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Introduction Since 2002, there has been dramatic growth in the number of registered nurse (RN) graduates from nursing programs in all types of institutional settings, with the largest increases in the for-profit sector. Aim To document trends in the growth of nursing programs and to compare their outcomes, as measured in first-time NCLEX® pass rates, by ownership type and degree, including bachelor of science in nursing, associate degree in nursing, and practical nurse. Methods We used 10 years of data (2007-2016) from the Integrated Postsecondary Education Data System (IPEDS) to track the number of programs and graduates by ownership type. We obtained 5 years of data (2011-2015) from state boards of nursing on first-time NCLEX pass rates by degree. We constructed a multivariate regression model with pass rates as the dependent variable and school ownership status as the independent variable. Covariates included a broad range of institution-level covariates obtained from IPEDS and county-level data on poverty obtained from the Area Health Resource File. Results From 2007-2016, there was a five-fold increase in the total number of for-profit nursing programs and a 14-fold increase in the number of graduates of for-profit nursing programs. Graduates of public nursing programs declined as a percentage of total graduates, whereas for-profit programs' share grew from 1.7% to 14.2 %. After controlling for demographic and socioeconomic factors, for-profit ownership was a significant predictor of lower NCLEX pass rates for all three degree programs. Conclusions Additional research is needed to understand why ownership status affects performance, but it is incumbent upon nursing leaders to review federal, state, and accreditation oversight to ensure minimum performance standards for all nursing programs.

Background Contraception care is essential to providing comprehensive healthcare; however, little is known nationally about the contraception workforce. Previous research has examined the supply, distribution, and adequacy of the health workforce providing contraception services, but this research has faced a series of data limitations, relying on surveys or focusing on a subset of practitioners and resulting in an incomplete picture of contraception practitioners in the United States. Objective This study aimed to construct a comprehensive database of the contraceptive workforce in the United States that provides the following 6 types of highly effective contraception: intrauterine device, implant, shot (depot medroxyprogesterone acetate), oral contraception, hormonal patch, and vaginal ring. In addition, we aimed to examine the difference in supply, distribution, the types of contraception services offered, and Medicaid participation. Study Design We constructed a national database of contraceptive service providers using multiple data sets: IQVIA prescription claims, preadjudicated medical claims, and the OneKey healthcare provider data set; the National Plan and Provider Enumeration System data set; and the Census Bureau’s American Community Survey data on population demographics. All statistical analyses were descriptive, including chi-squared tests for groupwise differences and pairwise post hoc tests with Bonferroni corrections for multiple comparisons. Results Although 73.1% of obstetrician-gynecologists and 72.6% of nurse-midwives prescribed the pill, patch, or ring, only 51.4% of family medicine physicians, 32.4% of pediatricians, and 19.8% of internal medicine physicians do so. The ratio of all primary care providers prescribing contraception to the female population of reproductive age (ages, 15–44 years) varied substantially across states, with a range of 27.9 providers per 10,000 population in New Jersey to 74.2 providers per 10,000 population in Maine. In addition, there are substantial differences across states for Medicaid acceptance. Of the obstetrician-gynecologists providing contraception, the percentage of providers who prescribe contraception to Medicaid patients ranged from 83.9% (District of Columbia) to 100% (North Dakota); for family medicine physicians, it ranged from 49.7% (Florida) to 91.1% (Massachusetts); and for internal medicine physicians, it ranged from 25.0% (Texas) to 75.9% (Delaware). For in-person contraception, there were large differences in the proportion of providers offering the 3 different contraceptive method types (intrauterine device, implant, and shot) by provider specialty. Conclusion This study found a significant difference in the distribution, types of contraception, and Medicaid participation of the contraception workforce. In addition to obstetrician-gynecologists and nurse-midwives, family medicine physicians, internal medicine physicians, pediatricians, advanced practice nurses, and physician assistants are important contraception providers. However, large gaps remain in the provision of highly effective services such as intrauterine devices and implants. Future research should examine provider characteristics, programs, and policies associated with the provision of different contraception services.

Background Care coordination is generally viewed as a key to success for health systems seeking to adapt to a range of new value-based payment policies. Purpose This study explores care coordination staffing in four health systems participating in new payment models, including Medicaid payment reform and Accountable Care Organizations. Methods Comparative case study design is used to describe models of care coordination. Analysis of 43 semi-structured interviews with leadership, clinicians, and care coordination staff at four health systems engaged in value-based contracts. Discussion Each of the sites engaged in significant task shifting of low-complexity care coordination activities to licensed practical nurses, medical assistants, and other unlicensed personnel freeing up registered nurses and social workers for more complex patients. Few have care coordination experience, requiring a significant investment in on-the-job training. Conclusion Payment reform is leading to a greater investment in the care coordination workforce. However, demonstrating the return on investment remains a challenge.

Objectives This study focuses on whether and how Pioneer Accountable Care Organization (ACO) leaders believe the deployment of the registered nurse workforce is changing in response to the shared savings incentives. Methods Semistructured phone interviews with leaders from 18 of the original 32 Pioneer ACOs were conducted. Results Narrative analysis suggests that all of the organizations are developing new and enhanced roles for registered nurses across the continuum of care. Overall, eight types of changes were reported: enhancement of roles, substitution, delegation, increased numbers of nurses, relocation of services, transfer of nurses from one setting to another, the use of liaison nurses across settings, and partnerships between nurses coordinating care in primary and acute care settings. Conclusions This exploratory study suggests that Pioneer ACO leaders believe that payment models are affecting the deployment of the health workforce and that these changes are, in turn, driving outcomes.