation in Medi-Cal: Ready for the Enrollment Boom?
08-11-14
Report on findings from a 2013 survey of a sample of California physicians regarding their participation in Medi-Cal (California's Medicaid program) the eve of the implementation of the Affordable Care Act.
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Calling All Doctors: What Type of Insurance Do You Accept?
06-01-14
Editorial accompanying an article on an audit study of physicians' acceptance of new patients with Medicaid and private health insurance.
Full Publication
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Identifying Potential Predictors of a Safe Attending Physician Workload: A Survey of Hospitalists
11-11-13
Attending physician workload may be compromising patient safety and quality of care. Recent studies show hospitalists, intensivists, and surgeons report that excessive attending physician workload has a negative impact on patient care.1–3 Because physician teams and hospitals differ in composition...
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Scope-of-Practice Laws for Nurse Practitioners Limit Cost Savings that can be Achieved in Retail Clinics
11-01-13
Retail clinics have the potential to reduce health spending by offering convenient, low-cost access to basic health care services. Retail clinics are often staffed by nurse practitioners (NPs), whose services are regulated by state scope-of-practice regulations. By limiting NPs’ work scope,...
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Policy Solutions to Address the Foreign-Educated and Foreign-Born Health Care Workforce in the United States
11-01-13
Foreign-educated and foreign-born health workers constitute a sizable and important portion of the US health care workforce. We review the distribution of these workers and their countries of origin, and we summarize the literature concerning their contributions to US health care. We also report on...