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. 2017 Feb;52 Suppl 1(Suppl 1):437-458.
doi: 10.1111/1475-6773.12643.

Does the Regulatory Environment Affect Nurse Practitioners' Patterns of Practice or Quality of Care in Health Centers?

Ellen T Kurtzman  1 , Burt S Barnow  2 , Jean E Johnson  1 , Samuel J Simmens  3 , Donna Lind Infeld  2 , Fitzhugh Mullan  4
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Does the Regulatory Environment Affect Nurse Practitioners' Patterns of Practice or Quality of Care in Health Centers?

Ellen T Kurtzman et al. Health Serv Res. 2017 Feb.

Abstract

Objective: To examine the impact of state-granted nurse practitioner (NP) independence on patient-level quality, service utilization, and referrals.

Data sources/study setting: The National Ambulatory Medical Care Survey's community health center (HC) subsample (2006-2011). Primary analyses included approximately 6,500 patient visits to 350 NPs in 220 HCs.

Study design: Propensity score matching and multivariate regression analysis were used to estimate the impact of state-granted NP independence on each outcome, separately. Estimates were adjusted for sampling weights and NAMCS's complex design.

Data collection/extraction methods: Every "NP-patient visit unit" was isolated using practitioner and patient visit codes and, using geographic identifiers, assigned to its state-year and that state-year's level of NP independence based on scope of practice policies. Nine outcomes were specified using ICD-9 codes, standardized drug classification codes, and NAMCS survey items.

Principal findings: After matching, no statistically significant differences in quality were detected by states' independence status, although NP visits in states with prescriptive independence received more educational services (aIRR 1.66; 95 percent CI 1.09-2.53; p = .02) and medications (aIRR 1.26; 95 percent CI 1.04-1.53; p = .02), and NP visits in states with practice independence had a higher odds of receiving physician referrals (AOR 1.88; 95 percent CI 1.10-3.22; p = .02) than those in restricted states.

Conclusions: Findings do not support a quality-scope of practice relationship.

Keywords: Nurse practitioner; community health center; quality of care; scope of practice; state policy.

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