A Novel Gap Staffing Metric for Primary Care in the Veterans Health Administration and Implications for Rural and Urban Clinics

O'Shea, Amy; Haraldsson, Bjarni; Shahnazi, Ariana F.; Sterling, Ryan; Wong, Edwin S.; Kaboli, Peter J.

doi:10.1097/jac.0000000000000429

Cited by 4 publications

(4 citation statements)

References 21 publications

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“…Respondents from rural clinics reported more job loss and more negative perceived staffing impacts–findings which may relate to clinic size/structure or pre-existing staffing challenges [ 44 ]. These negative impacts may be especially pronounced when sustained acutely during a time of unprecedented pre-existing healthcare strain.…”

Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making

et al. 2023

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Introduction Little is known about the impact of mandated vaccination policies on the primary care clinic workforce in the United States or differences between rural and urban settings, especially for COVID-19. With the continued pandemic and an anticipated increase in novel disease outbreaks and emerging vaccines, healthcare systems need additional information on how vaccine mandates impact the healthcare workforce to aid in future decision-making. Methods We conducted a cross-sectional survey of Oregon primary care clinic staff between October 28, 2021– November 18, 2021, following implementation of a COVID-19 vaccination mandate for healthcare personnel. The survey consisted of 19 questions that assessed the clinic-level impacts of the vaccination mandate. Outcomes included job loss among staff, receipt of an approved vaccination waiver, new vaccination among staff, and the perceived significance of the policy on clinic staffing. We used univariable descriptive statistics to compare outcomes between rural and urban clinics. The survey also included three open-ended questions that were analyzed using a template analysis approach. Results Staff from 80 clinics across 28 counties completed surveys, representing 38 rural and 42 urban clinics. Clinics reported job loss (46%), use of vaccination waivers (51%), and newly vaccinated staff (60%). Significantly more rural clinics (compared to urban) utilized medical and/or religious vaccination waivers (71% vs 33%, p = 0.04) and reported significant impact on clinic staffing (45% vs 21%, p = 0.048). There was also a non-significant trend toward more job loss for rural compared to urban clinics (53% vs. 41%, p = 0.547). Qualitative analysis highlighted a decline in clinic morale, small but meaningful detriments to patient care, and mixed opinions of the vaccination mandate. Conclusions Oregon’s COVID-19 vaccination mandate increased healthcare personnel vaccination rates, yet amplified staffing challenges with disproportionate impacts in rural areas. Staffing impacts in primary care clinics were greater than reported previously in hospital settings and with other vaccination mandates. Mitigating primary care staffing impacts, particularly in rural areas, will be critical in response to the continued pandemic and novel viruses in the future.

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Section: Discussionmentioning

confidence: 99%

Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making

et al. 2023

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“…To identify our study cohort, we began with all VA clinics or sites ( n = 1110) and excluded atypical such as community living centers or sites with fewer than 450 patients over the study period, similar to prior work. 21 The final study cohort included 1050 VA sites (CRH-PC: 254; non-CRH-PC: 796). All patients assigned to a PACT team in each site were included; patient assignments were identified from the Reengineered Patient Care Management Module in the Corporate Data Warehouse (CDW).…”

Section: Methodsmentioning

confidence: 99%

The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic

Gujral,

Scott,

Dismuke-Greer

et al. 2024

J GEN INTERN MED

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Background The COVID-19 pandemic disrupted delivery of health care services worldwide. We examined the impact of the pandemic on clinics participating in the Veterans Affairs (VA) Clinical Resource Hub (CRH) program, rolled out nationally in October 2019, to improve access to care at under-resourced VA clinics or “spoke” sites through telehealth services delivered by regional “hub” sites. Objective To assess whether the CRH program was associated with increased access to primary care, we compared use of primary, emergency, and inpatient care at sites that adopted CRH for primary care (CRH-PC) with sites that did not adopt CRH-PC, pre-post pandemic onset. Design Difference-in-difference and event study analyses, adjusting for site characteristics. Study Cohort A total of 1050 sites (254 CRH-PC sites; 796 comparison sites), fiscal years (FY) 2019–2021. Intervention CRH Program for Primary Care. Main Measures Quarterly number of VA visits per site for primary care (across all and by modality, in-person, video, and phone), emergency care, and inpatient care. Results In adjusted analyses, CRH-PC sites, compared with non-CRH-PC sites, had on average 221 additional primary care visits (a volume increase of 3.4% compared to pre-pandemic). By modality, CRH-PC sites had 643 fewer in-person visits post-pandemic (− 14.4%) but 723 and 128 more phone and video visits (+ 39.9% and + 159.5%), respectively. CRH-PC sites, compared with non-CRH-PC sites, had fewer VA ED visits (− 4.2%) and hospital stays (− 5.1%) in VA medical centers. Examining visits per patient, we found that CRH-PC sites had 48 additional telephone primary care visits per 1000 primary care patients (an increase of 9.8%), compared to non-program sites. Conclusions VA’s pre-pandemic rollout of a new primary care telehealth program intended to improve access facilitated primary care visits during the pandemic, a period fraught with care disruptions, and limited in-person health care delivery, indicating the potential for the program to offer health system resilience.

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“…Additionally, we controlled for several clinic-level characteristics including rural location and whether a clinic was hospital-based or a community-based outpatient clinic (CBOC). Clinic-level covariates also included a measure capturing degree to which a clinic is understaffed (FTE gap) (O'Shea et al, 2021), based on the number of PCPs employed at a clinic and the number of assigned patients. Finally, we controlled for the number of nonfederal PCPs per capita in each clinic's county as a proxy for the competitiveness of the PCP labor markets.…”

Section: Methodsmentioning

confidence: 99%

Identifying Individual and Clinic Characteristics Associated With Primary Care Provider Turnover During Implementation of the Veterans Health Administration Patient-Centered Medical Home

Reddy

Maynard

Kaboli

et al. 2023

Journal of Ambulatory Care Management

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Understanding which factors predict primary care provider (PCP) turnover can help organizations prepare for PCP shortages. We conducted a retrospective cohort study of Veteran Health Administration PCPs between 2012 and 2016. We analyzed whether 7 domains of the patient centered medical home (PCMH) implementation-including access, care coordination, comprehensiveness, self-management support, communication, shared decision-making, and team-based care-were associated with PCP turnover. We found that 2 domains of PCMH (access and self-management) were associated with lower turnover, which may reflect that practice cultures that support these characteristics may lower PCP turnover.

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A Novel Gap Staffing Metric for Primary Care in the Veterans Health Administration and Implications for Rural and Urban Clinics

Cited by 4 publications

References 21 publications

Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making

Impact of the COVID-19 vaccination mandate on the primary care workforce and differences between rural and urban settings to inform future policy decision-making

The Clinical Resource Hub Telehealth Program and Use of Primary Care, Emergency, and Inpatient Care During the COVID-19 Pandemic

Identifying Individual and Clinic Characteristics Associated With Primary Care Provider Turnover During Implementation of the Veterans Health Administration Patient-Centered Medical Home

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