On February 7, 2008, Governor Ritter issued Executive Order B 003 08 establishing the Collaborative Scopes of Care Study and creating an advisory committee to oversee the conduct of an evidence-based review that would inform the study findings. In issuing this executive order, the governor acknowledged "that it is clear from health manpower studies that we do not have sufficient numbers of providers, especially physicians and dentists, to meet the current [health care] needs of Coloradans." This problem is especially acute in rural and other underserved areas. Further, Governor Ritter called for a research group to "undertake a study of scopes of practices for advanced practice nurses, physician assistants and dental hygienists in terms of the services that are delivered, the settings in which those services are delivered and the quality of care provided." The purpose of this evidence-based review is to assess studies that directly relate to the following three key research questions:
- What are the quality, safety, efficacy and cost-effectiveness issues related to utilizing advanced practice nurses (APNs), physician assistants (PAs) and dental hygienists (DHs) as primary care providers, paying particular attention to the provision of primary care provided to underserved populations?
- What is the quality, safety and efficacy evidence for utilizing independent practice certified registered nurse anesthetists (CRNAs) in anesthesia settings?
- Are there models of care, care settings or aspects of care settings including relationships between different providers that have been shown to improve access to quality primary health care when employing APNs, PAs and DHs?