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

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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; =.02) and medications (aIRR 1.26; 95 percent CI 1.04–1.53; =.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; =.02) than those in restricted states.

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

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