Health outcomes and provider choice under full practice authority for certified nurse-midwives

Full practice authority grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration. In this study, we consider whether full practice authority for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008-2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, full practice authority increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore the mechanisms behind the increase in CNM/CM-attended deliveries, demonstrating that the rise in CNM/CM-attended deliveries represents higher use of existing CNM/CMs and is not fully explainable by improved reporting of CNM/CM deliveries or changes in CNM/CM labor supply.

Effects of giving psychologists prescriptive authority: Evidence from a natural experiment in the United States

BACKGROUND

Suicide is the tenth leading cause of death in the U.S. Six states have granted psychologists prescriptive authority to address shortages in the provision of behavioral and mental health care services to increase provider access to pharmacological interventions using psychotropic medications.

METHODS

This study estimates the impact of expanding scope of practice for specifically trained psychologists to include pharmacological interventions on mortality by self-inflicted injury in the U.S. by using the implementation of prescriptive authority for psychologists in New Mexico and Louisiana as a natural experiment using a staggered different-in-difference estimation. Additional robustness tests are conducted to identify heterogenous treatment effects, observe sensitivity of our results for Medicaid expansion, and to compare other forms of mortality that should not have been affected by psychologist prescriptive authority.

RESULTS

Mortality resulting from self-inflicted injury decreased by 5 to 7 percentage points in New Mexico and Louisiana following prescriptive authority expansions for psychologists. The effect is statistically significant for males, white populations, individuals who are married or single, and for people between the ages of 35 and 55.

CONCLUSIONS

In the U.S., expanding scope of practice for specifically trained psychologists to include prescriptive authority may help address poor mental health care outcomes, such as suicides. Similar policy expansions may be useful for other countries where referral from a psychologist and prescription assignment from a psychiatrist are separated.

Exploring the Relationship between Nurse Practitioner Full Practice Authority, Nurse Practitioner Workforce Diversity, and Disparate Primary Care Access

In this study, we examine how full nurse practitioner (NP) practice authority affects racial and ethnic diversity of the NP workforce. Specifically, the purpose of our research is to understand the relationship between the racial and ethnic composition of the NP workforce, NP level of practice authority, and the communities they service. In this paper, we compare the ethnic and racial composition of the NP workforce to the composition of the state's population, and then observe if there are any noticeable differences in the patients served by NPs when we compare full practice authority (FPA) and non-FPA states. We also estimate how FPA affects the race and ethnicity of Medicare patients served by NPs.

Throwing caution to the wind: How hurricanes affect COVID-19 spread

This study exploits the pathway of Hurricane Laura to assess its impact on the spread of COVID-19. Using US hospital data on confirmed and suspected adult COVID-19 cases, we find average daily cases per week rose by more than 12% primarily in tropical storm-affected counties in subsequent weeks. We suspect the key mechanisms involve constraints on social distancing for two reasons. First, there is significant evidence of storm-induced mobility. Second, lower income areas endured higher growth in hospital cases during the post-hurricane period. These findings provide crucial insights for policy-makers when designing natural disaster protocols to adjust for potential respiratory viral illnesses.