Indiana University-Purdue University Indianapolis (IUPUI) / Introduction: The U.S. is faced with a primary care (PC) workforce shortage; an
estimated 43 percent of the population has unmet health care needs and 18.2 percent of
the adult population lacks a usual source of care (USC) provider. The workforce
shortage limits even those with a USC from receiving the full scope of recommended
clinical services. One promising solution is reforming scope-of-practice (SOP) policies
for PC nurse practitioners (NPs).
Objectives: The primary objective of this dissertation was to assess the impact of
NP SOP policy implementation on NP practice patterns and patient access to PC by
evaluating NP time spent delivering patient care, NP role as USC providers, patient travel
times, and appointment availability.
Methods: The studies discussed in this dissertation leveraged cross-sectional data
from the National Sample Survey of Nurse Practitioners (NSSNP), time-series data from
the Medical Expenditure Panel Survey (MEPS), and the Nurse Practitioner Professional
Practice Index (NPPPI) to quantify variations in state policy environments. We used
generalized mixed effects models to examine relationships in the cross-sectional data
analyses and two-way fixed effect models to evaluate longitudinal data.
Results: Our analyses revealed several key findings: NP SOP policies do impact
the percentage of time NPs spend providing direct patient care; the NP workforce role as
USC providers has increased as SOP policies have changed; states with supportive reimbursement policies have more NPs working as USC providers; and states with fewer
NP supervision requirements have shorter patient travel times to USC providers.
Conclusion: The U.S. health care system must continue to evolve to address the
growing demand for PC services. While strategies to increase the supply of PC providers
may be an effective long-term solution, our findings suggest that NP SOP reform may be
a viable and complementary strategy to increasing the capacity of the PC workforce,
providing more immediate relief. / 2 years
| Identifer | oai:union.ndltd.org:IUPUI/oai:scholarworks.iupui.edu:1805/13389 |
| Date | 09 May 2017 |
| Creators | Norwood, Connor W. |
| Contributors | Harle, Christopher, Menachemi, Nir, Stone, Cynthia, Liu, Ziyue |
| Source Sets | Indiana University-Purdue University Indianapolis |
| Language | en_US |
| Detected Language | English |
| Type | Dissertation |
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