Harkness Project Title: Policies for Task-Shifting from Physicians to Nurses in Advanced Roles
Mentor: Linda H. Aiken, Ph.D. (University of Pennsylvania)
Placement: University of Pennsylvania
Biography at time of Harkness Fellowship: Claudia Maier, M.Sc., Dipl-Nursing, a 2014–15 German Harkness/B. Braun Stiftung Fellow in Health Care Policy and Practice, is a policy analyst in health systems and health workforce at Technische Universität Berlin and consultant with the WHO Regional Office for Europe. Prior to this, Maier worked in the Department of Evidence, Innovation, and Policy at UNAIDS on country investment cases on efficiency, sustainable financing and task-shifting, and integration of the HIV response. Earlier, Maier was a technical officer at the European Observatory on Health Systems and Policies, where she worked on the E.U.-funded PROMeTHEUS research project, a cross-country analysis of health professional mobility in the European region, and organized policy dialogues on health policy reforms across the region. She has also previously worked with the European Commission, a state-level Institute of Public Health in Germany, and at the University of Bielefeld, Germany. Her research interests include the health workforce, health professional mobility, task-shifting, integration of HIV/AIDS programs into health systems, and health systems governance. Maier has published in journals including Bulletin of the World Health Organization, Health Policy, and BMC Public Health. She is the editor of a volume on the mobility of health professionals in Europe and has authored various book chapters on the health workforce, mobility of health professionals, and migrant health. She received her M.Sc. in public health from the University of Bielefeld and is a Ph.D. candidate in the Department of Health Care Management at Technische Universität Berlin.
Project: The purpose of Maier’s research is to map the current situation of task-shifting from medical doctors to nurses in advanced roles and analyze the governance and finance situation in which task-shifting has been implemented in the U.S., Europe and other OECD countries. The research will share lessons and present policy options that enable nurses – as part of the primary care workforce - to practice to their full extent of training. A mixed methods approach will be used. First, a literature review, plus key informant interviews will be carried out and a survey sent to country experts. A task-shifting typology will be developed, covering the U.S., Europe and major OECD countries. In a subsequent step, the typology will be linked to major OECD and WHO workforce data in primary care. Second, a more in-depth analysis of the regulatory, finance and reimbursement policies will be carried out in the U.S., and compared to those countries in Europe that have demonstrated effective policy or financing instruments that enable implementation, such as in the Netherlands and two Baltic states, Lithuania and Estonia, and synthesized towards lessons for policy and practice. Third, site visits in the US will be conducted to explore how task-shifting is implemented, how it is incentivized and what role different financing models (fee-for-service vs mixed financing) plays. This research is timely, given the ACA’s health care reform that will translate into higher service use in primary care. The implications on the primary care workforce are significant. Identifying, addressing and removing policy and finance barriers and identifying enablers will be important for policymakers so NPs can practice to their fullest potential.
Email: [email protected]Harkness-Related Publications
H. Barnes, C.B. Maier, D. Altares Sarik, H.D. Germack, L.H. Aiken, M.D. McHugh. “Effects of Regulation and Payment Policies on Nurse Practitioners' Clinical Practices,” Medical Care Research and Review. 2016.
Barnes H, Maier CB, Altares Sarik D, Germack HD, Aiken LH, McHugh MD. “Effects of Regulation and Payment Policies on Nurse Practitioners' Clinical Practices,” Medical Care Research and Review. 2016.
Maier CB, Aiken LH. “Task shifting from physicians to nurses in primary care in 39 countries: a cross-country comparative study,” European Journal of Public Health, 2016.
Maier CB, Barnes H, Aiken LH, Busse R. “A Descriptive, Cross-country Analysis of the Nurse Practitioner Workforce in Six Countries: Size, Growth, Physician Substitution Potential,” BMJ Open. 2016.