By NextBestFitMeasure outcomes by clinician type and adjust scope
Publish outcome and prescribing data by clinician type; expand or restrict scope based on results.
Measure outcomes by clinician type.
Review ledgerHow this path connects
This path
Measure outcomes by clinician type and adjust scope
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Publish outcomes by clinician type
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Quality concerns when non-physicians practice independently
Publishing outcomes and prescribing by clinician type allows practice scope to expand or contract based on evidence and adjust over time.
What it creates or worsens
- Takes years, or money up front, before it pays off
Collecting outcome and prescribing evidence by clinician type takes years.
- Depends on uncertain evidence or judgments
It is hard to attribute observed outcomes to clinician type when deciding practice scope.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Quality concerns when non-physicians practice independently: Expanded independent practice may expose them to missed diagnoses or over-prescribing.
Who loses
None identified.
Where it has been tried
- U.S. VA: Granted NPs full practice authority (2016) with monitoring.
- United States: A 2020 nonexperimental evaluation of 139 VA medical centres found that a 10% increase in privileged primary-care NPs was associated with about 4% shorter new-patient waits, equivalent to 0.30 days.Sources: Health Services Research (2020)