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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 51 kB

Date submitted: September 08, 2011

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
In view of the latest Affordable Care & Health Reform legislation, how will keeping weak national and individual state-by-state lack of full recognition for autonomous practice in primary care for “non-physician” providers such as APRNs impact the exponential demand for increased access to care?
By restricting APRNs of full autonomous practice privileges, is cost effective quality access to care being restricted for Americans?
Can AHRQ support research for evidence-based solutions to help remedy this huge barrier to care for Americans?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
Comparison of access to quality health care in states that do not have statutory limitations to autonomous scope of practice for Advance Practice Registered Nurses (APRNs)versus states that do have statutory limitations for autonomous scope of practice of APRNs. Do state limitations to autonomous scope of practice for primary care APRNs impact in access to quality health care for Americans? Are these types of limitations posing as barriers to quality access of care for Americans, and if so, what are some of these barriers and what are some strategies derived to use in overcoming any barriers identified in the research?
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Primary care patients in the U.S. with or without insurance; especially those without regular care and those with chronic diseases such as type II diabetes, hypertension, cardiovascular diseases, obesity, etc.
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Consideration may apply to racial & ethnic groups impacted the most by these conditions; e.g., African-Americans, Latinos and/or Native Americans.
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Decreased levels for weight at or below the 50 percentile, BMI, lipids, hemoglobin A1c levels; attaining blood pressure readings at or below 120/80, etc.
Describe any health-related risks, side effects, or harms that you are concerned about.
Evidence pointing to poor state or federal legislation that could lead to worse healthcare outcomes or worse yet eventual increases in fatalities related to policies that limit access to care.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Cancer
  • Cardiovascular disease, including stroke and hypertension
  • Depression and other mental health disorders
  • Diabetes mellitus
  • Infectious diseases, including HIV/AIDS
  • Obesity
  • Peptic ulcer disease and dyspepsia
  • Pregnancy, including preterm birth
  • Pulmonary disease/asthma
  • Substance abuse
AHRQ Priority Populations
  • Low income groups
  • Minority groups
  • Women
  • Children
  • Elderly
  • Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care
Federal Health Care Program
  • Medicaid
  • Medicare
  • State Children's Health Insurance Program (SCHIP)
  • Other


Describe why this topic is important.
There is a documented lack of primary care providers for the next decades, in proportion to the documented needs of over 45 million Americans needing health insurance coverage and care.

APRNs have a consistent and documented pattern of attaining nationally set parameters for quality of care outcomes, either equal to or surpassing in many areas, the care provided by other primary care providers such as physicians. Many exceptional APRNs have also demonstrated superior levels of care through the same measures asked of physicians but through independent nurse-managed health centers, achieving NCQA recognition (at Level 3) for Patient Centered Medical Home (PCMH) requirements.

There is no evidence of substandard quality of care or validity of a dangerous assumption of risks being imposed on the care of Americans by enabling APRNs to practice to their fullest extent of their capabilities (as recommended by the IOM’s 2010 Report on the Future of Nursing).
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
We are working locally with some of the IOM 2010 recommendations & representatives related to nurse practice concerns in order to achieve change that may impact on the quality of care and access for Americans. Some recommendations may be made to respective Governors and policy makers for needed changes to current laws an/or regulations. Positive outcomes for the APRNs derived from this type of research will undoubtedly impact interested physician providers and most certainly, the American patient.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
If yes, please explain:
Yes, all the above examples are potential barriers to health care; thus need attention from providers AND policy makers at local, state and national levels.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
It will help in championing these complex issues for a greater and unbiased view in order to be shared with policy makers and leaders in health care who may still be reticent to considering overdue revisions to health policy and law(s). Ultimately, the patients will reap the benefits of better increased access to top quality of care.
Describe the timeframe in which an answer to your question is needed.
The sooner the better, but before new policies and laws (or amendments or back-peddling on health care reform) is pushed without more of the facts and implications being readily available for those decision-makers.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
Undoubtedly, Americans with OR without health insurance coverage (or the most vulnerable due to poverty or lower SES) will be adversely impacted.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Nurse/Nurse Practitioner/Physician Assistant
Are you making a suggestion as an individual or on behalf of an organization?
Please tell us how you heard about the Effective Health Care Program
Searches online and reading evidence-based literature.