Expanded Scopes Of Practice For Dental Hygienists Associated With Improved Oral Health Outcomes For Adults.

Dental hygienists are important members of the oral health care team, providing preventive and prophylactic services and oral health education. However, scope-of-practice parameters in some states limit their ability to provide needed services effectively. In 2001 we developed the Dental Hygiene Professional Practice Index, a numerical tool to measure the state-level professional practice environment for dental hygienists. We used the index to score state-level scopes of practice in all fifty states and the District of Columbia in 2001 and 2014. The mean composite score on the index increased from 43.5 in 2001 to 57.6 in 2014, on a 100-point scale. We also analyzed the association of each state's composite score with an oral health outcome: tooth extractions among the adult population because of decay or disease. After we controlled for individual- and state-level factors, we found in multilevel modeling that more autonomous dental hygienist scope of practice had a positive and significant association with population oral health in both 2001 and 2014.

Racial/Ethnic Pay Disparities among Registered Nurses (RNs) in U.S. Hospitals: An Econometric Regression Decomposition.

OBJECTIVE: To detect the presence of racial and ethnic pay disparities between minority and white hospital RNs using a national sample. DATA SOURCES/STUDY SETTING: The National Sample Survey of Registered Nurses, 2008, which is representative at both the state and national level. STUDY DESIGN: Cross-sectional data were analyzed using multivariate regression and regression decomposition. Differences between groups were decomposed into differences in the possession of characteristics and differences in the value of the same characteristic between different groups, the latter being a commonly used measure of wage discrimination. DATA COLLECTION/EXTRACTION METHODS: As the majority of minority hospital RNs are employed within the most densely populated (central) counties of metropolitan statistical areas (MSAs), only hospital RNs employed in the central counties of MSAs were selected. PRINCIPAL FINDINGS: Regression decomposition found that black and Hispanic RNs earned less than whites and Asians, while Asian RNs earned more than white RNs. The majority of pay variation between white RNs, versus Asian, black, or Hispanic RNs was due to unexplained differences in the value of the same characteristic between groups. CONCLUSIONS: Differences in earnings between underrepresented and overrepresented hospital RNs is suggestive of discrimination.

The effect of local primary care physician supply on the utilization of preventive health services in the United States.

Little research has examined the effect of physician supply on health-related measures at the individual and community level simultaneously. Using telephone survey data from six counties in upstate New York, a commuting radius was constructed between the zip codes of respondents and their primary care physicians. The relationships between local physician supply, the probability of having a primary care physician, and receiving preventive health care checks were analyzed. Both logistic regression and multilevel modeling results indicated the local supply of primary care physicians affects the probability of having a primary care physician, which in turn affects preventive healthcare service utilization.

Practice patterns of underrepresented minority nurse practitioners in New York state, 2000.

Using data collected from a sample of 1,319 nurse practitioners (NPs) in New York state in 2000, differences in practice patterns by race and ethnicity were identified. NPs from underrepresented minority (URM) groups were more likely than non-URM NPs to work in hospitals, community health centers, and schools but less likely to work in physician offices and NP practices. URM NPs were also more likely to report a specialty certification in women's health. Several different measures of primary care provision were examined, with URM NPs substantially more likely to meet all four measures of primary care practice than non-URM NPs. Finally, URM NPs were more likely than non-URM NPs to practice in federally designated health profession shortage areas.

A Dental Hygiene Professional Practice Index (DHPPI) and access to oral health status and service use in the United States.

PURPOSE: The purpose of this article is to summarize a larger study that developed a statistical index that defines the professional practice environment of dental hygienists (DHs) in the United States, and to determine the extent to which the index scores are related to the number of DHs and dentists, the utilization of dental services, and selected oral health outcomes across the 50 states. METHODS: A Dental Hygiene Professional Practice Index (DHPPI) defines the professional status, supervision requirements, tasks permitted, and reimbursement options for DHs in each of the 50 states and the District of Columbia, as of December 31, 2001. Spearman rank order correlations between the DHPPI and numbers of oral health professionals, utilization of oral health services, and oral health outcomes in the 50 states are also presented. RESULTS: The analyses revealed that: There are significant differences in the legal practice environments (as reflected in the DHPPI) across the 50 states and the District of Columbia. Between 1990 and 2001, the number of DHs per capita increased by 46% in the United States, while the number of dentists per 100,000 population increased by only 10%. The DHPPI was not significantly correlated with the number of DHs or dentists in the 50 states in 2001. The DHPPI was significantly positively correlated with the salaries of DHs in 2001. The DHPPI was also significantly and positively correlated with a number of indicators of utilization of oral health services and oral health outcomes. CONCLUSIONS: Both access to oral health services and oral health outcomes are positively correlated with the DHPPI. This suggests that states with low DHPPI scores would be logical candidates for revised DH practice statutes and regulations to accomplish these objectives.