兰德-The-Impact-of-Full-Practice-Authority-for-Nurse-Practitioners-and-Other-Advanced-Practice-Registered-Nurses-in-Ohio_37页_338kb

Summary of the Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practice Registered Nurses in Ohio

Core Content

This report examines the potential impact of granting full practice authority (FPA) to advanced practice registered nurses (APRNs), including nurse practitioners (NPs), certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), and clinical nurse specialists (CNSs), in the state of Ohio. It is based on a comprehensive literature review that evaluates the effects of relaxing scope-of-practice (SOP) laws on health-care access, quality, and costs.

Main Views

• Access and Utilization: Relaxing SOP laws to allow FPA for NPs is likely to increase access to care, as APRNs can provide more services independently. One study found a 2% increase in office visits in states that relaxed SOP laws. Other subjective measures of access, such as timely and convenient care, also improved by up to 10% or more. NPs may also be more willing to work in underserved areas, such as rural regions or with Medicaid beneficiaries.

• Quality and Outcomes: Studies suggest that less-restrictive SOP laws may lead to better quality of care, as evidenced by a 14% reduction in ambulatory care-sensitive (ACS) emergency department (ED) admissions in states with FPA. Patients in these states also report improved self-perceived health and better care experiences, such as providers listening more carefully and explaining things clearly. However, the results are not statistically consistent over time, and the overall impact on quality remains inconclusive.

• Costs: The effect of SOP laws on costs is inconclusive. While some studies indicate that prices for services like well-child visits may decrease due to increased NP supply and competition, total health-care costs could rise due to increased utilization. However, a reduction in ACS-related ED visits may offset some of these increases. States that grant NPs full prescriptive authority tend to have slightly higher overall costs, but this may be due to higher prescription costs rather than an increase in total spending. There is no definitive evidence of an overall cost increase or decrease.

Key Information

• APRN Supply and Practice: APRNs are the fastest-growing segment of the U.S. primary care workforce. However, in Ohio, NPs are restricted and must have a collaborative or supervisory agreement with a physician, which limits their ability to practice independently.

• Literature Review: Three high-quality studies were included in the analysis, all using robust national databases. These studies focused on the impact of SOP changes on access, quality, and costs. Two of the studies were working papers, and only one was published in a peer-reviewed journal.

• State-Specific Impact: The report estimates that if Ohio were to adopt FPA for NPs, it could lead to improved access to care, potential increases in quality, and mixed effects on costs. The findings are extrapolated from studies in other states, as no studies directly assessed the impact of SOP laws on CNMs, CRNAs, or CNSs in Ohio.

• Limitations: The analysis is based on a limited number of studies, and many findings are based on indirect comparisons. The impact of SOP laws on costs is not fully understood, and the effect on other APRN roles remains speculative due to lack of direct evidence.

Conclusion

The report concludes that granting APRNs full practice authority in Ohio could improve health-care access and potentially enhance care quality, with no clear increase in costs. However, due to the limited number of studies and the complexity of SOP laws, the overall impact remains inconclusive. The findings suggest that policymakers and stakeholders should consider the potential benefits of FPA for APRNs while being aware of the uncertainties in cost implications.

Tables Summary

• Table 2.1: Summary of results when SOP laws are changed from restrictive to full practice authority. It shows likely increases in access, possible increases in quality, and inconclusive effects on costs.

• Table 3.1: Indicates that the number of adults receiving preventive-care visits could increase significantly in Ohio if SOP laws are relaxed.

• Table 3.2: Suggests that more Ohio residents would report improved access to care.

• Table 3.3: Shows a reduction in ambulatory care-sensitive ED visits following SOP relaxation.

• Table 3.4: Highlights improvements in patients' self-reported health status and care experiences.

• Table 3.5: Indicates that total health expenditures for office visits may increase due to higher utilization, while ED visits may decrease.

Appendix and References

• The appendix provides detailed information on the literature review methods and the studies assessed.
• References include key studies and organizations that support or caution against the expansion of APRN practice authority.

Key Takeaways

• Access: Likely to improve with FPA for NPs.
• Quality: Possibly enhanced, but evidence is inconclusive.
• Costs: Mixed effects; potential for both increases and decreases.
• State-Specific Context: Ohio has some of the strictest SOP laws in the country, and changing these laws could have significant implications for the state's health-care system.
• Recommendation: The report aims to inform legislators and stakeholders about the potential benefits and uncertainties of expanding APRN practice authority in Ohio.