Advanced Practice Nurse Outcomes 1990–2008

A Systematic Review

Robin P. Newhouse, PhD, RN, NEA-BC; Julie Stanik-Hutt, PhD, ACNP, CCNS, FAAN; Kathleen M. White, PhD, RN, NEA-BC, FAAN; Meg Johantgen, PhD, RN; Eric B. Bass, MD, MPH; George Zangaro, PhD, RN; Renee F. Wilson, MS; Lily Fountain, MS, CNM, RN; Donald M. Steinwachs, PhD; Lou Heindel, DNP, CRNA; Jonathan P. Weiner, PhD

Disclosures

Nurs Econ. 2011;29(5):230-250. 

In This Article

Abstract and Introduction

Introduction

Quality, access, and cost of health care are high-priority global concerns. In the United States, these issues are pressing due to the escalating cost of managing chronic diseases (Department of Health and Human Services, 2009), the variation in quality of care delivered (Kuehn, 2009), and the inadequate number of primary care physicians (Freed & Stockman, 2009; Kuehn, 2009; Lakhan & Laird, 2009). At this critical time, we still do not know which models of care are best, how to integrate advanced practice registered nurses (APRN) providers, or to what extent APRN providers can contribute to improved access to and quality of health care. These deficits are untenable when the health care needs of society are great and the health reform debate progresses in legislative arenas. How to expand health care services for the American public, at an affordable cost, is central to this dispute.

Advanced practice registered nurses have assumed an increasing role as providers in the health care system, particularly for underserved populations. APRNs complete specialty-specific graduate programs that include education, training, and practice experience needed to complete a national board certification examination before entry into practice. Nurses practicing in APRN roles include nurse practitioners (NPs), clinical nurse specialists (CNSs), certified nurse-midwives (CNMs), and certified registered nurse anesthetists (CRNAs). Several systematic reviews have assessed what is known about NP practice (Brown & Grimes, 1995; Horrocks, Anderson, & Salisbury, 2002; Laurant et al., 2005; Sox, 1979). Similar or better outcomes are found for patient satisfaction (Brown & Grimes, 1995; Horrocks et al., 2002; Laurant et al., 2005; Sox, 1979), patient health status (Horrocks et al., 2002; Laurant et al., 2005), functional status (Brown & Grimes, 1995), and the use of the emergency department (Brown & Grimes, 1995; Laurant et al., 2005). A Cochrane review indicated midwifery care outside the United States was associated with a reduced risk of losing a baby before 24 weeks, a reduced use of regional analgesia, fewer episiotomies or instrumental births, increased chance of a spontaneous vaginal birth, and increased initiation of breastfeeding (Hatem, Sandall, Devane, Soltani, & Gates, 2008). No systematic reviews of CNS or CRNA outcomes have been published.

Although these reviews provide some information about the effects of APRNs on specific outcomes, an updated comprehensive review of the scientific literature on the care provided by APRNs in the United States is needed to inform educational, public, and organizational policy. This review is the most current and complete assessment of the comparability of APRNs to other providers, strengthening and extending the conclusions drawn from previous reviews by including evidence from over a span of 18 years on all types of APRNs and all outcomes, patient populations, and settings.

This systematic review compared the processes and outcomes of care delivered by APRNs to a comparison provider group, most often physicians. The intent was to consider the broad range of studies and outcome measures across these groups using a systematic, transparent, and reproducible review process.

Aim. The aim of this systematic review was to answer the following question: Compared to other providers (physicians or teams without APRNs), are APRN patient outcomes of care similar?

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