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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
26 to 50 of 67 Research Studies DisplayedPoghosyan L, Ghaffari A, Liu J
Organizational support for nurse practitioners in primary care and workforce outcomes.
Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. In this study, the researchers investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. The investigators concluded that nurse practitioners from primary care practices with higher levels of organizational support were more likely to be satisfied with their jobs, have less intent to leave their jobs, and report better quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Organizational support for nurse practitioners in primary care and workforce outcomes.
Nurs Res 2020 Jul/Aug;69(4):280-88. doi: 10.1097/nnr.0000000000000425..
Keywords: Provider: Clinician, Provider, Primary Care, Burnout, Stress, Workforce, Organizational Change
Bansal P, Bingemann TA, Greenhawt M
Clinician wellness during the COVID-19 pandemic: extraordinary times and unusual challenges for the allergist/immunologist.
This article describes current challenges for the allergy/immunology community due to the COVID-19 pandemic. The need for social distancing adds to complexity of care and can create isolation and anxiety. The authors suggests that tools such as the Strength-Focused and Meaning-Oriented Approach to Resilience and Transformation approach, wellness apps, mindfulness and gratitude can be used to help reduce issues contributing to burnout, depression, anxiety, substance abuse, and posttraumatic stress disorder.
AHRQ-funded; HS024599.
Citation: Bansal P, Bingemann TA, Greenhawt M .
Clinician wellness during the COVID-19 pandemic: extraordinary times and unusual challenges for the allergist/immunologist.
J Allergy Clin Immunol Pract 2020 Jun;8(6):1781-90.e3. doi: 10.1016/j.jaip.2020.04.001..
Keywords: COVID-19, Burnout, Stress, Provider: Clinician, Provider: Physician
Westafer LM, Kunz A, Bugajska P
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Providers often pursue imaging in patients at low risk of pulmonary embolism (PE), resulting in imaging yields <10% and false-positive imaging rates of 10% to 25%. Attempts to curb overtesting have had only modest success and no interventions have used implementation science frameworks. The objective of this study was to identify barriers and facilitators to the adoption of evidence-based diagnostic testing for PE.
AHRQ-funded; HS025701.
Citation: Westafer LM, Kunz A, Bugajska P .
Provider perspectives on the use of evidence-based risk stratification tools in the evaluation of pulmonary embolism: a qualitative study.
Acad Emerg Med 2020 Jun;27(6):447-56. doi: 10.1111/acem.13908..
Keywords: Respiratory Conditions, Evidence-Based Practice, Diagnostic Safety and Quality, Imaging, Decision Making, Clinical Decision Support (CDS), Practice Patterns, Provider: Physician, Provider: Clinician, Provider
Poghosyan L, Ghaffari A, Liu J
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
Primary care practices increasingly rely on the growing workforce of nurse practitioners (NPs) to meet primary care demand. Understanding teamwork between NPs and physicians in primary care practices is critically important. In this study, the investigators assessed teamwork between NPs and physicians practicing within the same primary care practice and determined how teamwork affected their job satisfaction, intent to leave their current job, and quality of care.
AHRQ-funded; HS024758.
Citation: Poghosyan L, Ghaffari A, Liu J .
Physician-nurse practitioner teamwork in primary care practices in New York: a cross-sectional survey.
J Gen Intern Med 2020 Apr;35(4):1021-28. doi: 10.1007/s11606-019-05509-2..
Keywords: Primary Care: Models of Care, Primary Care, Provider: Clinician, Provider: Physician, Provider, Workforce, Quality of Care
Adler-Milstein J, Zhao W, Willard-Grace R
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
This study examined whether objective measures of electronic health record (EHR) use-related to time, volume of work, and proficiency are associated with either exhaustion or cynicism. The authors combined Maslach Burnout Inventory survey measures with objective, vendor-defined EHR use measures from log files. Data was collected from all primary care clinics of a large, urban medical academic center in early 2018. One-third of clinicians had high cynicism and 51% had high emotional exhaustion. The clinicians with the most exhaustion spent time using the EHR after hours.
AHRQ-funded; HS022241.
Citation: Adler-Milstein J, Zhao W, Willard-Grace R .
Electronic health records and burnout: time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians
J Am Med Inform Assoc 2020 Apr;27(4):531-38. doi: 10.1093/jamia/ocz220..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Burnout, Provider: Clinician, Provider: Physician, Provider, Primary Care
Kohut MR, Keller SC, Linder JA
AHRQ Author: Miller MA
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Researchers conducted semi-structured interviews with clinicians to determine how they perceive demand for antibiotics in the outpatient setting. They conducted interviews with 25 clinicians from nine practices across three states. Patient demand was the most common reason why non-indicated antibiotics were prescribed. Clinicians felt that if they didn’t prescribe them they would experience repercussions in their reputation and practice and that certain patients are impossible to please without an antibiotic prescription regardless of the diagnosis.
AHRQ-authored; AHRQ-funded; 233201500020I.
Citation: Kohut MR, Keller SC, Linder JA .
The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting.
Fam Pract 2020 Mar 25;37(2):276-82. doi: 10.1093/fampra/cmz066..
Keywords: Antibiotics, Medication, Antimicrobial Stewardship, Ambulatory Care and Surgery, Provider: Clinician, Provider: Physician, Provider
Kennedy-Metz L, Weiss P, Parker SH
Results of exploratory investigation into adherence to auditory coping instructions during an acutely stressful task.
Healthcare providers often perform under significant stress, during which their performance must be optimal, but is known to suffer. Stress management interventions in this context can provide cognitive support to rescue performance. This exploratory study sought to evaluate the effect of stress intervention components on stress and performance while clinicians engaged in two versions of a computer-based task, differing in overall level of demand: one high-stress and one low-stress.
AHRQ-funded; HS023465.
Citation: Kennedy-Metz L, Weiss P, Parker SH .
Results of exploratory investigation into adherence to auditory coping instructions during an acutely stressful task.
Stress 2020 Mar;23(2):144-52. doi: 10.1080/10253890.2019.1660317..
Keywords: Stress, Provider: Clinician, Provider
Gomes KM, Ratwani RM
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
In this research letter, the authors studied usability of electronic health records (EHR) with the system usability scale (SUS). They found that SUS scores decreased for 44% of vendors. Clinician satisfaction with EHR usability is not improving for many widely used products, and the authors recommended increased focus on clinician end users during product design and development as well as optimized certification requirements in order to improve usability.
AHRQ-funded; HS025136.
Citation: Gomes KM, Ratwani RM .
Evaluating improvements and shortcomings in clinician satisfaction with electronic health record usability.
JAMA Netw Open 2019 Dec 2;2(12):e1916651. doi: 10.1001/jamanetworkopen.2019.16651..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Southern WN, Applebaum JR, Salmasian H
Clinician experience of electronic health record configurations displaying 1 vs 4 records at a time.
Most electronic health record (EHR) systems have the capability to display more than 1 patient record at a time; however, there is wide variation in practice. In this study, the investigators looked at clinician satisfaction of EHR configuration with varying numbers of records displayed.
AHRQ-funded; HS026121.
Citation: Southern WN, Applebaum JR, Salmasian H .
Clinician experience of electronic health record configurations displaying 1 vs 4 records at a time.
JAMA Intern Med 2019 Dec;179(12):1723-25. doi: 10.1001/jamainternmed.2019.3688..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Provider: Clinician, Provider
Adams DR, Williams NJ, Becker-Haimes EM
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
In this study, the investigators prospectively examined the relationship between therapist financial strain and turnover in 247 therapists in 28 community mental health agencies. The investigators expected greater therapist financial strain to predict higher turnover and participation in a system-funded evidence-based practice (EBP) training initiative to alleviate this effect. They found that, controlling for covariates, financial strain predicted therapist turnover but not for therapists who participated in an EBP training initiative.
AHRQ-funded; HS000084.
Citation: Adams DR, Williams NJ, Becker-Haimes EM .
Therapist financial strain and turnover: interactions with system-level implementation of evidence-based practices.
Adm Policy Ment Health 2019 Nov;46(6):713-23. doi: 10.1007/s10488-019-00949-8..
Keywords: Healthcare Costs, Evidence-Based Practice, Behavioral Health, Provider, Provider: Clinician, Training, Workforce
Zikmund-Fisher BJ, Solomon JB, Scherer AM
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
Patient portals of electronic health record systems currently present patients with tables of laboratory test results, but visual displays can increase patient understanding and sensitivity to result variations. In this study, the investigators sought to assess physician preferences and concerns about visual display designs as potential motivators or barriers to their implementation.
Citation: Zikmund-Fisher BJ, Solomon JB, Scherer AM .
Primary care providers' preferences and concerns regarding specific visual displays for returning hemoglobin A1c test results to patients.
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Keywords: Primary Care, Electronic Health Records (EHRs), Education: Patient and Caregiver, Health Information Technology (HIT), Provider: Clinician, Provider: Physician, Provider
Bernstein A, Rogers KM, Possin KL
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
The prevalence of dementia, a neurocognitive disorder (NCD), is expected to triple in the next 30 years. In this study, the investigators surveyed a national sample of primary care physicians to characterize their attitudes and practices with respect to the evaluation and management of NCDs.
AHRQ-funded; HS022241.
Citation: Bernstein A, Rogers KM, Possin KL .
Primary care provider attitudes and practices evaluating and managing patients with neurocognitive disorders.
J Gen Intern Med 2019 Sep;34(9):1691-92. doi: 10.1007/s11606-019-05013-7..
Keywords: Dementia, Neurological Disorders, Provider: Physician, Provider: Clinician, Provider, Primary Care
Rogers ES, Cuthel AM, Berry CA
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
This study examined the effectiveness of practice facilitation to improve cardiovascular disease in 257 small independent primary care practices (SIPs) enrolled in the AHRQ-funded EvidenceNOW initiative called HealthyHearts. These SIPs were enrolled in HealthyHearts NYC in New York City. Interviews were conducted with SIPs with 3 or fewer office staff and their answers were compared with interviews with practices with more than 3 office staff. Three facilitation benefits were found to the most important, including 1. Creating awareness of quality gaps; 2. Connecting practices to information, resources, and strategies, and; 3. Optimizing the HER for QI goals.
AHRQ-funded; HS023922.
Citation: Rogers ES, Cuthel AM, Berry CA .
Clinician perspectives on the benefits of practice facilitation for small primary care practices.
Ann Fam Med 2019 Aug 12;17(Suppl 1):S17-s23. doi: 10.1370/afm.2427..
Keywords: Primary Care, Provider: Clinician, Provider: Physician, Provider, Quality Improvement, Quality of Care, Cardiovascular Conditions, Heart Disease and Health, Evidence-Based Practice, Patient-Centered Healthcare, Patient-Centered Outcomes Research
Kroth PJ, Morioka-Douglas N, Veres S
Association of electronic health record design and use factors with clinician stress and burnout.
The authors sought to determine which electronic health record (EHR) design and use factors are associated with clinician stress and burnout and to identify other sources that contribute to this problem. Surveying ambulatory primary care and subspecialty clinicians from 3 institutions, they found that, although EHR design and use factors are associated with clinician stress and burnout, other challenges, such as chaotic clinic atmospheres and workload control, explain considerably more of the variance in these adverse clinician outcomes.
AHRQ-funded; HS022065.
Citation: Kroth PJ, Morioka-Douglas N, Veres S .
Association of electronic health record design and use factors with clinician stress and burnout.
JAMA Netw Open 2019 Aug 2;2(8):e199609. doi: 10.1001/jamanetworkopen.2019.9609..
Keywords: Burnout, Stress, Electronic Health Records (EHRs), Health Information Technology (HIT), Primary Care, Provider: Clinician, Provider: Physician, Provider: Nurse
Poghosyan L, Ghaffari A, Shaffer J
Nurse practitioner primary care organizational climate questionnaire: item response theory and differential item functioning.
This study evaluated the Nurse Practitioner Primary Care Organization Climate Questionnaire (NP-PCOCQ) and the items on the questionnaire using item response theory (IRT) and also conducted differential item functioning (DIF) analysis. The questionnaire was sent to 278 primary nurse practitioners (NPs) in New York State, and 314 NPs in Massachusetts. Data was collected online in NY and a mail survey was used in MA in 2012. Out of 29 items on the questionnaire, only 5 exhibited DIF. Out of these results, a shortened 24-item questionnaire was developed.
AHRQ-funded; HS020999.
Citation: Poghosyan L, Ghaffari A, Shaffer J .
Nurse practitioner primary care organizational climate questionnaire: item response theory and differential item functioning.
J Clin Nurs 2019 Aug;28(15-16):2934-45. doi: 10.1111/jocn.14895..
Keywords: Primary Care, Provider: Clinician, Provider: Nurse, Provider
Hoonakker PLT, Wooldridge AR, Hose BZ
Information flow during pediatric trauma care transitions: things falling through the cracks.
In order to investigate information flow during pediatric trauma care transitions, researchers interviewed 18 clinicians about communication and coordination between the emergency department, operating room, and pediatric intensive care unit, then surveyed the clinicians about patient safety during these transitions. They found that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To manage the transition of this fragile and complex population better, they recommend finding ways to manage the information flow during these transitions better by, for instance, providing technological support to ensure shared mental models.
AHRQ-funded; HS023837.
Citation: Hoonakker PLT, Wooldridge AR, Hose BZ .
Information flow during pediatric trauma care transitions: things falling through the cracks.
Intern Emerg Med 2019 Aug;14(5):797-805. doi: 10.1007/s11739-019-02110-7..
Keywords: Children/Adolescents, Communication, Emergency Department, Healthcare Delivery, Intensive Care Unit (ICU), Patient Safety, Provider, Provider: Clinician, Surgery, Transitions of Care, Trauma
Linzer M, Poplau S, Prasad K
Characteristics of health care organizations associated with clinician trust: results from the healthy work place study.
This study examined clinician trust among clinicians in private practices using retrospective cohort data from the Healthy Work Place randomized clinical trial. Thirty-four primary care practices in the Upper Midwest and East Coast were sampled. The study included 165 clinicians with most being physicians, and some advanced practice clinicians (nurse practitioners and physician assistants). Measures of clinician trust included belonging, loyalty, safety focus, sense of trust, and responsibility to clinicians in need. The population surveyed were 87.7% physicians and 52.1% women. Most (63.6%) worked in family medicine and the rest in internal medicine. Greater work control was associated with higher levels of trust. Men were more likely to express loyalty and high trust. Higher trust was associated with greater work satisfaction and leads to better staff retention and lower stress levels.
AHRQ-funded.
Citation: Linzer M, Poplau S, Prasad K .
Characteristics of health care organizations associated with clinician trust: results from the healthy work place study.
JAMA Netw Open 2019 Jun 5;2(6):e196201. doi: 10.1001/jamanetworkopen.2019.6201..
Keywords: Primary Care, Provider, Provider: Clinician, Provider: Nurse, Provider: Physician
Aronson PL, Schaeffer P, Fraenkel L
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
This paper discusses the reasons for wide variation in the decision to perform lumbar punctures (LPs) in febrile infants 8 weeks or less. Semi-structured interviews were conducted with 15 pediatric and general emergency medicine physicians and 8 pediatric emergency medicine nurses at an urban, academic medical center. Five themes emerged from the interviews that included: age of the infant, the physician’s clinical experience, physician’s use of research findings, the physician’s values, and the role of the primary care pediatrician.
AHRQ-funded; HS026006.
Citation: Aronson PL, Schaeffer P, Fraenkel L .
Physicians' and nurses' perspectives on the decision to perform lumbar punctures on febrile infants </=8 weeks old.
Hosp Pediatr 2019 Jun;9(6):405-14. doi: 10.1542/hpeds.2019-0002..
Keywords: Newborns/Infants, Decision Making, Provider: Physician, Provider: Nurse, Provider: Clinician, Provider, Emergency Department, Diagnostic Safety and Quality
Patel MR, Friese CR, Mendelsohn-Victor K
Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices.
This study examined the effects of electronic health records (EHRs) on communication and patient safety in oncology practices. The authors conducted a survey of 297 oncology nurses and prescribers in a statewide collaborative. They found there was an inverse relationship between reliance on EHRs and safety.
AHRQ-funded; HS024914.
Citation: Patel MR, Friese CR, Mendelsohn-Victor K .
Clinician perspectives on electronic health records, communication, and patient safety across diverse medical oncology practices.
J Oncol Pract 2019 Jun;15(6):e529-e36. doi: 10.1200/jop.18.00507..
Keywords: Cancer, Communication, Electronic Health Records (EHRs), Health Information Technology (HIT), Patient Safety, Provider, Provider: Clinician
Pack AP, Golin CE, Hill LM
Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data.
This study looked into the value of using graphical display prototypes of hypothetical daily drug concentrations measured in hair for patients to assess their medication adherence. Investigators surveyed 30 HIV-positive patients and 29 clinicians to assess their preferences for three different prototypes. Patients and clinicians generally found the prototypes acceptable, but clinicians largely preferred daily drug concentrations in bar graph display. Patients with lower health literacy had trouble understanding the link between medication-taking and drug concentrations in hair and also preferred pictographs over bar or line graphs.
AHRQ-funded; HS000032.
Citation: Pack AP, Golin CE, Hill LM .
Patient and clinician perspectives on optimizing graphical displays of longitudinal medication adherence data.
Patient Educ Couns 2019 Jun;102(6):1090-97. doi: 10.1016/j.pec.2018.12.029..
Keywords: Clinician-Patient Communication, Communication, Health Literacy, Medication, Patient Adherence/Compliance, Provider, Provider: Clinician
Nocon RS, Fairchild PC, Gao Y
Provider and staff morale, job satisfaction, and burnout over a 4-year medical home intervention.
This study examined the impact of adopting the patient-centered medical home (PCMH) on clinicians and staff at primary care practices. A longitudinal study was done comparing baseline (201) and post-intervention (2013-2014) survey results. Five-hundred thirty-six providers and staff at baseline and 589 were surveyed post-intervention. Almost half of all clinics reported improved better job morale, job satisfaction, and freedom from burnout. However, there were some clinics that saw a decrease in the percentage of providers reporting high job satisfaction and freedom from burnout. Control clinics were not used in this study, so it is impossible to know if results were similar in non-PCMH primary care practices.
AHRQ-funded; HS000084.
Citation: Nocon RS, Fairchild PC, Gao Y .
Provider and staff morale, job satisfaction, and burnout over a 4-year medical home intervention.
J Gen Intern Med 2019 Jun;34(6):952-59. doi: 10.1007/s11606-019-04893-z..
Keywords: Burnout, Patient-Centered Healthcare, Primary Care, Primary Care: Models of Care, Provider, Provider: Clinician, Stress
Baloh J, Thom KA, Perencevich E
Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices.
The purpose of this study was to examine the practices and beliefs of health care workers related to the use of nonsterile gloves and associated hand hygiene (HH) before gloving. Gloving and HH practices of health care workers at three large academic hospitals were observed as they entered patient rooms, and interviews were conducted with providers, nurses, and nursing assistants to elicit their beliefs and perceptions of these hygiene practices. While interviewed health care workers reported 100% HH compliance before gloving, observed HH compliance was only 42% and observed gloving before entering contact precaution rooms was 78%. Most health care workers described glove use more often than was necessary, and generally used gloves for their own safety, and sanitized their hands before gloving for patient safety. The authors conclude that HH and glove use are intertwined in clinical practice and should be considered jointly to improve infection prevention improvement efforts.
AHRQ-funded; HS024108.
Citation: Baloh J, Thom KA, Perencevich E .
Hand hygiene before donning nonsterile gloves: healthcareworkers' beliefs and practices.
Am J Infect Control 2019 May;47(5):492-97. doi: 10.1016/j.ajic.2018.11.015..
Keywords: Provider: Clinician, Provider, Provider: Health Personnel, Patient Safety, Prevention
Kamal AH, Bowman B, Ritchie CS
Identifying palliative care champions to promote high-quality care to those with serious illness.
This article discusses the shortage of palliative care specialists in the United States now and in the future. In 2010, the shortage quantified as anywhere from 6000 to 18,000 palliative care physicians. Projections to 2030 do not show that the workforce will increase by that time. The authors suggest the use of “Palliative Care Champions” who are physicians with basic palliative care training.
AHRQ-funded; HS023681.
Citation: Kamal AH, Bowman B, Ritchie CS .
Identifying palliative care champions to promote high-quality care to those with serious illness.
J Am Geriatr Soc 2019 May;67(S2):S461-s67. doi: 10.1111/jgs.15799..
Keywords: Palliative Care, Quality of Care, Provider: Clinician, Provider: Physician
P Dellsperger, KC Fallaw, D
AHRQ Author: Rangachari
A mixed-method study of practitioners' perspectives on issues related to EHR medication reconciliation at a health system.
This study sought to identify issues related to electronic health record (EHR) medication reconciliation (MedRec) from the perspective of practitioners directly involved in the EHR MedRec process, with the goal of reducing medication discrepancies during transitions of care and improving the accuracy of patient medication lists. The study was conducted in two rounds: individual interviews, then a survey of physicians, nurses, and pharmacists based in the outpatient and inpatient medicine service at AU Health. The survey elicited practitioner ratings of the importance of issues identified during the interviews. Issues that were rated as important by more than 70 percent of respondents include care coordination, patient education, ownership and accountability, processes-of-care, IT-related issues, and workforce training. From these issues, the authors conclude that there is an absence of shared understanding among practitioners regarding the value of EHR MedRec in promoting patient safety, which contributes to work-arounds and the suboptimal use of the EHR MedRec system, and there is also a sociotechnical dimension to many of these issues which creates an additional layer of complexity.
AHRQ-funded; HS024335.
Citation: P Dellsperger, KC Fallaw, D .
A mixed-method study of practitioners' perspectives on issues related to EHR medication reconciliation at a health system.
Qual Manag Health Care 2019 Apr/Jun;28(2):84-95. doi: 10.1097/qmh.0000000000000208..
Keywords: Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Medication: Safety, Patient Safety, Provider, Provider: Clinician
Patel EY, Petemann V, Mark BA
Does state-level nurse practitioner scope-of-practice policy affect access to care?
This study attempts to fill a critical gap between policy reform that grants state-level nurse practitioners (NPs) scope of practice (SOP) and a useful synthesis of empirical studies that assesses the relationship of NP SOP policy to its impact on access to care. Researchers applied Aday and Andersen's Access Framework to operationalize access to care and to map components of access to care that might relate to NP SOP through concepts identified in their review. Their findings suggest that full state-level NP SOP policy is associated with increases in various components of access to care, but that additional work will be required to evaluate causality and underlying mechanisms behind the policy's effect on access.
AHRQ-funded; HS000032.
Citation: Patel EY, Petemann V, Mark BA .
Does state-level nurse practitioner scope-of-practice policy affect access to care?
West J Nurs Res 2019 Apr;41(4):488-518. doi: 10.1177/0193945918795168..
Keywords: Access to Care, Policy, Provider, Provider: Clinician