By Nancy Fishman, BSN, MPH and Maryjoan Ladden, PhD, RN, FAAN. Fishman and Ladden are senior program offers at the Robert Wood Johnson Foundation

Spring is blooming all around us here in central New Jersey and that means nice weather, flowers and a constant search for allergy solutions! For those of us on the Robert Wood Johnson Foundation (RWJF) Human Capital team, this brings up several questions about how to use the primary care workforce more creatively. In this scenario, who in the primary care office could help us with our common allergy symptoms? How would we feel if we went in for a visit and didn’t see a health professional but were instead counseled about common over-the-counter treatments by the medical assistant according to standard protocol?

These are questions that seem practical and every day, but tie back to some basic questions about the primary care workforce and how we could be more creative in using all members of that workforce to improve patient access to care and the value of that care.

At the Robert Wood Johnson Foundation, we are all aware of the shortage of primary care providers – but short of producing a large number of physicians, nurse practitioners and physician assistants this instant – we need to get creative with what we have.

To that end, we are thrilled to be launching a new program to identify those practices that are already creatively using their whole office teams in new ways. This program “The Primary Care Team: Learning from Effective Ambulatory Practices” (LEAP) will first identify and then study sites that have succeeded in providing high quality health care and involving all staff in new and creative ways.

We believe that studying these sites will provide us with insights that we can share with other practices that would like to make changes.

The Robert Wood Johnson Foundation (RWJF) yesterday announced the launch of a new program designed to make primary care more accessible and effective by identifying practices that maximize the services of the primary care workforce.

The Primary Care Team: Learning from Effective Ambulatory Practices (the LEAP Project) will identify primary care practices that use health professionals and other staff in ways that maximize access to their services, so these workforce models can be replicated and adopted more widely. Its goal is to identify and then study the innovative staffing arrangements of up to 30 high-functioning primary care practices.

With millions more Americans poised to enter the health system as the Affordable Care Act is implemented, the new program will identify changes in policy, workforce, culture, education and training related to primary care that can improve the way practices function. “The nation will not be able to train new primary care providers quickly enough to meet the need, so part of the solution must be to use the workforce we have more effectively. This new program will identify ways to do that,” said John Lumpkin, MD, MPH, RWJF senior vice president and director of the Health Care Group.

The LEAP Project will be directed by Ed Wagner, MD, MPH, and Margaret Flinter, PhD, APRN, and the MacColl Center for Health Care Innovation at Group Health Research Institute in Seattle will serve as its national program office. Wagner is director of the MacColl Center and Flinter, a family nurse practitioner by clinical background, is senior vice president and clinical director of the Community Health Center, Inc., a statewide Federally Qualified Health Center in Connecticut and director of its Weitzman Center for Innovation. She is an alumna of the RWJF Executive Nurse Fellows program.

Learn more about the new program here.

Related websites

• Learn more about RWJF funded Improving Chronic Illness Care
• Group Health Research Institute

By Laura Sadowski, MD, MPH, and Romina Kee, MD, Robert Wood Johnson Foundation (RWJF) Clinical Scholar alumnae

Becoming homeless is distressing for anyone, and it is especially challenging for people with chronic health problems who need ongoing care.

The face of America’s homeless population is changing. When the job market collapsed a few years ago, millions of families were forced out of their homes. A 2009 national survey of organizations providing services to the homeless found that an estimated 10 to 19 percent had become homeless in the past year due to foreclosure. Nearly one percent of the U.S. population experiences homelessness each year.

Previous research on the health/medical, legal, housing and social services costs accrued by people who are homeless has focused on subsets of the population—those with mental illnesses, substance abuse problems, or the “chronic homeless” (those who have been without stable housing for 24 or more months). But they comprise a small portion of America’s homeless population. The chronic homeless, for instance, represent just 18 percent.

So how do we ensure that all homeless patients – regardless of their individual circumstances – get the care they need, while reducing costs?

In our study published in a special edition of Health Services Research: Bridging the Gap Between Research and Health Policy, we looked at a novel, broader sample: homeless adults with chronic conditions. Unlike previous studies, the majority of our study subjects were not mentally ill, substance abusers, HIV infected, veterans, or frequent users of the health care system.