The Impact of Nurse Practitioner Full Practice Authority on Pediatric Care Experiences: A National Secondary Data Analysis

INTRODUCTION: Pediatric primary care access in the United States is hindered by pediatrician shortages, particularly in underserved and rural areas. Nurse practitioners (NPs), especially pediatric NPs, play an essential role to meet the demand for care in pediatric populations. However, little is known about how full practice authority (FPA) for NPs affects pediatric care experiences. METHODS: Using restricted-access Medical Expenditure Panel Survey data (2010-2019), we conducted ordinal logistic regressions under a difference-in-differences framework, where we observe outcomes in places with and without the policy intervention in the time periods before and after the policy change to elicit how much of the outcome change is driven by the policy. Outcomes included parent- and provider-reported measures of pediatric care. Models included FPA status, analysis of the years after the policy change, rurality, and the overall outcomes change when accounting for year and state. RESULTS: FPA implementation was associated with significant improvements in perceived time with providers and parental respect during visits. The percentage change in outcomes was smaller in rural areas. DISCUSSION/CONCLUSION: FPA may enhance pediatric care experiences, particularly in non-rural areas. Targeted investments in rural infrastructure and further pediatric-specific evaluations are needed to optimize the impact of scope-of-practice reform.