Impact of Nurse Practitioner Practice Regulations on Rural Population Health Outcomes

Healthcare - Tập 6 Số 2 - Trang 65
Judith Ortiz1, Richard Hofler2, Angeline Bushy3, Yi-Ling Lin1, Ahmad Khanijahani1, Andrea Bitney4
1College of Health and Public Affairs, University of Central Florida, Orlando, FL 32816, USA
2College of Business Administration, University of Central Florida, Orlando, FL 32816, USA
3College of Nursing, University of Central Florida, Orlando, FL 32816, USA
4College of Sciences, University of Central Florida, Orlando, FL 32816, USA

Tóm tắt

Background: For decades, U.S. rural areas have experienced shortages of primary care providers. Nurse practitioners (NPs) are helping to reduce that shortage. However, NP scope of practice regulations vary from state-to-state ranging from autonomous practice to direct physician oversight. The purpose of this study was to determine if clinical outcomes of older rural adult patients vary by the level of practice autonomy that states grant to NPs. Methods: This cross-sectional study analyzed data from a sample of Rural Health Clinics (RHCs) (n = 503) located in eight Southeastern states. Independent t-tests were performed for each of five variables to compare patient outcomes of the experimental RHCs (those in “reduced practice” states) to those of the control RHCs (in “restricted practice” states). Results: After matching, no statistically significant difference was found in patient outcomes for RHCs in reduced practice states compared to those in restricted practice states. Yet, expanded scope of practice may improve provider supply, healthcare access and utilization, and quality of care (Martsolf et al., 2016). Conclusions: Although this study found no significant relationship between Advanced Registered Nurse Practitioner (ARNP) scope of practice and select patient outcome variables, there are strong indications that the quality of patient outcomes is not reduced when the scope of practice is expanded.

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Tài liệu tham khảo

Office of Minority Health (2018, June 12). HHS Action Plan to Reduce Racial and Ethnic Health Disparities: Implementation Progress Report 2011–2014, Available online: https://www.minorityhealth.hhs.gov/assets/pdf/FINAL_HHS_Action_Plan_Progress_Report_11_2_2015.pdf.

Office of Minority Health (2018, June 12). Minority Population Profile, Available online: https://www.minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=26.

Institute of Medicine (IOM) (2018, June 12). The Future of Nursing: Leading Change, Advancing Health, Available online: https://www.ncbi.nlm.nih.gov/pubmed/24983041.

Van Vleet, A., and Paradise, J. (2018, June 12). Tapping Nurse Practitioners to Meet Rising Demand for Primary Care. Available online: https://www.kff.org/medicaid/issue-brief/tapping-nurse-practitioners-to-meet-rising-demand-for-primary-care/.

National Council of State Legislatures (NCSL) (2018, June 12). Meeting the Primary Care Needs of Rural America. Examining the Role of Non-Physician Providers. Available online: http://www.ncsl.org/research/health/meeting-the-primary-care-needs-of-rural-america.aspx.

American Association of Nurse Practitioners (AANP) (2018, June 12). Scope of Practice for Nurse Practitioners. Available online: https://www.aanp.org/images/documents/publications/scopeofpractice.pdf.

American Association of Nurse Practitioners (ARNP) (2018, June 12). State Practice Environment. Available online: https://www.aanp.org.

Graves, 2016, Role of geography and nurse practitioner scope-of-practice in efforts to expand primary care system capacity, Med. Care, 54, 81, 10.1097/MLR.0000000000000454

Kurtzman, 2017, Does the regulatory environment affect nurse practitioners’ patterns of practice or quality of care in health centers?, Health Serv. Res., 52, 437, 10.1111/1475-6773.12643

Sakr, 1999, Care of minor injuries by emergency nurse practitioners or junior doctors: a randomized controlled trial, Lancet, 354, 1321, 10.1016/S0140-6736(99)02447-2

Newhouse, 2011, Advanced practice nurse outcomes 1990–2008: A systematic review, Nurs. Econ., 29, 230

Sonenberg, 2017, Considering disparities: How do nurse practitioner regulatory policies, access to care, and health outcomes vary across four states?, Nurse Outlook, 65, 143, 10.1016/j.outlook.2016.10.005

Centers for Medicare and Medicaid Services (2018, June 12). Rural Health Clinic, Available online: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/RuralHlthClinfctsht.pdf.

University of Washington (2018, June 12). Rural Urban Community Area (RUCA) Codes Maps. Available online: http://depts.washington.edu/uwruca/ruca-maps.php.

1998, Tutorial in biostatistics: propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group, Stat. Med., 17, 2265, 10.1002/(SICI)1097-0258(19981015)17:19<2265::AID-SIM918>3.0.CO;2-B

Brookhart, 2006, Variable selection for propensity score models, Am. J. Epidemiol., 163, 1149, 10.1093/aje/kwj149

Martsolf, 2016, Cost of transformation among primary care practices participating in a medical home pilot, J. General Int. Med., 31, 723, 10.1007/s11606-015-3553-6

Spetz, 2017, Nurse practitioner autonomy and satisfaction in rural settings, Med. Res. Rev., 74, 227

National Council of State Legislatures (NCSL) (2018, June 12). Closing the Gaps in Rural Primary Care Workforce. Available online: http://www.ncsl.org/research/health/closing-the-gaps-in-the-rural-primary-care-workfor.aspx.

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Healthcare

Tập 6 Số 2

65

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