TOPLINE

Full practice authority for nurse practitioners (NPs) was associated with lower readmission rates for chronic conditions than restricted practice authority, especially in rural counties.

METHODOLOGY

• Researchers conducted a secondary analysis of restricted‑use Medical Expenditure Panel Survey (MEPS) data, accessed at the Agency for Healthcare Research and Quality in February 2025, evaluating readmissions for five chronic conditions: high cholesterol levels (n = 33,409), high blood pressure (n = 38,858), diabetes (n = 13,075), emphysema (n = 2509), and asthma (n = 17,018) from 2010 to 2019.
• Outcomes between two treatment states that adopted full practice authority during the study period and 14 control states that maintained restricted NP practice authority throughout were compared.
• Researchers evaluated whether granting full practice authority for NPs reduced hospital readmissions and emergency department visits related to the abovementioned chronic conditions.

TAKEAWAY

• States with full vs restricted practice authority had a lower incidence of readmissions for high cholesterol levels (incidence rate ratio [IRR], 0.9863 vs 0.9910), high blood pressure (IRR, 0.9758 vs 0.9834), diabetes (IRR, 0.9746 vs 1.0019), and asthma (IRR, 0.9710 vs 0.9908); all differences were statistically significant.
• Emphysema represented an exception, with a higher incidence of readmissions in states with full practice authority (IRR, 0.9850) than in those with restricted practice authority (IRR, 0.9775).
• Rural counties in states with full practice authority had substantially lower readmission rates for high cholesterol levels (coefficient, -1.4177) and diabetes (coefficient, -8.8500).
• Difference-in-difference models yielded inconsistent results with low explanatory power, indicating that “the models explain very little of the variation in outcomes and may be subject to noise or spurious findings.”

IN PRACTICE

“The observed reductions in readmissions for patients with chronic diseases in FPA states, particularly when viewed through the lens of IRR data, underscore the value of NPs as integral providers in the management of chronic conditions,” the authors wrote. “Policy efforts to remove unnecessary restrictions on NP practice have the potential to significantly improve health outcomes and promote equitable access to care across the United States.”

SOURCE

The study was led by Joyce J. Fitzpatrick, PhD, Marian K. Shaughnessy Nurse Leadership Academy, Case Western Reserve University, Cleveland. It was published online in April 2026 in Medical Care.

LIMITATIONS

The study used observational data, was limited to two treatment states and 14 control states, and could not fully account for unmeasured confounding variables such as socioeconomic factors, regional healthcare policies, or variations in provider density. Additionally, MEPS data may contain inaccuracies due to self-reported data, underreporting of medical conditions, or misclassification of variables, particularly rural status or provider authority across states.

DISCLOSURES

The study was funded by the Diana Davis Spencer Foundation and a sub-award grant from Case Western Reserve University to the Knee Regulatory Research Center. One author reported serving as a consultant to the Marian K. Shaughnessy Nurse Leadership Academy. The other authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.