We mailed 11,000 surveys for the California Board of Registered Nursing last week - I think they went out on Wednesday May 7.  10,000 of these are 16-page surveys for nurses with Active licenses, and 1000 are shorter surveys for nurses with inactive or expired licenses.  

On Monday this week we started to get some "return to sender/undeliverable" envelopes back.  On Tuesday we got some more.

On Wednesday we got more "return to senders" and then we also got these completed surveys...The pile on the left is now almost fully logged with a count of 100 so far.  I think the total count for those piles will be about 220.

 

And then on Thursday, we got this:

 

Holy crap!  Yes, that's four completely full boxes of completed surveys.  Since the Wednesday delivery filled one box, I think there must be at least another 800 returned surveys here, making a total of 1000 returns in the first 2 days we have been getting any back.

To say that we are feeling a bit swamped would be an understatement.   But we also are very excited!  Whenever you receive a survey, and are tempted to throw it in the trash, please remember that there are researchers like me who need your help.  State government agencies want to understand trends in nursing employment, education, and job satisfaction so they can plan smart policies to address problems.  The success in California of expanding nursing education programs and moving us toward an end to our nursing shortage was driven at least in part by data that clearly showed the scope of the problem and analyses that estimated exactly how many more RNs we need to graduate to solve the problem.  

So do your nice, earnest, policy-wonk researchers a favor, and fill out your surveys!

The buzzphrase in health care policy over the past few years has been Pay for Performance, sometimes charmingly abbreviated P4P.  The theory behind this is that health care providers, such as hospitals, have historically been paid the same amount of money whether or not they provide excellent quality health care.  In fact, some payment schemes - such as those that offer extra payment for extremely expensive patients - may reward poor performance.  When Aunt Thelma gets a hospital-acquired infection, she is in the hospital longer and the hospital may get more money from insurance companies.

If one could come up with a good way to pay hospitals, doctors, and others more money when they do better, then they'd be paid like most of the rest of us.  If they do better they should be paid more, right?  Even the federal government has embraced this idea, in Medicare for example, as well as state Medicaid programs.  Private insurers in the US and the Brits, with their centralized National Health System, are moving into this area as well.  Some very good research indicates that these programs can help improve quality of care and improve the cost vs. effectiveness of health care.  

P4P has potential to improve the value of what we pay for in health care, thus raising quality and perhaps even cutting costs.  So what's the catch?  If a hospital (or other provider) doesn't have an adequate budget to engage in quality-improving activities, P4P programs are not likely to be helpful.  In fact, P4P could result in hospitals with already-tight budgets being penalized for low performance, thus starving them financially and reducing their ability to address quality problems.  

This is all theory, or at least was until a paper published in the Journal of the American Medical Association.  The focus of the study is hospitals designated as "Safety-Net Hospitals', meaning those that care for high shares of the poor and uninsured.  Many of these hospitals are located in central cities and rural areas, a large share are publicly funded, and they tend to be chronically short on money because Medicaid payment are low and many of their patients are not insured by any program or company.  Rachel Werner, a researcher at the VA in Philly, and her colleagues conclude: "Safety-net hospitals tended to have smaller gains in quality performance measures over 3 years and were less likely to be high-performing over time than non–safety-net hospitals. An incentive system based on these measures has the potential to increase disparities among hospitals."

This differential between the safety-net hospitals and other hospitals highlights that the issues faced by the majority of US residents who have health insurance are totally different from those of the uninsured and poor.  Those of us with insurance can whine about the cost of insurance and the poor quality of care we think we get, but... what about those who don't have any insurance at all, who are depending on under-funded hospitals and doctors who don't want to take Medicaid because the payments are too low?  Do we care enough to push for universal health insurance?  What are we willing to give up to get universal coverage?

Now, don't tell me we can get universal coverage without giving up anything.  I'm an economist, and economics is all about trade-offs.  Zero-sum and all that...

Thank goodness, our Surveys of California RNs have gone in the mail!  If you get one please fill it out... 

I finished the Sea Otter socks at the Berkeley Conference on Global Health Workforce this weekend.  It was a great conference, with many interesting papers and a wordwide set of attendees.  I think those who traveled the farthest came from Uganda, although the woman from Thailand could have traveled farther.  There was a heavy emphasis on the health workforce issues of Africa, which are immense.  The issues are not simply with whether there are enough workers, but also whether the governments have enough money to pay them, whether they show up at work, and whether they live in the places of greatest need.  I heard several times: "The government pretends to pay the workers, and the workers pretend to work."  

This is a good moment to remember Knitters Without Borders, which helps provide key medical services to those in great need.

Anyway, here are the socks.  Project details on Ravelry.

   

Orlando is a strange place.  Our 2000 person academic/policy conference was here.



Above is the view from a suite near the top floor of the Dolphin. Yes, those are huge, enormous swans on top of the other hotel building.  When I drove up in the shuttle from the airport, all I could think was "holy crap!"

So we went to Downtown Disney for dinner.  Really, where else would you go?  And there are enormous Lego dinosaurs around.



There's also a nightclub complex called Pleasure Island - about 8 clubs, ranging from comedy to hip-hop to heavy metal to dance.  We hit the dance place. One of our group found it so amusing he has posted a YouTube of a few of us dancing.  You'll have to go there and search on health economists gone wild to find it - it's a bit too embarrassing to link here, but not so embarrassing I won't let you look for it if you want.

I spent a fair number of conference session swatching the yarn I bought in Barcelona two years ago.



At the bottom of the above swatch is garter stitch, because I was thinking I'd do the multidirectional tank top that Lenore loves.  However, the fluffy bits in the yarn stick out oddly with garter stitch, and I don't like it.  And the gauge gets wonky.  So in the middle is stockinette.  Much better, isn't it?  On top is 2x2 rib, which I think is ok also.

But a full stockinette top sounds horribly boring to me, especially coming off the giant stockinette mohair sweater (that is not done yet).  How about this?



A cousin of the Jaywalker zigzag, 4 straight stitches between each increase or decrease part.  I think this is it.  I washed it and it's drying now - I will then use Knitware to put together the pattern.

Yesterday I was downtown for a conference of the State Nursing Workforce Centers, and there in Union Square are signs honoring UCSF's Nursing School for its 100th anniversary.  Pretty odd to see that among the downtown shoppers!

The first leg of my summer travels is approaching - all work and no play.  The first stop will be the AcademyHealth meeting in Orlando, June 1-5.  I'm presenting a paper on forecasting nursing shortages, chairing a session, and participating in a roundtable on innovative approaches in nursing workforce policy.  (If you haven't figured out my research specialty by now...)

The Orlando part of this kinda sucks.  It's going to be hot, the kids aren't out of school yet, and there won't be enough spare time to hit Epcot.  Or if there is some time I have a hard time shelling out a ton of money for 3 hours at Epcot.  And Disney things just aren't the same without K and CJ.

Then I'm back for a few days.  There will be the State Nursing Workforce Centers conference in San Francisco immediately upon my return, and then I'm presenting a report to the Board of Registered Nursing on that Friday.

And then it's the Girl Scouts Camporee at Camp Jones Gulch.

And then it's a Sunday departure to get to Martinsburg WV for a site visit for another study (not nursing!), and then to New Jersey for a Nursing Economics conference.  And then I come home.

I'm missing the last day of school for K and CJ.  And I'm missing the next-to-the-last-day picnics for both their classes.  At least I'll be back to enjoy the Friday that they have no school, before the summer day-camp thing begins.  

So, if I don't post much, that's why.  Oh yeah, and the report and grant proposal I have to write.  I'm skeining yarn, I promise.  I hope to have a delivery for 9R by Thursday!

I just got the score of my application for a federal research grant - this is a grant that got a great score two years ago, but the funds of the agency were changed mid-year, leaving me high and dry...

Anyway, my grant was in the top four reviewed this cycle at the agency!  That means the grant will definitely be considered for funding, and given its score, odds are really good that I'll finally get to do this study.  I've been working on this for four years, and am about to pop with excitement!!!

I guess that means I won't be lose my day job anytime soon - less time for dyeing yarn, but that's ok!

1. Teaching.  It's Advanced Quantitative Methods for 2nd year doctoral students.  I'm co-teaching, so I didn't do the first lecture, but I'm doing lectures 2, 3, 4, 6, 8 or something like that.  The students seem to have kept up with me this week... and I didn't see anybody fall asleep.  If anything can put you to sleep, it's this material... unless you're a major data geek like I am.

2. Surveys.  



This baby goes in the mail Monday.  We are surveying 8000 nurses with active California licenses, and 1000 with inactive or recently lapsed licenses.  I doubt any nurses who get the survey are reading this, but... if you get the survey, please please please please fill it out and mail it back!  Or, please go on line to complete it.

3. Socks.



This is the second sock - I've started the heel flap.  The yarn is fun and reasonably comfy, but I think I prefer to do a bit of pattern.  Maybe it's time for another pair of Embossed Leaves?

4. Freezing in Yosemite.  We went camping last weekend at Tuolumne Meadows and it was literally freezing.  So freezing that our water in the water jugs froze.  We wore all our clothes to bed and still were cold.  But, the hiking was beautiful and the days weren't too hot (!!).

There are other things in the works, but no photos.  I am doing cardi in Noro Blossom, swatching some mohair boucle for a pullover, and plotting my next bath of dyeing.  I'm awaiting a bit lot of undyed yarn to attack... including a surprise for a family member!

Well, actually, on the internet.  Click here.

Yipes!

Last Saturday, I went to CJ's dance recital, held by Kirkpatrick's School of Dance.  To say this was a high-stakes recital, especially compared with our Parks-and-Recreation-Department experience, is an understatement.  People were putting makeup on their 5-year-olds.  CJ thankfully refused the offers of blush and lip gloss.  I think she looked fabulous in her natural beauty, but that might just be because I'm her mom.



She tap-danced to a song from Oklahoma, which was adorable.  She's the third from the right.



I'm hoping that MIL managed to get photos with better zoom. I had the digital camera, which wasn't ideal.

I left before intermission and dashed to the airport for the AcademyHealth meeting in Seattle.  I presented posters on two projects (learn more here and here) on Sunday.  After attending 10 straight hours of meetings and conference research sessions, I went on a nice walk with Beth & Surrey, grabbed a beer, and then had dinner at Palace Kitchen with a group.  The oddest thing of the day: the luncheon plenary was a great talk about infectious microbes and national security, including the bird flu, right after we ate chicken for lunch. 

Monday involved more sessions, starting with a RWJF breakfast at 8am and going until I finished the lunch and took a break with Julie.  We caught a bus and headed here:



Hilltop Yarns, in the Queen Anne neighborhood.  We picked it based on proximity and good reviews on the web.  It's lovely inside.  


Most of what they had I can find in the SF region, but I did make some purchases.  I have three words that justify my buying.



Fleece Artist



Handmaiden

The Fleece Artist is their sock yarn.  You can find Fleece Artist in one shop in the SF area.  Yep, just one.  As for the Handmaiden... you just can't get it in California.  Really.  30 million people in this state and not one shop sells Handmaiden.  I think that justifies purchases of the new Sea Silk and some Silk Rumple, don't you?  That Sea Silk is as beautiful as the reviews - they had a sample scarf in the purple you see above, and the drape and sheen are amazing.

With our purchases in tow, we headed back to the conference for a few more sessions.  There was another group dinner - this one with Surrey, Janet, and Steve.  And a few martinis.  Surrey and I (and Steve, who got separated from us, but that's another story) tried to find nightlife, but apart from some strange dudes who weren't sure if they were drunk or inept muggers and a biker bar called Shorty's, we struck out.

Alas.  Tuesday made up for it.  None of the conference sessions were appealing, so I went to Pike Place Market to get small gifts for the kids, and then took a cab to the small boat harbor for a bit of this.


Brought to you by Captain Steve.  



Perfect weather, great views.  We could see Mt Rainier and snow on top of the Olympics, although there was enough haze and fog that the photos didn't turn out well.  Some things are better left to memory.

I had one more dinner with Janet and a friend of hers, and spent all day Wednesday on a site visit for a study.  I got home in time to see the kids before they went to bed (whew!!!).  Today I had to go to the office, but Saturday we leave for vacation, so I didn't feel too guilty about heading out another day.

Now, about that vacation... tent cabins, lots of sitting time.  Socks are a given.  Should I bring the cable-eight sleeveless top in Pachuko Cotton too?  I'm definitely going to work on the yarn I got from Dye-O-Rama...

I am proud to say that we, the dorky Health Economist of Lynn, Steve, and Surrey, closed down Madison.  On a Monday night.  Yeah, it wasn't that hard.

And I got this much done on the Embossed Leaves Socks.  What a great pattern!



And here is the best geek promotional material I've seen in a long time.  I think Lauren would especially appreciate it.



I returned home to find a huge pile of packages waiting for me.  It's like Christmas!  All had great goodies, some ordered, some not.

I have coffee, which I am drinking now.



We have Jacquard dyes from Dharma, for my next foray into dyeing and maybe selling.



We have the new June Bug sock yarn for Project Spectrum from Mama-E.



And now I'm saving the best for last!  I opened the box from Canada to find this lovely wrapping and some postcards from Cowichan Valley, BC. and Vancouver Island.  It's from Gina Davison, my Dye-O-Rama Buddy!



And here's what's under the ribbon. 


From left - her yarn (Stormy Seas, which is simply beautiful.  Louet Gems Pearl is the base yarn and the color is deep blue with some hint of dark turquoise and purple, and other colors.  Really amazing!  I cannot wait to work on it.  You also can see some  Eucalan.  But what else is in here?



Here's another shot of the yarn (more to come in better light soon).  And also some #1 DPNs from Crystal Palace (so I can start socks!), Harlan's chocolates (mmmm), and this really cool Zip Clip in a knitting motif to put on a zipper (I think I know what garment will get it).  Oh yes, and a lovely bag for putting the sock I'm knitting in while I work on it (see the top right).  What a generous package!  I am so thrilled with that yarn. It's very different than I would have dyed myself given my directions, which makes it even more fabulous.  

Thanks Gina!

Today is Montessori Graduation from my preschooler.  How quickly they grow up!

One of the themes I've seen in many blogs post-Olympics is the pleasure and confusion of being permitted polygamy in knitting.  The most visible sign is the Yarn Harlot, of course, who has been doing nothing but garter stitch.  Lu is having the same problem, with small projects and many new things underway.  And Xanthia is looking into crochet, of all things!  

I guess I'm following the trend.  I finished the Glitter Fringe scarf while in Tahoe, as well as the baby hat for Davis.  Photos later.

I pulled out the White Lies Designs Bella kit (in rose wool) and put all the yarns into balls.  I also pulled out the Tess sock yarn for the DH socks.

And then I pulled out the Artful Yarns Broadway (color #3) to make the diagonal scarf on the ball label (a brainless project for my seminar today, which I messed up and had to frog 5 rows).

But now I'm thinking about Frank's wife going through chemo and am thinking a chemo cap might be the ticket.  I have some leftover 1824 cotton in a lovely sage green that is very soft...  And Sue could use a cheerful scarf after her chemo.  Somehow doing this breast cancer study with Mary has made me more sensitive to those I know who have the disease.