State Nurse Practitioner Practice Regulations and U.S. Health Care Delivery Outcomes: A Systematic Review

There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforc...

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Bibliographic Details
Published in:Medical Care Research and Review 2021-06, Vol.78 (3), p.183-196
Main Authors: Yang, Bo Kyum, Johantgen, Mary E., Trinkoff, Alison M., Idzik, Shannon R., Wince, Jessica, Tomlinson, Carissa
Format: Article
Language:English
Subjects:
Access
Clinical outcomes
Delivery of Health Care
Health care
Health care access
Health care delivery
Health care expenditures
Health services
Health services utilization
Health status
Humans
Nurse Practitioners
Policy making
Primary Health Care
Quality of care
Quality of Health Care
Regulation
Regulations
Rural populations
State regulations
Systematic review
Underserved populations
Workforce
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Summary:There is a great variation across states in nurse practitioner (NP) scope of practice moderated by state regulations. The purpose of this study was to synthesize the evidence from studies of the impact of state NP practice regulations on U.S. health care delivery outcomes (e.g., health care workforce, access to care, utilization, care quality, or cost of care), guided by Donabedian’s structure, process, and outcomes framework. This systematic review was performed using Medline, CINAHL, PsycINFO, and PubMed according to Preferred Reporting Items for Systematic and Meta-Analysis on the literature from January 2000 to August 2019. The results indicate that expanded state NP practice regulations were associated with greater NP supply and improved access to care among rural and underserved populations without decreasing care quality. This evidence could provide guidance for policy makers in states with more restrictive NP practice regulations when they consider granting greater practice independence to NPs.
ISSN:1077-5587
1552-6801
DOI:10.1177/1077558719901216