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APHA Scientific Session and Event Listing

Jeanne M. Sears, MS, RN¹, Thomas M. Wickizer, PhD, MPH¹, Gary M. Franklin, MD, MPH², and Bobbie Berkowitz, RN, PhD, FAAN³. (1) Health Services, University of Washington, Box 357660, Seattle, WA 98195, 425-828-4241, jeannes@u.washington.edu, (2) Environmental and Occupational Health Sciences, University of Washington, Box 358772, Seattle, WA 98195, (3) University of Washington School of Nursing, Box 357263, University of Washington, Seattle, WA 98195

On 7/1/04, Substitute House Bill (SHB) 1691 authorized nurse practitioners (NPs) to independently perform most functions of an attending physician in the Washington State workers' compensation (WC) system. The bill was implemented as a pilot program with a 3-year sunset date. An evaluation was legislatively mandated due to stakeholder interest in the effects of NP role expansion.

NPs provide about 10% of generalist outpatient visits in Washington State and are now submitting about 4% of WC claims. Within their scope of practice NPs deliver care that is equivalent in quality to that of physicians, yet few state WC systems designate NPs as attending providers. Little information is available on outcomes of WC-related care provided by NPs. Legislation that would expand the Federal Employees Compensation Act's definition of physician to include NPs and physician assistants is currently under consideration. Evaluation of the effects of NP role expansion on WC-related disability and costs is of pressing importance to state and federal policy makers.

The research objective is to evaluate the effect of SHB 1691 on disability outcomes and claim costs for injured workers. The “after-only” multilevel study design compares NPs and primary care physicians in the role of attending provider based on the disability outcomes and medical and time loss costs of injured workers in their care, controlling for injury type and severity and for sociodemographic and contextual variables. Population-based claims data for the two years following implementation of SHB 1691 are provided by the Washington State Department of Labor & Industries.

Learning Objectives:

• Identify the effect that SHB 1691 had on nurse practitioner practice restrictions in the Washington State workers’ compensation system.
• State how disability outcomes differed between nurse practitioners and primary care physicians in the role of attending provider.
• State how claim costs (medical or time loss) differed between nurse practitioners and primary care physicians in the role of attending provider.

Keywords: Nurse Practitioners, Workers' Compensation

Presenting author's disclosure statement:

Not Answered

Handout (.ppt format, 138.0 kb)