Does Expanded State Scope of Practice for Nurse Practitioners and Physician Assistants Increase Utilization in Community Health Centers?

Objective: To examine the impact of expanded state scope of practice (SOP) for nurse practitioners (NPs) and physician assistants (PAs) on primary care utilization in community health centers (CHCs).

Data sources/study setting: Uniform Data System (UDS) for 739 CHCs from 2009 to 2015.

Study design: We used a Difference-in-Differences approach. During our study period, 12 states liberalized NP SOP laws and 14 states changed their PA SOP regulations. Changes in the number of visits per full-time equivalent clinician (NP, PA, or primary care physician (PCP)) per year were the outcomes of interest.

Data collection/extraction methods: Three service utilization measures extracted from UDS were linked to the degree of state SOP restriction for NPs and PAs in a given year.

Principal findings: Granting independent practice and prescriptive authority for NPs resulted in statistically significant increases in NP visits, and decreases in both PA and PCP visits, for those CHCs with a high proportion of advanced practice staff along with the increased provision of support staff. PA SOP liberalization had no statistically significant effect on PA visits.

Conclusions: The findings suggest that NPs’ and PAs’ responsibilities may vary across CHCs. As the NP and PA workforce continues to grow, and as SOP laws continue to be liberalized, it is important to advance evidence on how to most efficiently deploy these staff.