2 research outputs found
Recruitment, Retention, and Evaluation Associated with American Recovery and Reinvestment Act of 2009
Healthcare workforce shortages are central to healthcare reform discussions and are critical areas of interest for Indiana State Department of Health (ISDH). The National Health Service Corps (NHSC) is a financial incentive program that provides scholarship or loan repayment to primary healthcare providers in return for periods of obligation serving federally designated underserved communities. The American Recovery and Reinvestment Act of 2009 (ARRA) increased funding to the NHSC program with the intent of strengthening and expanding the NHSC program capacity. In addition to building workforce capacity, funding was made available to State Primary Care Offices (PCOs) for the coordination and implementation of activities to support NHSC participants, enhance recruitment and retention post-obligation, and evaluation of the impact of ARRA funding for the NHSC program.
Indiana Area Health Education Centers (AHEC) Network entered into a contract with ISDH for the purpose of supporting current ARRA-funded NHSC scholars, clinicians, and obligation sites
to improve retention and provider satisfaction. In addition, a team of researchers at the Center for Health Policy (CHP) in the Richard M. Fairbanks School of Public Health, Indiana
University Purdue University Indianapolis (IUPUI) were subcontracted to perform an evaluation of activities outlined in the AHEC contract and evaluate the impact of ARRA funding on NHSC clinician retention, primary healthcare access, and primary care capacity. The NHSC project team, comprised of key personnel from AHEC and CHP, developed and administered surveys, conducted key informant interviews facilitated focus groups to gather data representing perspectives and experiences from ARRA-funded NHSC clinicians and obligation sites administrators to identify key issues and generate recommendations for the Indiana NHSC Program. The NHSC project team was comprised of key personnel from AHEC and CHP. The team developed and administered surveys, conducted key informant interviews, and facilitated focus groups. The activities were carried out to gather data on perspectives and experiences of
ARRA-funded NHSC clinicians and site administrators in order to generate recommendations for the Indiana NHSC Program
Empagliflozin in Patients with Chronic Kidney Disease
Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo