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Establishing a Full NP SOP in Michigan Could Improve Outcomes, but Evidence Is Limited

• Overall, evidence of the relationship between NP SOP regulations and any specific aspect of health care delivery is relatively limited (in terms of number and quality of studies). We identified only 14 studies.
• The literature review suggests that full SOP can possibly contribute to improvements in provider supply, access to care, utilization of care, and quality of care (patient-centeredness). The effect of full SOP on costs and health outcomes was largely inconclusive.
• Our exclusion criteria resulted in only two studies being included in the estimates of Michigan-specific impacts. Using these restrictions, we were able to calculate expected effects on access and quality. Our estimates suggest that establishing full SOP for NPs could lead to potentially meaningful improvements in access and quality (patient-centeredness) in Michigan.

Many policymakers and clinicians have argued that expanding the number and utilization of nurse practitioners (NPs) is an important strategy to meet future growth in the demand for health care services in the United States. State scope-of-practice (SOP) regulations, which govern the breadth of services that NPs can independently provide, affect the supply of NPs and their effectiveness in meeting patients' care needs. NPs in Michigan have no defined SOP and currently function under the SOP of registered nurses, which limits their ability to practice and prescribe.

The purposes of this report are to (1) examine the existing literature on the relationship between state NP SOP regulations and various health care delivery outcomes (provider supply, access to care, utilization of care, costs of care, and quality of care) and (2) estimate the impact in Michigan if its legislature defined a full SOP for NPs. To do this, we developed a conceptual framework to guide the research and conducted an extensive literature review. We then applied estimates from the literature to construct Michigan-specific impacts of defining a full SOP for NPs.

Our review of the literature demonstrates that granting NPs full SOP would possibly improve access to care, utilization of care, and provider supply in Michigan. Given limitations in the evidence, we were unable to conclusively estimate the effect of a full NP SOP across a wide range of health care domains.

• Chapter One

  Introduction

• Chapter Two

  Conceptual Framework

• Chapter Three

  Literature Review

• Chapter Four

  Michigan-Specific Impact

• Chapter Five

  Discussion

• Appendix A

  Literature Review Flow Diagram

• Appendix B

  Detailed Study Summaries

• Appendix C

  Study Quality Dimensions

• Appendix D

  Method Details

• Appendix E

  Summary of Effect Estimates