Beyond Business: The Intersection of Health Administration and Patient Care

Dr. Ganisher Davlyatov briefly hesitates when asked about his interdisciplinary research. He notes that much of his work involves health-related research and participation in various projects. As he begins to discuss his current projects, Davlyatov’s initial uncertainty about conducting interdisciplinary research quickly vanishes. 

Social Workers and CMS Determinants of Health Screening  

One of his interdisciplinary projects focuses on collaborating with social workers to collect data on the social determinants of health. He notes, "The Centers for Medicare and Medicaid Services (CMS) encourage all healthcare organizations to collect social determinants of health measures from patients." This means that OU Health also collects the data to ensure compliance with CMS requirements. While nurses, nurse practitioners, physicians, and other healthcare providers can conduct the screening, typically, it is the social workers who conduct more in-depth assessments and connect patients with necessary resources and support services. He has found that a significant barrier to data collection is that social workers aren't paid enough for the time they spend conducting the screenings. That's the first issue. The second issue is the challenge of seeing the benefits of conducting the screenings. "I have spoken with social workers, and they don't see the value because we just do it for the sake of compliance, but we are not following up and helping the patients," states Davlyatov. The screening data is much more valuable if utilized to help improve the quality of life and access to care for patients. "My goal is to figure out how we can use this data to help people," says Davlyatov. For this project, he is interviewing social workers to understand how the screening rates can be increased, how the social workers can be fairly compensated for their time, and ways to ensure patients benefit from the screening data. 

The second component of this research is looking at disparities in how social determinants data are collected. "Let's say we have 10,000 patients, and we need to screen all of them (100% response rate), but that's not possible for a variety of reasons (e.g., time, availability of social workers, and patients' willingness to respond)," Davlyatov explains. "In an ideal scenario, screening would be random, but the reality is that individual demographic factors such as the patient's race, age, gender, and even clothing could affect the likelihood of one’s screening." Davlyatov stresses the need for continuous education and monitoring of the screening process to minimize selection bias and ensure random screening selections. He appreciates that this research has exposed him to the field of social work, helped him understand their perspectives, and shed light on why the response rate is so low. "As a researcher in healthcare administration, I'm thinking about developing a process so that the patients benefit from the screenings and the healthcare providers are motivated to conduct them," states Davlyatov. "It's not just about being CMS compliant; it's about helping local patients." As a next step, Davlyatov is considering using artificial intelligence and machine learning, in combination with electronic health record data, to deter bias and help healthcare providers predict which patients would be appropriate for social screening.   

The Rise of Contract Nurses 

Another project that Ganisher is working on involves collaborating with the OU College of Nursing to research the impact of contract nurses post-COVID. He remarks that many organizations, such as hospitals, nursing homes, and hospices, rely on nursing staff as their main employees. These facilities typically employ nurses full-time, which usually benefits both the nurses and the employers. The pandemic highlighted a significant shortage of nurses in Oklahoma and across the country, leading many facilities to rely on contract work. Contract nurses are full-time employees of a third-party agency, not of a hospital, nursing home, or hospice. "The agency then contracts with multiple organizations, meaning the same nurse may work at ten different locations," notes Davlyatov. The benefit for the nurses is that the pay is often double or triple what they would receive in a traditional setting. However, these positions often lack benefits like insurance, pension, paid leave, etc. Contract nurses benefit an organization when the demand is high, such as during a pandemic, since they can hire nurses on demand but are not committed to paying them when the demand drops. "You don't have to worry about it hurting your bottom line," says Davlyatov. Contract nursing was a win/win situation during the pandemic, but it has persisted. "Many of the younger generation nurses want flexible hours and higher pay," he notes. One of the issues that Davlyatov has observed is that this impacts the culture of traditional organizations and may affect the quality of care.    

"A new nurse every day means that patients and providers don't have an opportunity to bond with the nursing staff," he remarks. In the long term, this ends up hurting the organization's bottom line financially since contract nurses cost significantly more than traditional employees. With this in mind, Davlyatov is working with the OU College of Nursing to brainstorm possible solutions. They plan to speak with several hospital administrators to determine how they are dealing with the rise of contract nursing, whether they have plans to adapt, and if there are policy changes that might help. "The nursing shortage in Oklahoma is a real issue, and it’s increasing our reliance on contract nurses," claims Davlyatov. One of the potential solutions is to increase pay to traditionally employed nurses, but who foots the bill? Patients could end up paying more for care to offset a salary increase. "It's a bit complicated, but we want to understand how administrators are approaching this and what the state and federal governments could do to assist," says Davlyatov. "It was a great temporary solution during the pandemic, but contract nursing isn't sustainable in the long run."  

Oklahoma Medicaid Expansion  

In June of 2023, the George Kaiser Family Foundation awarded Davlyatov a grant to study the economic and fiscal impacts of the 2021 Oklahoma Medicaid expansion. His primary aim is to determine how the expansion affects the State of Oklahoma. 'Essentially, we are looking at how much money the expansion is bringing in and how it’s impacting the State’s budget to determine if we are in the red or the green,' states Davlyatov. His research is multifaceted and considers a variety of factors. For example, states that have expanded Medicaid have noted additional revenue. However, these states have also recognized the need for additional medical providers to serve the expanded Medicaid population. Furthermore, the taxes generated by the expansion also impact secondary businesses in the state. While this research has a significant monetary focus, Davlyatov is also interested in how Medicaid expansion in Oklahoma is helping to improve access to care and the quality of life among our citizens.  

“Now that more people are eligible for and being covered by Medicaid, I want to research which services they are using, how often they are using these services, and how this all affects access to medical care,” states Davlyatov. Fortunately, there is an existing roadmap for this research due to the numerous other states that have previously expanded Medicaid. “We are late in the game,” he says. “We have excellent examples from other states of how and what they did and how it impacted their economy, population, etc.” When asked about his data sources, Davlyatov noted that his team primarily uses public information from the state (e.g., budget details) and Medicaid enrollment data from 2017 to 2022 to determine how many people were enrolled pre- and post-expansion. This data provides critical information about the number of patients, demographics, where they live, and the capacity of the providers in those areas. Davlyatov raises a couple of questions related to the findings: “Do we have enough providers to serve the patients, and how far do the providers live from the population?” At this point, Davlyatov is still in the data collection phase. Once ready for analysis, he will work with his research team on developing policy briefs.