兰德-The-Impact-of-Establishing-a-Full-Scope-of-Practice-for-Advanced-Practice-Registered-Nurses-in-the-State-of-Indiana_51页_647kb

Summary of "The Impact of Establishing a Full Scope of Practice for Advanced Practice Registered Nurses in the State of Indiana"

Core Content

This report examines the potential impact of granting full scope of practice (SOP) authority to Advanced Practice Registered Nurses (APRNs) in Indiana, including nurse practitioners (NPs), certified nurse midwives (CNMs), clinical nurse specialists (CNSs), and certified registered nurse anesthetists (CRNAs). It draws on a prior literature review and a conceptual framework to estimate the effects of full SOP on provider supply, access to care, utilization, costs, quality of care, and health outcomes in Indiana.

Main Findings

• Provider Supply: Full SOP is associated with a possible improvement in provider supply. While most studies found a positive correlation, the majority used cross-sectional data, which limits the ability to determine causality.
• Access to Care: Full SOP may improve access to care, particularly for underserved populations. Studies suggest that APRNs with full authority can increase the availability of care in areas with physician shortages.
• Utilization: There is evidence that full SOP can lead to increased utilization of health care services, including more office-based visits and annual checkups.
• Costs: Full SOP may reduce overall health care costs by increasing the supply of providers and reducing the need for physician oversight, which can lower administrative expenses.
• Quality of Care: Full SOP is linked to a possible improvement in the quality of care as measured by patient experience. However, there is limited evidence on the impact of SOP on clinical outcomes.
• Health Outcomes: While some studies suggest that full SOP may improve health outcomes, the evidence is inconclusive due to the limited number of high-quality studies and the focus on patient experience rather than clinical outcomes.

Key Information

• Current Regulations in Indiana: APRNs in Indiana are required to have a collaborative agreement with a physician to prescribe medications. These agreements involve a physician reviewing 5% of an APRN's prescriptions weekly and APRNs paying an annual fee.
• Effect of Full SOP: Allowing APRNs full prescriptive and practice authority could increase their productive capacity and provider supply, leading to better access to care, especially in rural and underserved areas.
• Cost Implications: Restrictive SOP regulations increase both administrative and psychic costs for APRNs and health care organizations. Full SOP could reduce these costs and improve efficiency.
• Methodology: The literature review included 20 studies, using data from 1988 to 2013. These studies were categorized based on their focus (provider supply, access, utilization, costs, quality, and patient outcomes) and their methodological quality.
• Study Quality: Studies using longitudinal data and regression adjustment had the lowest risk of bias, while cross-sectional designs and those without adjustment had the highest risk of bias.
• Limitations: The evidence is limited, particularly for APRNs other than NPs. Most studies focus on NPs, and the findings on CNMs, CNSs, and CRNAs are less robust.

Conclusion

The report concludes that while the evidence for the impact of full SOP on APRNs in Indiana is not comprehensive, it suggests that full SOP could improve access to care, utilization, and potentially reduce costs. However, due to the limited number of high-quality studies, the effects on quality and health outcomes remain inconclusive. The findings are intended to inform policymakers, professional associations, and stakeholders in Indiana about the potential benefits and challenges of expanding APRN SOP.

Appendix Overview

• Appendix A: Literature Review Flow Diagram – Outlines the process of identifying and screening studies.
• Appendix B: Detailed Article Summaries – Provides in-depth descriptions of each study included in the review.
• Appendix C: Study Quality Dimensions – Summarizes the quality of each study based on data recency, generalizability, and risk of bias.
• Appendix D: Methods Details – Explains the methodology used in the literature review and the conceptual framework.
• Appendix E: Summary of Effect Estimates – Presents detailed estimates of the effects of full SOP on various health care domains.

References

The report references a variety of studies and sources, including the National Bureau of Economic Research, the Agency for Healthcare Research and Quality, and the National Conference of State Legislatures, to support its findings.

Key Terms

• APRN: Advanced Practice Registered Nurse
• SOP: Scope of Practice
• NP: Nurse Practitioner
• CNM: Certified Nurse Midwife
• CNS: Clinical Nurse Specialist
• CRNA: Certified Registered Nurse Anesthetist
• ACS: Ambulatory Care Sensitive
• ED: Emergency Department

Table of Results