Advanced Practice Registered Nurse Involvement in Pregnancy Episodes: U.S. Trends From 2008–2014

Background: In the United States, states are increasingly adopting scope of practice reform to allow full practice authority (FPA) for advanced practice registered nurses (APRNs), such as nurse practitioners (NPs) and certified nurse midwives (CNMs). Little is known about the extent and trends of APRN participation in the care of patients during pregnancy episodes (i.e., the period from a woman's last menstrual period to birth and resolution of all pregnancy-related outcomes) and whether their involvement changes with FPA. Purpose: To examine the participation of APRNs in office-based prenatal care between states that allow APRN FPA and those that do not. Methods: Using a retrospective commercial insurance claims database, we identified continuously enrolled females undergoing a pregnancy test and constructed comprehensive care information of each pregnancy episode. We then identified the proportion of episodes in which at least one prenatal office-based evaluation and management visit was performed by an APRN (i.e., involvement) and the share of these visits within a pregnancy episode performed by APRNs (i.e., intensity of involvement) for each year from 2008 to 2014 and compared intertemporal and geospatial trends. Statistical tests of differences in means and proportions were used to examine differences in APRN involvement and intensity between states that allow APRN FPA and those that do not. Results: Between 2008 and 2014, NP involvement increased 304% and CNM involvement increased 134%. Involvement increased in both FPA (NPs: 267%, CNMs: 106%) and non-FPA (NPs: 307%, CNMs: 156%) states over the sample period. Involvement was higher in FPA states (p < 0.001) for NPs and CNMs in all years. Intensity exhibited little variation across the sample. Conclusion: APRN involvement in care during pregnancy episodes has increased over time, although considerable variation exists between states.