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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Care Coordination.

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Strategy. Nurse Practitioner Scope of Practice

Approach. Encourage regulations allowing Nurse Practitioners to provide the full scope of care to children

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Overview. Nurse Practitioners (NPs) have graduate-level nursing education and must complete national board certification exams. The NP scope of practice is regulated by state-level Nurse Practice Acts and Boards of Nursing and varies by state, ranging from requirements to collaborate with or be supervised by physicians to autonomy to provide care to the full scope of NP training and skills without physician oversight (e.g., independent practice and prescription authority). NPs frequently specialize in primary care, acute care, or mental healthcare.[1] There is strong evidence that NPs provide high quality routine care that is equivalent to and sometimes better than, comparable care provided by physicians.[2,3,4]

Evidence. Scientifically Rigorous Evidence. Strategies based on scientifically rigorous evidence are proven effective across multiple robust studies. While success is highly likely, local impact may vary. Monitor outcomes and use data to tailor these strategies to the community's unique needs.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • NP-to-Patient ratios
  • Provider satisfaction and workforce surveys
  • Patient satisfaction surveys

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Quality of Care. This strategy promotes the degree to which healthcare services meet established standards aimed at achieving optimal health outcomes.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of counties partnered with Title V that adopt regulations recognizing NPs as primary care providers and care coordinators for children. (Measures policy implementation for NP-led CC)
  • Number of NPs who receive specialized training through Title V in pediatric care coordination models, tools, and best practices under expanded scope of practice. (Measures workforce development for CC)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of NP pediatric care delivery models partnered with Title V that incorporate evidence-based care coordination practices and tools. (Measures CC quality and standardization)
  • Percent of pediatric visits with NPs that include assessment of care coordination needs, development of shared care plans, and follow-up on care goals. (Measures consistent application of CC process)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of pediatric practices that adopt interoperable health information technology systems promoted by Title V to facilitate care coordination and information exchange among NP-led teams that results in improved QI indicators. (Measures CC infrastructure and connectivity)
  • Number of local initiatives implemented to support the integration of NP-led care coordination into medical home and accountable care models for children that results in improved health outcomes. (Measures alignment of CC with broader system transformation efforts)
  • Number of counties that demonstrate sustained improvements in pediatric care quality, utilization, and costs through widespread adoption of NP-led care coordination. (Measures population health and value impact of CC)
  • Number of replication sites and spread initiatives that successfully adapt and scale NP-led pediatric care coordination best practices to new populations and settings. (Measures dissemination and expansion of CC impact)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of youth and families who are engaged as co-designers and partners in shaping NP-led care coordination approaches that report high levels of engagement. (Measures participatory in CC development)
  • Percent of local initiatives implemented to support the integration of NP-led care coordination into medical home and accountable care models for children that results in improved health outcomes. (Measures alignment of CC with broader system transformation efforts)
  • Percent reduction in care fragmentation and unmet care coordination needs experienced by children and families. (Measures CC impact)
  • Percent of NPs serving in communities who feel equipped to lead transformative care coordination efforts. (Measures workforce capacity and agency for advancing CC)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Xue 2016 - Xue Y, Ye Z, Brewer C, Spetz J. Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review. Nursing Outlook. 2016;64(1):71–85.
[2] Stanik-Hutt J, Newhouse RP, White KM, et al. The quality and effectiveness of care provided by nurse practitioners. The Journal for Nurse Practitioners. 2013;9(8):492–500.e13.
[3] Buerhaus PI, DesRoches CM, Dittus R, Donelan K. Practice characteristics of primary care nurse practitioners and physicians. Nursing Outlook. 2015;63(2):144–153.
[4] Martínez-González NA, Djalali S, Tandjung R, et al. Substitution of physicians by nurses in primary care: A systematic review and meta-analysis. BMC Health Services Research. 2014;14:214.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.