1 Brandeis University, Waltham, MA, USA.
2 Boston College, Chestnut Hill, MA, USA.
Med Care Res Rev. 2019 Oct;76(5):597-626. doi: 10.1177/1077558717732402. Epub 2017 Sep 14.
State scope of practice (SoP) laws impose significant restrictions on the services that a nurse practitioner (NP) may provide in some states, yet evidence about SoP limitations on the quality of primary care is very limited. This study uses six different classifications of state regulations and bivariate and multivariate analyses to compare beneficiaries attributed to primary care nurse practitioners and primary care physicians in 2013 testing two hypotheses: (1) chronic disease management, cancer screening, preventable hospitalizations, and adverse outcomes of care provided by primary care nurse practitioners are better in reduced and restricted practice states compared to states without restrictions and (2) by decreasing access to care, SoP restrictions negatively affect the quality of primary care. Results show a lack of consistent association between quality of primary care provided by NPs and state SoP restrictions. State regulations restricting NP SoP do not improve the quality of care.
州执业范围（SoP）法律对护士从业者（NP）在某些州可提供的服务施加了重大限制，但关于 SoP 对初级保健质量限制的证据非常有限。本研究使用六种不同的州法规分类以及双变量和多变量分析，比较了 2013 年归因于初级保健护士从业者和初级保健医生的受益人的情况，检验了两个假设：（1）在限制较少的州和没有限制的州相比，初级保健护士从业者在慢性病管理、癌症筛查、可预防住院和护理不良后果方面的管理效果更好；（2）通过减少护理机会，SoP 限制对初级保健的质量产生负面影响。结果表明，NP 提供的初级保健质量与州 SoP 限制之间没有一致的关联。限制 NP SoP 的州法规并不能提高护理质量。
