NP References

The following list of articles and opinion pieces demonstrate the quality, professionalism, outcomes, patient satisfaction and cost effectiveness of nurse practitioners.  Simply click on the link to view the study, article or summary.

 

Online Articles & Reports Relevant to Quality/Outcomes, Cost Effectiveness of

and Access to Nurse Practitioner Services

 

American Academy of Nurse Practitioners. (2010). Quality of nurse practitioner practice. Austin, TX: Author. http://www.npagr.org/QualityofNPPracticeAANP.pdf

American Association of Nurse Practitioners. (2012). Nurse practitioner perspective on requiring team based care for individual licensure. Austin, TX: Author. http://www.aanp.org/images/documents/federal-legislation/NPPerspectiveonReqTeamBasedCare.pdf

Florida Senate Committee on Health Regulation. (2008). Authorization for advanced practice registered nurses to prescribe controlled substances. Tallahassee, FL: Author. https://flanp.org/files/2009-117hr.pdf

Kentucky Coalition of Nurse Practitioners and Nurse Midwives. (2009). Nurse practitioners and nurse midwives provide quality, cost-effective care but barriers to their practice decrease patient access to care. Retrieved from http://www.kcnpnm.org/?page=white_paper

Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, C.E…. & Von Kohorn, I. (2012). Core principles & values of effective team-based health care. Discussion Paper, Institute of Medicine, Washington, DC. Retrieved from http://www.iom.edu/Global/Perspectives/2012/TeamBasedCare.aspx

Newhouse, R.P., Stanik-Hutt, J., White, K.M., Johantgen, M., Bass, E.B., Zangaro, G., Wilson, R.F., Fountain, L…. & Weiner, J.P. (September-October 2011).  Advanced practice nurse outcomes 1990-2008: A systematic review.  Nursing Economics, 29(5), 1-21.  Retrieved from https://www.nursingeconomics.net/ce/2013/article3001021.pdf

Safriet, B.J. (2011).  Federal options for maximizing the value of advanced practice nurses in providing quality, cost-effective health care. In Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health (Washington, DC: National Academies Press), 443-475. http://www.nap.edu/openbook.php?record_id=12956&page=443

 

COST-EFFECTIVENESS

American Academy of Nurse Practitioners. (2010). Nurse practitioner cost-effectiveness. Austin, TX: Author. http://www.unitedhealthgroup.com/hrm/unh_workingpaper1.pdf

Eibner, C., Hussey, P., Ridgely, M., & McGlynn, E. (2009). Controlling health care spending in Massachusetts: An analysis of options. Santa Monica, CA: RAND Corporation. http://www.rand.org/pubs/technical_reports/TR733.html

Florida Legislature Office of Program Policy Analysis and Government Accountability [OPPAGA]. (2010). Expanding scope of practice for advanced registered nurse practitioners, physician assistants, optometrists, and dental hygienists; Research Memorandum. Tallahassee, FL: Author. https://flanp.org/files/OPPAGA-Scope-of-Practice-Memo_1-13-2011.pdf

Florida TaxWatch. (2010). Report and recommendations of the Florida TaxWatch Government Cost Savings Task Force for fiscal year 2011-12. Tallahassee, FL: Author. https://flanp.org/files/Florida-tax-watch2011-2012.pdf

Institute for Alternative Futures.  (January 2012).  Primary Care 2025: A Scenario Exploration. Alexandria, VA.   Retrieved from http://www.altfutures.org/pubs/pc2025/IAF-PrimaryCare2025Scenarios.pdf

Institute of Medicine. (2012a). Geographic adjustment in Medicare payment – Phase I: Improving accuracy. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2011/Geographic-Adjustment-in-Medicare-Payment-Phase-I-Improving-Accuracy.aspx

Institute of Medicine. (2012b). Geographic adjustment in Medicare payment – Phase II: Implications for access, quality, and efficiency. Washington, DC: The National Academies Press. Retrieved from http://iom.edu/Reports/2012/Geographic-Adjustment-in-Medicare-Payment-Phase-II.aspx

Kentucky Coalition of Nurse Practitioners and Nurse Midwives. (2009). Nurse practitioners and nurse midwives provide quality, cost-effective care but barriers to their practice decrease patient access to care. Retrieved from http://www.kcnpnm.org/?page=white_paper

Safriet, B.J. (2011).  Federal options for maximizing the value of advanced practice nurses in providing quality, cost-effective health care. In Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health. Washington, DC: National Academies Press, pp. 443-475. http://www.nap.edu/openbook.php?record_id=12956&page=443

The Perryman Group. (2012). The economic benefits of more fully utilizing advanced practice registered nurses in the provision of health care in Texas: An analysis of local and statewide effects on business activity. Waco, TX: Author. https://flanp.org/files/Perryman-APRN-Ultilization-Economic-Impact-Report-May-2012.pdf

UnitedHealth Center for Health Reform & Modernization. (2009). Federal health care cost containment – How in practice can it be done? Options with a real world track record of success. http://www.unitedhealthgroup.com/hrm/unh_workingpaper1.pdf

Venning, P., Durie, A., Roland, M., Roberts, C., & Leese, B. (2000). Randomised controlled trial comparing cost effectiveness of general practitioners and nurse practitioners in primary care.  British Medical Journal, 320, 1048-1053. Retrieved from http://www.bmj.com/content/320/7241/1048

 

ACCESS

AARP Public Policy Institute, Center to Champion Nursing in America. (2012). Improving Access to Primary Care: The Growing Role of Advanced Practice Registered Nurses. Washington, DC: Author.  https://flanp.org/files/CCNA_Improving_Access_to_Primary_Care_-_APRNs.pdf

AARP Public Policy Institute, Center to Champion Nursing in America. (2010). Access to care and advanced practice nurses: A review of southern U.S. practice laws. Washington, DC: Author.  https://flanp.org/files/AARPSouthernStatesBrief.pdf

Bipartisan Policy Center. (October 2011).  The complexities of national health care workforce planning.  Retrieved from http://bipartisanpolicy.org/library/report/complexities-national-health-care-workforce-planning

Cassidy, A. (2012, October 25). Health policy brief: Nurse practitioners and primary care. Retrieved from http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=79

Cronenwett, L., & Dzau, V.  (2010). Who will provide primary care and how will they be trained?  Proceedings of a conference sponsored by the Josiah Macy, Jr. Foundation. (B. Culliton and S. Russell, eds.). Durham, NC: Josiah Macy, Jr. Foundation. http://www.macyfoundation.org/docs/macy_pubs/JMF_PrimaryCare_Monograph.pdf

Deloitte Center for Health Solutions. (2011).    Primary Care:  Today and Tomorrow, Issue Brief. Retrieved from http://www.deloitte.com/centerforhealthsolutions

Florida Senate Committee on Health Regulation. (2008). Authorization for advanced practice registered nurses to prescribe controlled substances. Tallahassee, FL: Author. https://flanp.org/files/2009-117hr.pdf

Federal Trade Commission. (2008). Letter to Hon. Elaine Neblitz [regarding retail clinics and restraint of trade issues]. http://www.ftc.gov/os/2008/06/V080013letter.pdf

Federal Trade Commission. (2011). Letter to Hon. Daphne Campbell (regarding H.B. 4103 regulation of ARNPs). https://flanp.org/files/FTC-opinion-March-222C2011.pdf

Institute for Alternative Futures.  (January 2012).  Primary Care 2025: A Scenario Exploration. Alexandria, VA. Retrieved from http://www.altfutures.org/pubs/pc2025/IAF-PrimaryCare2025Scenarios.pdf

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health; Report brief. Washington, DC: Author. http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief.aspx

Institute of Medicine. (2012a). Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. Retrieved from http://www.iom.edu/Reports/2011/Geographic-Adjustment-in-Medicare-Payment-Phase-I-Improving-Accuracy.aspx

Institute of Medicine. (2012b). Geographic adjustment in Medicare payment: Phase II: Implications for access, quality, and efficiency. Washington, DC: The National Academies Press. Retrieved from http://iom.edu/Reports/2012/Geographic-Adjustment-in-Medicare-Payment-Phase-II.aspx

Kentucky Coalition of Nurse Practitioners and Nurse Midwives. (2009). Nurse practitioners and nurse midwives provide quality, cost-effective care but barriers to their practice decrease patient access to care. Retrieved from http://www.kcnpnm.org/?page=white_paper

National Council of State Boards of Nursing [NCSBN].  (2012). APRN Maps: NCSBN’s APRN Campaign for Consensus: State progress toward unifor­mity Consensus Model implementation status. Retrieved from https://www.ncsbn.org/2567.htm

 

National Council of State Boards of Nursing, (2009). Changes in healthcare professions scope of practice: Legislative considerations. Chicago, Ill. Retrieved from https://www.ncsbn.org/ScopeofPractice_09.pdf

National Governors Association.  (2012, December).  The role of nurse practitioners in meeting increasing demand for primary care.  Retrieved from http://www.nga.org/cms/home/nga-center-for-best-practices/center-publications/page-health-publications/col2-content/main-content-list/the-role-of-nurse-practitioners.html

Naylor, M.D., & Kurtzman, E.T. (2010).  The role of nurse practitioners in reinventing primary care. Health Affairs, 29(5), 893–899. http://www.stormontvail.org/NaylorHeaAff2010.pdf

Paradise, J., Dark, C., & Bitler, N. (2011, March).  Improving access to adult primary care in Medicaid: Exploring the potential role of nurse practitioners and physician assistants. Retrieved from www.kff.org/medicaid/upload/8167.pdf

Safriet, B.J. (2011).  Federal options for maximizing the value of advanced practice nurses in providing quality, cost-effective health care. In Institute of Medicine, The Future of Nursing: Leading Change, Advancing Health (Washington, DC: National Academies Press), 443-475. http://www.nap.edu/openbook.php?record_id=12956&page=443

U.S. Department of Justice, Drug Enforcement Administration Office of Diversion Control. (2012). Mid-level practitioners authorization by state. http://www.deadiversion.usdoj.gov/drugreg/practioners/mlp_by_state.pdf

 

 

National Organizations and News Media Support for Lifting Barriers to APRN Practice

2013 World Health Organization

WHO Nursing and Midwives Progress Report 2008-2012  http://www.who.int/hrh/nursing_midwifery/NursingMidwiferyProgressReport.pdf

In December, 2013, WHO released a progress report that encompassed an extensive 5 year review of nurses (including advanced practice nurses) and midwives across the globe, and their contributions to global health.  WHO recommends strengthening advance practice roles, and strongly supports nurse/midwife-led primary health care models.

2013 Consumer Reports

The Nurse Practitioner will See You Now. http://www.consumerreports.org/cro/magazine/2013/08/the-nurse-practitioner-will-see-you-now/index.htm

Consumer Reports reviewed the evidence and spoke to researchers and clinicians in investigating the role of nurse practitioners and physician assistants in filling the ever-expanding need for primary care, and concluded that increasing reliance on non-MD providers is a win-win: more accessible care from nonphysicians leaving more time for physicians to perform more complex tasks.

2013 New England Journal of Medicine   

            Expanding the Role of Advanced Nurse Practitioners- Risks and Rewards.

            http://www.nejm.org/doi/full/10.1056/NEJMhpr1301084

John Inglehart, founding editor of Health Affairs, and national correspondent for NEJM, provided a recent historical perspective on the role of APRNs and the opposition to independent practice by organized medicine, and concluded that greater leadership among physicians and nurses who are prepared to challenge their guilds is imperative in addressing these complex issues.

2012 National Governors Association

The Role of Nurse Practitioners in Meeting Increasing Demand for Primary Care.

    www.nga.org/files/live/sites/NGA/files/…/1212NursePractitionersPaper.pdf

The NGA undertook a review of the literature and state rules governing NP practice, and recommended that to better meet the increasing need for primary care, states should look to easing practice restrictions and modifying reimbursement policies to better utilize NPs.

2010 Institute of Medicine

The Future of Nursing: Leading Change, Advancing Health

http://www.iom.edu/Reports/2010/The-future-of-nursing-leading-change-advancing-health.aspx

The IOM performed an exhaustive review of the role of nurses in the U.S. Healthcare System, and provided 8 recommendations, the first being that nurses should practice to the full extent of their education and training.  These recommendations are directed to policy makers and other groups that have the power to improve the healthcare system and ultimately, the health outcomes of our citizens by more appropriate utilization of the most numerous healthcare provider with the closest contact with the patient- nurses.

2010 Florida Legislature: OPPAGA Report

Expanding Scope of Practice for Advanced Registered Nurse Practitioners, Physician Assistants, Optometrists, and Dental Hygenists.  A Research Memorandum by the The Office of Program Policy Analysis and Government Accountability.

http://statepolicyoptions.nga.org/policy_article/expanding-scope-practice-advanced-registered-nurse-practitioners-physician-assistants-optometrists-and-dental-hygienists

OPPAGA researched the utilization of APRNs and PAs in primary care in Florida, and calculated an estimated cost savings of $7-44 million annually for Medicaid alone, and $339 million across Florida’s entire healthcare system if these providers were utilized in a manner consistent with other states.

2004 Federal Trade Commission

Improving Health Care: A Dose of Competition: A Report by the Federal Trade Commission and the Department of Justice

http://www.ftc.gov/reports/improving-health-care-dose-competition-report-federal-trade-commission-department-justice

In an executive summary, the FTC concluded that restrictions on practice of qualified individuals may limit free-market competition, and violate the antitrust and consumer protection laws.

2001 Barbara Safriet, J.D., L.L.M.

Federal Options for Maximizing the Value of Advanced Practice Nurses in Providing Quality, Cost-Effective Health Care.

http://www.iom.edu/~/media/Files/Activity%20Files/Workforce/Nursing/Federal%20Options%20for%20Maximizing%20the%20Value%20of%20Advanced%20Practice%20Nurses.pdf

Although titled Federal Options, this article by Safriet is a nice synopsis of the issue of variation in APRN practice laws across states.

 

Quality of APRN Care

Advanced Practice Nursing Outcomes 1990-2008: A Systematic Review. By B. Newhouse

http://ctnursingresearchalliance.com/documents/2011-Article-3001021.pdf

A large number of studies have been done that address quality of APRN care.  A systematic review synthesizing many of these studies was published in 2013 that nicely summarized the data.  In almost all instances, no statistical difference was found in outcomes when care was provided by APRNs, and in some cases, the outcomes were improved.

Certified Registered Nurse Anesthetists

Because the care delivered by nurse anesthetists is substantially different from that of the other APRN roles, CRNAs were not included in several of the above studies.  The following are CRNA specific studies:

2010 Health Affairs

No Harm Found when Nurse Anesthetists work without Supervision by Physicians. by B. Dulisse

http://content.healthaffairs.org/content/29/8/1469.full.pdf+html

A study was conducted comparing anesthesia outcomes in states requiring physician supervision of CRNAs to those states not requiring physician supervision of CRNAs.   The study found no difference in anesthesia outcomes, and recommended that CRNAs be allowed to work without the supervision of a surgeon or anesthesiologist.

 

2010 Nursing Economics

Cost Effectiveness Analysis of Anesthesia Providers. By P. Hogan

https://www.aana.com/resources2/research/Documents/nec_mj_10_hogan.pdf

Anesthesia care is of high quality and safe whether provided by a CRNA or an anesthesiologist.  This study reviewed costs associated with various models of anesthesia delivery, and concluded that increasing

the number of CRNAs, and permitting them to practice in the most efficient delivery models will be a key to containing costs while maintaining quality care.

More information at the AANP Website:

http://www.aanp.org/publications/position-statements-papers

 

 

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