State Scope of Practice Restrictions and Nurse Practitioner Practice in Nursing Homes: 2012-2019

Health affairs scholar Pub Date : 2024-02-12 DOI:10.1093/haschl/qxae018

K. Ryskina, Junning Liang, Ashley Z Ritter, J. Spetz, Hilary Barnes

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Abstract

Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, healthcare workforce characteristics, state fixed effects, and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least one NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.

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州执业范围限制与护理院执业护士：2012-2019 年

有人建议增加执业护士（NPs）的参与度，以此来应对基层医疗机构和农村地区等难以吸引医生的医疗服务环境所面临的挑战。疗养院也面临这样的医生短缺问题。我们评估了 2012-2019 年各州执业范围规定对护理院 NP 执业的影响。通过线性概率模型，我们估算了作为州执业范围法规函数的护理人员为养老院患者提供诊疗服务的比例。控制变量包括县人口、社会经济、医疗保健劳动力特征、州固定效应和年份指标。由全科医生进行的养老院访视比例从 2012 年的 24% 增加到 2019 年的 42%。在至少有一名护师访问过的县，执业范围监管的扩大与护师进行的养老院访问比例和总量的增加有关。这些关系主要集中在城市县的短期住院患者中。取消对护师执业范围的限制可能会解决城市地区养老院临床医生短缺的问题，因为护师已经在养老院执业。然而，要改善长期护理居民和农村地区患者获得高级临床医生护理的机会，可能需要额外的干预措施和资源。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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