WEBVTT 00:00:00.622 --> 00:00:06.407 position:50% align:middle - [Female] Ying Xue is an associate professor and holds the Loretta C. Ford Endowed Professorship 00:00:06.407 --> 00:00:10.099 position:50% align:middle in Primary Care Nursing at the University of Rochester. 00:00:10.390 --> 00:00:16.896 position:50% align:middle Her research aims to develop empirical evidence to guide national policies to optimize the nursing 00:00:16.896 --> 00:00:20.922 position:50% align:middle workforce and to improve health care delivery and outcomes. 00:00:21.060 --> 00:00:27.172 position:50% align:middle Currently, Dr. Xue's research focuses on the role of nurse practitioners in improving access 00:00:27.172 --> 00:00:31.337 position:50% align:middle to primary care, especially for vulnerable populations. 00:00:37.255 --> 00:00:42.795 position:50% align:middle - [Dr. Xue] Hello, my name is Ying Xue, associate professor and the Loretta Ford Endowed 00:00:42.795 --> 00:00:48.452 position:50% align:middle Professorship in Primary Care Nursing at the University of Rochester School of Nursing. 00:00:48.925 --> 00:00:55.895 position:50% align:middle My presentation topic is Scope-of-Practice Regulation and Nurse Practitioners as Usual Source 00:00:55.895 --> 00:00:57.421 position:50% align:middle of Care Providers. 00:00:58.765 --> 00:01:04.726 position:50% align:middle Improving access to care is a top priority of the national and state health care agenda. 00:01:05.264 --> 00:01:11.559 position:50% align:middle Several trends suggest that the nurse practitioner workforce has untapped potential to expand the 00:01:11.559 --> 00:01:15.458 position:50% align:middle healthcare capacity to increase access to care. 00:01:16.059 --> 00:01:21.316 position:50% align:middle First, the NP workforce has grown significantly over the past decade. 00:01:21.828 --> 00:01:28.466 position:50% align:middle From 2010 to 2016, the average annual growth rate was 9.4%. 00:01:28.811 --> 00:01:39.003 position:50% align:middle As of 2020, more than 290,000 NPs were licensed in the U.S., and 69% delivered primary care. 00:01:39.614 --> 00:01:47.828 position:50% align:middle Second, the growth of NP workforce is evident in all space, indicating the expanding reach of NPs 00:01:47.828 --> 00:01:49.381 position:50% align:middle in the healthcare system. 00:01:50.093 --> 00:01:56.736 position:50% align:middle Third, NP supply has increased substantially in rural and the low-income areas, 00:01:56.736 --> 00:02:05.347 position:50% align:middle exerting an increasingly important role in addressing the critical demand for access to care where the need 00:02:05.347 --> 00:02:06.655 position:50% align:middle is the greatest. 00:02:07.307 --> 00:02:14.817 position:50% align:middle Fourth, extensive evidence has shown that NPs demonstrate clinical performance comparable 00:02:14.817 --> 00:02:21.667 position:50% align:middle with primary care physicians with regard to process of care, reduction of symptoms, 00:02:21.667 --> 00:02:27.077 position:50% align:middle improvement in health and functional status, and decrease in mortality. 00:02:27.427 --> 00:02:35.436 position:50% align:middle In addition, studies have reported higher patient satisfaction among patients seen by NPs than those seen 00:02:35.436 --> 00:02:37.487 position:50% align:middle by primary care physicians. 00:02:40.146 --> 00:02:44.279 position:50% align:middle NPs can improve access to care through two avenues. 00:02:44.476 --> 00:02:52.707 position:50% align:middle One, is a complementary or supplemental role, in which they perform tasks delegated by physicians. 00:02:53.126 --> 00:02:59.326 position:50% align:middle Through teamwork with physicians, they expand the capacity and increase efficiency 00:02:59.326 --> 00:03:00.982 position:50% align:middle of healthcare delivery. 00:03:01.493 --> 00:03:07.520 position:50% align:middle The other is a substitution role, in which they serve as a usual source of care provider 00:03:07.520 --> 00:03:10.332 position:50% align:middle as an alternative to physicians. 00:03:10.963 --> 00:03:18.338 position:50% align:middle In this role, NPs have primary responsibility for their patients, though they may consult with and refer 00:03:18.338 --> 00:03:20.071 position:50% align:middle patients to physicians. 00:03:21.903 --> 00:03:26.743 position:50% align:middle NP practice is governed by state-level scope-of-practice regulation, 00:03:26.743 --> 00:03:29.175 position:50% align:middle which varies across states. 00:03:29.603 --> 00:03:35.232 position:50% align:middle According to the classification by the American Association of Nurse Practitioner, 00:03:35.232 --> 00:03:40.332 position:50% align:middle there are three types of scope-of-practice regulation, full scope-of-practice, 00:03:40.332 --> 00:03:44.556 position:50% align:middle reduced, and restricted scope-of-practice regulation. 00:03:45.232 --> 00:03:50.492 position:50% align:middle This map shows 2021 state NP practice environment. 00:03:51.122 --> 00:03:57.262 position:50% align:middle State with full scope-of-practice regulation, which are in green color, permit all NPs 00:03:57.262 --> 00:04:03.336 position:50% align:middle to evaluate patients, diagnose, order, and interpret diagnostic test, 00:04:03.336 --> 00:04:09.559 position:50% align:middle and initiate and manage treatments, including prescribing medications and control the 00:04:09.559 --> 00:04:16.150 position:50% align:middle substance under the exclusive licensure authority of the state boards of nursing. 00:04:17.816 --> 00:04:22.636 position:50% align:middle While states have reduced or restricted scope-of-practice regulation, 00:04:22.636 --> 00:04:29.748 position:50% align:middle which are in yellow or red color, reduce or restrict the ability of NPs to engage 00:04:29.748 --> 00:04:33.489 position:50% align:middle in at least one element of NP practice. 00:04:33.489 --> 00:04:39.510 position:50% align:middle Currently, 23 states and D.C. have full scope-of-practice regulation. 00:04:39.914 --> 00:04:45.465 position:50% align:middle Sixteen states have reduced scope-of-practice regulation, and 11 states have 00:04:45.465 --> 00:04:48.111 position:50% align:middle a restricted scope-of-practice regulation. 00:04:50.813 --> 00:04:58.864 position:50% align:middle The extent to which NPs serve in substitution role as a usual source of care provider nationally and whether 00:04:58.864 --> 00:05:04.642 position:50% align:middle this is associated with state scope-of-practice regulation is not well understood. 00:05:05.253 --> 00:05:13.201 position:50% align:middle So far, most of the studies have used the insurance claims data to examine NPs as primary care providers. 00:05:13.533 --> 00:05:20.273 position:50% align:middle However, because NP surveys can be built using a collaborating physicians identifier, 00:05:20.273 --> 00:05:26.489 position:50% align:middle in some circumstance, claims data do not consistently identify NP care. 00:05:27.373 --> 00:05:34.278 position:50% align:middle Two recent studies used patient survey data or patient electronic medical records. 00:05:34.278 --> 00:05:41.520 position:50% align:middle However, they either did not provide a separate estimate for NP care, or the study setting 00:05:41.520 --> 00:05:43.907 position:50% align:middle had limited generalizability. 00:05:46.538 --> 00:05:54.758 position:50% align:middle Therefore, the objective of this study were to provide an estimate of NP as usual source of care providers, 00:05:54.758 --> 00:05:59.475 position:50% align:middle and to examine their relationship with state scope-of-practice regulations. 00:06:02.046 --> 00:06:10.121 position:50% align:middle We performed retrospective analysis on a sample of U.S. adults from 2010 to 2016. 00:06:10.694 --> 00:06:18.386 position:50% align:middle The dataset included restricted version full-year consolidated household component data of the 00:06:18.386 --> 00:06:24.776 position:50% align:middle Medical Expenditure Panel Survey, which was more to replace the data from the Area Health 00:06:24.776 --> 00:06:33.159 position:50% align:middle Resources File, National Provider Identifier registry, and the state NP practice environment data. 00:06:35.535 --> 00:06:42.515 position:50% align:middle The usual source of care provider was determined from the MEPS adult sample for those who had the usual 00:06:42.515 --> 00:06:49.975 position:50% align:middle source of care and identified the type of usual source of care as a person or person-in-facility. 00:06:50.485 --> 00:06:57.699 position:50% align:middle This measure exclude individual who report their primary source of care is a hospital emergency room. 00:06:58.055 --> 00:07:02.575 position:50% align:middle And is the most common measure of access to care in the literature. 00:07:03.809 --> 00:07:11.859 position:50% align:middle NP as a usual source of care provider was identified by respondents' reporting an NP as their usual source 00:07:11.859 --> 00:07:13.204 position:50% align:middle of care provider. 00:07:15.989 --> 00:07:21.979 position:50% align:middle Based on Aday and Anderson's framework for the study of access to medical care, 00:07:21.979 --> 00:07:29.349 position:50% align:middle we included the following covariates in the model, county-level primary care NP supply, 00:07:29.349 --> 00:07:34.071 position:50% align:middle primary care physician supply, physician assistant supply. 00:07:34.711 --> 00:07:37.649 position:50% align:middle Individual-level demographic variables. 00:07:37.881 --> 00:07:43.170 position:50% align:middle Health insurance coverage, perceived physical and mental health status. 00:07:43.501 --> 00:07:48.918 position:50% align:middle The geographic location of respondents, including U.S. census region 00:07:48.918 --> 00:07:53.367 position:50% align:middle and the metropolitan status of the county location of residence. 00:07:56.551 --> 00:08:03.809 position:50% align:middle In the analysis, we applied individual-level sample weight, and accounted for the sample design. 00:08:04.143 --> 00:08:10.263 position:50% align:middle We calculated estimates of the number and the proportion of adults whose usual source of care 00:08:10.263 --> 00:08:11.637 position:50% align:middle was an NP. 00:08:11.792 --> 00:08:17.573 position:50% align:middle We further examined the trends of NP as a usual source of care provider overall and 00:08:17.573 --> 00:08:20.231 position:50% align:middle by state scope-of-practice regulation. 00:08:21.083 --> 00:08:27.543 position:50% align:middle To examine the relationship between NP as a usual source of care provider and state scope-of-practice 00:08:27.543 --> 00:08:35.250 position:50% align:middle regulation while controlling for covariates, we used the pooled seven years of data due to the small 00:08:35.250 --> 00:08:41.630 position:50% align:middle sample size of adults who had an NP as their usual source of care provider in each year. 00:08:42.480 --> 00:08:48.978 position:50% align:middle We performed a multi-level survey analysis using a generalized linear mixed model. 00:08:49.520 --> 00:08:56.075 position:50% align:middle The data have a three-level hierarchical structure, state, county, and individual. 00:08:56.636 --> 00:09:02.266 position:50% align:middle In divided three-level model, we applied intercept random effects 00:09:02.266 --> 00:09:04.789 position:50% align:middle and unstructured covariance structure. 00:09:05.399 --> 00:09:09.898 position:50% align:middle Analysis were performed using SAS Version 9.4. 00:09:12.283 --> 00:09:14.012 position:50% align:middle Study results. 00:09:15.057 --> 00:09:26.149 position:50% align:middle From 2010 to 2016, 7 states, including Connecticut, Maryland, Minnesota, Nebraska, Nevada, North Dakota, 00:09:26.149 --> 00:09:32.556 position:50% align:middle and Vermont, changed their scope-of-practice regulation, all from reduced scope of practice 00:09:32.556 --> 00:09:34.262 position:50% align:middle to full scope of practice. 00:09:34.767 --> 00:09:41.873 position:50% align:middle At the end year of our study period, 2016, 21 states and D.C. had the full 00:09:41.873 --> 00:09:48.195 position:50% align:middle scope-of-practice regulation, 17 states had reduced scope-of-practice regulation, 00:09:48.195 --> 00:09:52.544 position:50% align:middle and 12 states had a restricted scope-of-practice regulation. 00:09:53.160 --> 00:09:58.553 position:50% align:middle The majority of states with reduced or restricted scope-of-practice regulation were 00:09:58.553 --> 00:10:00.765 position:50% align:middle in the Midwest or South. 00:10:03.415 --> 00:10:09.780 position:50% align:middle This figure present the trends in the weighted estimate of the proportion of adults whose usuals 00:10:09.780 --> 00:10:18.197 position:50% align:middle source of care provider was an NP nationally and by state NP regulation from 2010 to 2016. 00:10:19.014 --> 00:10:29.409 position:50% align:middle Nationally, this proportion increased from 1.65% in 2010 to 2.79% in 2016. 00:10:30.111 --> 00:10:40.833 position:50% align:middle In state with full scope-of-practice regulation, this proportion increased from 2.48% to 5.91%. 00:10:40.833 --> 00:10:51.376 position:50% align:middle And the proportions rose from 2.14% to 2.87% in state with reduced scope-of-practice regulation. 00:10:51.744 --> 00:11:00.598 position:50% align:middle And from 0.92% to 1.68% in states with restricted scope-of-practice regulation. 00:11:02.841 --> 00:11:10.329 position:50% align:middle This table shows the characteristic of the sample whose usual source of care provider was an NP overall 00:11:10.329 --> 00:11:13.699 position:50% align:middle and by state NP scope-of-practice regulation. 00:11:14.393 --> 00:11:22.269 position:50% align:middle The pooled data included a sample of 1,134 adults respondents with an NP as their usual source 00:11:22.269 --> 00:11:28.855 position:50% align:middle of care provider, representing a national estimate of almost 40 million adults. 00:11:29.697 --> 00:11:38.373 position:50% align:middle This sample was similar across states with different scope-of-practice regulations with regard to age, sex, 00:11:38.373 --> 00:11:42.419 position:50% align:middle marital status, and perceived physical health status. 00:11:43.123 --> 00:11:46.838 position:50% align:middle The mean age was around 49 years old. 00:11:46.983 --> 00:11:54.893 position:50% align:middle About one third was male, 50% were married, and over 70% perceived their physical health 00:11:54.893 --> 00:11:56.605 position:50% align:middle as good to excellent. 00:11:57.483 --> 00:12:03.926 position:50% align:middle There were difference across the scope-of-practice categories in race/ethnicity, education, 00:12:03.926 --> 00:12:08.476 position:50% align:middle health insurance coverage, perceived mental health status, 00:12:08.476 --> 00:12:13.061 position:50% align:middle residential location in non-metropolitan area and region. 00:12:13.746 --> 00:12:20.076 position:50% align:middle About 80% of the sample in states with full scope of practice was non-Hispanic white, 00:12:20.076 --> 00:12:27.886 position:50% align:middle compared to 74% in states with reduced scope of practice, and 65% in states 00:12:27.886 --> 00:12:30.151 position:50% align:middle with restricted scope of practice. 00:12:31.003 --> 00:12:36.383 position:50% align:middle About 48% of the sample in states with full scope of practice 00:12:36.383 --> 00:12:44.998 position:50% align:middle and in states with restricted scope of practice had education higher than high school as compared to 35% 00:12:44.998 --> 00:12:48.300 position:50% align:middle in states with reduced scope of practice. 00:12:50.213 --> 00:12:53.737 position:50% align:middle The majority of the sample had private health insurance. 00:12:54.033 --> 00:13:00.530 position:50% align:middle The proportion of uninsured was the highest in states with reduced scope of practice, 00:13:00.530 --> 00:13:06.848 position:50% align:middle followed by states with restricted scope of practice and states with full scope of practice. 00:13:07.501 --> 00:13:13.560 position:50% align:middle About 20% of the sample perceived their mental health status as fair or poor in states 00:13:13.560 --> 00:13:18.074 position:50% align:middle with full scope of practice, compared with 15% in states 00:13:18.074 --> 00:13:24.511 position:50% align:middle with reduced scope of practice, and 11% in states with restricted scope of practice. 00:13:25.400 --> 00:13:32.978 position:50% align:middle The proportion of non-metropolitan residents was the highest in states with reduced scope of practice, 00:13:32.978 --> 00:13:38.806 position:50% align:middle followed by states with full scope of practice and state with restricted scope of practice. 00:13:39.535 --> 00:13:44.525 position:50% align:middle The majority of the sample in states with full scope of practice were from the West, 00:13:44.525 --> 00:13:50.505 position:50% align:middle and the majority of the sample in states with reduced scope of practice or restricted scope of practice were 00:13:50.505 --> 00:13:51.762 position:50% align:middle from the South. 00:13:54.164 --> 00:14:00.175 position:50% align:middle Controlling for the covariates, divided three-level model shows the hours of having 00:14:00.175 --> 00:14:06.838 position:50% align:middle an NP as usual source of care provider were significantly less in states with restricted 00:14:06.838 --> 00:14:11.012 position:50% align:middle scope of practice than in states with full scope of practice. 00:14:11.217 --> 00:14:17.036 position:50% align:middle However, the hours in states with reduced scope of practice were not statistically different 00:14:17.036 --> 00:14:19.926 position:50% align:middle from that in states with full scope of practice. 00:14:20.839 --> 00:14:27.615 position:50% align:middle County-level NP supply was statistical [inaudible] greater hours of having an NP as usual 00:14:27.615 --> 00:14:29.320 position:50% align:middle source of care provider. 00:14:29.873 --> 00:14:37.980 position:50% align:middle Other covariates that was [inaudible] greater hours of having an NP as usual source of care provider 00:14:37.980 --> 00:14:42.723 position:50% align:middle include age, gender, and the perceived physical health status 00:14:42.723 --> 00:14:45.843 position:50% align:middle as fair or poor versus excellent. 00:14:46.448 --> 00:14:56.150 position:50% align:middle Respondents' hours of having an NP as usual source of care provider was 0.98 for 1-year increase in age, 00:14:56.150 --> 00:14:58.156 position:50% align:middle and was also lower for men. 00:14:58.790 --> 00:15:05.563 position:50% align:middle The hours of having an NP as usual source of care provider were higher among responders who 00:15:05.563 --> 00:15:09.933 position:50% align:middle perceive their health status as fair or poor versus excellent. 00:15:12.028 --> 00:15:13.175 position:50% align:middle Discussion. 00:15:13.537 --> 00:15:21.725 position:50% align:middle Our analysis showed that 2.79% of adults in the U.S. reported an NP as usual source of care provider 00:15:21.725 --> 00:15:29.628 position:50% align:middle in 2016, which increased from 1.65% from 2010. 00:15:30.206 --> 00:15:34.560 position:50% align:middle This percentage varied by state scope-of-practice regulation. 00:15:35.571 --> 00:15:42.990 position:50% align:middle The increase in having an NP as usual source of care provider, though moderate, may be helping to address 00:15:42.990 --> 00:15:47.930 position:50% align:middle the growing demand for primary care and to expand access to care. 00:15:48.791 --> 00:15:56.011 position:50% align:middle Primary evidence indicate that process in states with full scope-of-practice regulation had lower hours 00:15:56.011 --> 00:16:03.088 position:50% align:middle of extended travel time longer than 30 minutes to a primary care provider than those in states 00:16:03.088 --> 00:16:06.100 position:50% align:middle with restricted scope-of-practice regulation. 00:16:07.246 --> 00:16:13.613 position:50% align:middle Despite the growth of NP care, the national average of the percentage of adults who 00:16:13.613 --> 00:16:20.528 position:50% align:middle had NP as their usual source of care provider was small, indicating majority of NPs practice 00:16:20.528 --> 00:16:23.534 position:50% align:middle in collaborative or supplemental role. 00:16:26.128 --> 00:16:35.692 position:50% align:middle Adults cared for by NP were often on public insurance, uninsured, or resided in non-metropolitan areas. 00:16:35.971 --> 00:16:44.621 position:50% align:middle Our previous work indicate that NP supply was higher and grew faster in low-income and rural areas, 00:16:44.621 --> 00:16:47.532 position:50% align:middle where primary care physician supply was low. 00:16:48.461 --> 00:16:56.451 position:50% align:middle Our findings about usual source of care suggest that NPs may serve as substitutes for physicians in area 00:16:56.451 --> 00:16:59.693 position:50% align:middle with a higher proportion of vulnerable populations. 00:17:01.632 --> 00:17:07.566 position:50% align:middle We found the odds of having an NP as usual source of care provider in states with restricted 00:17:07.566 --> 00:17:14.992 position:50% align:middle scope-of-practice regulation was 87% lower than in states with full scope-of-practice regulation. 00:17:15.231 --> 00:17:17.573 position:50% align:middle There are several explanations. 00:17:18.031 --> 00:17:26.076 position:50% align:middle First, evidence indicate that scope-of-practice regulation may be associated with organizational hiring 00:17:26.076 --> 00:17:27.747 position:50% align:middle practice for NPs. 00:17:28.441 --> 00:17:35.859 position:50% align:middle Rural hospitals located in states granting prescriptive authority to NPs were more likely than rural hospital 00:17:35.859 --> 00:17:42.926 position:50% align:middle in states without this authority to establish a provider-based rural health clinic 00:17:42.926 --> 00:17:49.616 position:50% align:middle designed to stimulate the use of NPs and the PAs to improve access to primary care 00:17:49.616 --> 00:17:52.207 position:50% align:middle in underserved rural areas. 00:17:52.886 --> 00:18:00.605 position:50% align:middle Community health centers and the primary care clinics were also more likely to hire and use NPs in states 00:18:00.605 --> 00:18:03.020 position:50% align:middle with full scope-of-practice regulation. 00:18:03.819 --> 00:18:10.955 position:50% align:middle Second, state scope-of-practice regulation have been shown to be associated with the role of NP 00:18:10.955 --> 00:18:12.496 position:50% align:middle in care delivery. 00:18:13.065 --> 00:18:19.795 position:50% align:middle NP were more likely to have their own patient panel in states with full scope-of-practice regulation 00:18:19.795 --> 00:18:24.101 position:50% align:middle than in states with reduced or restricted regulation. 00:18:25.055 --> 00:18:31.775 position:50% align:middle Third, restricted scope-of-practice regulation require physician supervision, 00:18:31.775 --> 00:18:40.109 position:50% align:middle which might limit how and where NPs can practice, as they depend on the availability of physicians. 00:18:41.575 --> 00:18:49.225 position:50% align:middle The study also find that higher county-level NP supply, independent of state scope-of-practice regulation, 00:18:49.225 --> 00:18:55.187 position:50% align:middle was associated with greater likelihood of having an NP as usual source of care provider. 00:18:55.715 --> 00:19:03.587 position:50% align:middle To our knowledge, this is the first study to provide empirical evidence on the association between NP supply 00:19:03.587 --> 00:19:06.802 position:50% align:middle and NPs as a usual source of care provider. 00:19:07.522 --> 00:19:13.689 position:50% align:middle These findings support the notion that higher NP supply expand access to care. 00:19:14.525 --> 00:19:21.364 position:50% align:middle As discussed previously, NP appear to be more likely serve in a substitution role 00:19:21.364 --> 00:19:25.922 position:50% align:middle in area with a higher proportion of vulnerable populations, 00:19:25.922 --> 00:19:32.763 position:50% align:middle which suggests that they play an important role in reducing the disparities in access to care. 00:19:35.135 --> 00:19:37.335 position:50% align:middle The study has several limitations. 00:19:37.595 --> 00:19:44.673 position:50% align:middle First, the MEPS is a self-reported survey, response to survey question regarding the type of usual 00:19:44.673 --> 00:19:48.055 position:50% align:middle source of care provider might not be accurate. 00:19:48.415 --> 00:19:55.036 position:50% align:middle Patients might misperceive an NP as a physician, and thus the number of adults having an NP as usual 00:19:55.036 --> 00:19:58.758 position:50% align:middle source of care provider could be underestimated. 00:19:59.155 --> 00:20:05.983 position:50% align:middle Second, due to the small sample size of adults with an NP as their usual source of care provider in each 00:20:05.983 --> 00:20:13.893 position:50% align:middle study year, we were now able to analyze the multiple-year data using a time series approach, 00:20:13.893 --> 00:20:19.053 position:50% align:middle therefore capturing changes in scope-of-practice regulation over time, 00:20:19.053 --> 00:20:24.743 position:50% align:middle which would have permitted a stronger causal inference of the relationship between scope-of-practice 00:20:24.743 --> 00:20:30.408 position:50% align:middle regulation and the likelihood of having an NP as usual source of care provider. 00:20:31.114 --> 00:20:38.505 position:50% align:middle In addition, we were not able to test the hypothesis of mediation and the moderation effects among state 00:20:38.505 --> 00:20:44.856 position:50% align:middle scope-of-practice regulations, NP supply, and NPs as a usual source of care provider. 00:20:46.354 --> 00:20:52.654 position:50% align:middle Third, state scope-of-practice regulation was broadly classified into three groups, 00:20:52.654 --> 00:20:58.269 position:50% align:middle which did not take into consideration nuanced provision of state-level legislation. 00:20:58.630 --> 00:21:05.418 position:50% align:middle For example, some states with full scope-of-practice regulation require NPs to fulfill a certain number 00:21:05.418 --> 00:21:13.264 position:50% align:middle of hours of post-licensure practice with physician collaboration or mentoring before they are granted the 00:21:13.264 --> 00:21:16.910 position:50% align:middle full scope of practice and the prescriptive authority. 00:21:19.834 --> 00:21:22.047 position:50% align:middle Implications of the study. 00:21:22.437 --> 00:21:28.125 position:50% align:middle Improving access to care is a top priority in the national and state healthcare agenda. 00:21:28.373 --> 00:21:35.253 position:50% align:middle It also is a major goal in guiding legislative and regulatory agencies regarding changes in the 00:21:35.253 --> 00:21:38.482 position:50% align:middle scope of practice of healthcare professions. 00:21:39.001 --> 00:21:45.791 position:50% align:middle Our study provides empirical evidence on the link between full scope-of-practice regulation and increased 00:21:45.791 --> 00:21:48.010 position:50% align:middle care provided by NPs. 00:21:48.349 --> 00:21:55.141 position:50% align:middle Particularly, this increase benefit adults who were on public health insurance, uninsured, 00:21:55.141 --> 00:21:58.648 position:50% align:middle and those residing in non-metropolitan areas. 00:21:59.401 --> 00:22:05.492 position:50% align:middle Such information can assist state legislators and stakeholders in their decision-making 00:22:05.492 --> 00:22:10.159 position:50% align:middle concerning whether or not to expand NP scope-of-practice regulation. 00:22:11.602 --> 00:22:18.902 position:50% align:middle Finally, I'd like to acknowledge the funding from the National Council State Boards of Nursing for this study 00:22:18.902 --> 00:22:20.418 position:50% align:middle and our research team. 00:22:21.412 --> 00:22:27.432 position:50% align:middle In addition, the data analysis in this study was conducted at the Centre for Financing, 00:22:27.432 --> 00:22:30.413 position:50% align:middle Access and Cost Trends Data Center. 00:22:30.785 --> 00:22:37.622 position:50% align:middle The results and conclusions in this study are those of the authors and do not indicate concurrence by the 00:22:37.622 --> 00:22:42.963 position:50% align:middle AHRQ or the U.S. Department of Health and Human Services. 00:22:45.195 --> 00:22:46.156 position:50% align:middle Thank you. 00:23:05.231 --> 00:23:10.650 position:50% align:middle Thank you for your attention, it was my great pleasure to speaking at the 00:23:10.650 --> 00:23:14.342 position:50% align:middle NCSBN Scientific Symposia. 00:23:15.087 --> 00:23:22.581 position:50% align:middle So, I saw one question asking about whether the PPT available. 00:23:22.837 --> 00:23:31.510 position:50% align:middle Yeah, I hope the National Council State Boards of Nursing would make my presentation PPT available 00:23:31.510 --> 00:23:33.654 position:50% align:middle to all the participants. 00:23:34.020 --> 00:23:41.422 position:50% align:middle So, I'm also happy to send you a copy of the presentation. 00:23:41.830 --> 00:23:53.993 position:50% align:middle So, I can be reached at Ying, my first name, and underscore, last name, @urmc.rochester.edu. 00:23:54.320 --> 00:23:59.470 position:50% align:middle Yeah, so please send me an email, and then I will be happy to send you a copy 00:23:59.470 --> 00:24:01.391 position:50% align:middle of my presentation. 00:24:02.416 --> 00:24:13.315 position:50% align:middle Also, as an update, this work was published in the Journal of Nursing Regulation in October 2020. 00:24:13.315 --> 00:24:21.386 position:50% align:middle So, if you'd like to learn more details about this work, you can read the paper. 00:24:22.176 --> 00:24:26.412 position:50% align:middle Yeah, so I see there are two questions. 00:24:26.412 --> 00:24:29.338 position:50% align:middle I haven't seen the second one. 00:24:29.667 --> 00:24:33.243 position:50% align:middle So, I'm waiting. There might be a delay. 00:24:33.243 --> 00:24:36.005 position:50% align:middle Okay, so there are more questions. 00:24:37.450 --> 00:24:42.611 position:50% align:middle So, I have a little bit trouble seeing from my side. 00:24:42.611 --> 00:24:44.780 position:50% align:middle Okay, so now I see it. 00:24:46.110 --> 00:24:52.850 position:50% align:middle Okay, so I will answer the question. It might not be in order. 00:24:52.850 --> 00:24:58.480 position:50% align:middle So, okay, I will see, the first question is from Cassie Scott. 00:24:58.700 --> 00:25:05.757 position:50% align:middle "Did you see the recently released quantitative survey done by AONL, ANA, 00:25:05.757 --> 00:25:14.185 position:50% align:middle and Johnson & Johnson show that only 57% of physicians surveyed, though allowing nurses to practice to limit 00:25:14.185 --> 00:25:21.735 position:50% align:middle of their license, will be beneficial in underserved community to improve healthcare disparity? 00:25:21.735 --> 00:25:23.445 position:50% align:middle Thoughts on that?" 00:25:25.215 --> 00:25:35.678 position:50% align:middle Yeah, so that is...we have to provide empirical evidence to demonstrate the value of NPs' work. 00:25:36.076 --> 00:25:39.787 position:50% align:middle So, that was our motivation for this work. 00:25:40.066 --> 00:25:51.198 position:50% align:middle So, we will continue to build on the evidence of this work and further along, you know, all the future work. 00:25:51.956 --> 00:26:03.356 position:50% align:middle And so, that we hope with more evidence available, we will promote evidence-based policymaking to change 00:26:03.992 --> 00:26:07.203 position:50% align:middle and expand NP scope of practice. 00:26:07.371 --> 00:26:19.027 position:50% align:middle So, as you know, or probably know that recently, California passed the legislation to allow NP to have 00:26:19.027 --> 00:26:23.856 position:50% align:middle full scope of practice effective in 2023. 00:26:24.321 --> 00:26:26.737 position:50% align:middle That is a very exciting step. 00:26:26.941 --> 00:26:34.482 position:50% align:middle So, we hope that more and more states would follow the steps of California 00:26:34.482 --> 00:26:38.061 position:50% align:middle and to expand the scope of practice for NPs. 00:26:41.662 --> 00:26:46.392 position:50% align:middle So, I see another question coming from Mary Hines. 00:26:46.392 --> 00:26:54.102 position:50% align:middle "So, I'm an NP in Colorado that owns her own business, and I am the primary care provider of a large 00:26:54.102 --> 00:26:55.557 position:50% align:middle panel of children. 00:26:55.852 --> 00:27:02.211 position:50% align:middle One of the concern I have is that it is not only regulation that controls practice, 00:27:02.211 --> 00:27:10.486 position:50% align:middle but the lack of preparation of NPs to practice in solo roles and advocating for changes in SOP. 00:27:10.486 --> 00:27:16.035 position:50% align:middle Do you think you would find the same result in family and pediatric practice?" 00:27:18.641 --> 00:27:28.801 position:50% align:middle Yeah, so I think this is not, you know, surprising to me that, I think, right now, 00:27:28.801 --> 00:27:34.270 position:50% align:middle there's more and more education program to address this issue. 00:27:34.519 --> 00:27:43.008 position:50% align:middle That is to better prepare NP to practice in, you know, variety shows, including, you know, solo practice. 00:27:43.395 --> 00:27:54.104 position:50% align:middle So, that's why you see there's growing programs to have NP residency so that we hope that can fill that gap. 00:27:57.195 --> 00:27:59.965 position:50% align:middle Okay, a question from Melissa Charlie. 00:28:01.089 --> 00:28:08.373 position:50% align:middle "For your analysis, did you consider adding the state-level data expanded Medicaid or not?" 00:28:08.373 --> 00:28:17.582 position:50% align:middle Okay, so yeah, so we have a state-level data, but we didn't including expanding Medicaid or not. 00:28:17.582 --> 00:28:21.569 position:50% align:middle But however, we included insurance status. 00:28:21.569 --> 00:28:30.504 position:50% align:middle So, which I think the Medicaid expansion was already reflected in the patient's individual-level 00:28:30.504 --> 00:28:32.395 position:50% align:middle health insurance status. 00:28:36.971 --> 00:28:43.851 position:50% align:middle Okay, so, yeah, so just one quick last question there, because we are running out of time, 00:28:43.851 --> 00:28:45.801 position:50% align:middle so from Michelle Buck. 00:28:45.801 --> 00:28:51.741 position:50% align:middle "Did you have any data of impact of employer restriction to full scope of practice in state 00:28:51.741 --> 00:28:54.325 position:50% align:middle which grant full scope-of-practice authority?" 00:28:54.481 --> 00:28:56.511 position:50% align:middle That is excellent question. 00:28:56.671 --> 00:29:04.428 position:50% align:middle So unfortunately, in our data, we did not, you know, have data to control for that. 00:29:04.428 --> 00:29:10.743 position:50% align:middle We are aware that there are, you know, a variety of organization-level practice. 00:29:10.948 --> 00:29:17.434 position:50% align:middle So, which can, you know, be different from state regulation. 00:29:22.478 --> 00:29:25.237 position:50% align:middle Thank you. Thank you for all your questions. 00:29:25.768 --> 00:29:31.323 position:50% align:middle For the questions that I didn't have time to answer, so please send me an email, 00:29:31.323 --> 00:29:33.929 position:50% align:middle I'll be happy to answer your questions. 00:29:33.929 --> 00:29:35.099 position:50% align:middle Thank you again.