Health Policy Research

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Formulating a Health Policy Research Agenda

The Health Services Research Ad Hoc Committee (HSR-AHC) met to set a direction for future research.

Representatives from each of its affiliates—AANA, AANA Foundation, COA, and NBCRNA—posed critical research questions in the HSR domains of policy, education, and practice.

Criteria Considered in Formulating the Critical Questions

  • Is the question scientifically well-posed (i.e., is it stated in a hypothetical form that leads to a research design and analysis with scientific credibility)?
  • Does the research question require data that is accessible or attainable at a reasonable cost or effort?
  • Is the research question posed in a way that can explain variability (i.e., different outcomes under different conditions)?
  • Are the units of analysis (observation) clearly identified?
  • Does the research extend our understanding of the phenomena being investigated; does it elaborate, extend, or fill in gaps in our present knowledge?

To learn more about how the HSR Agenda was developed, please view our HSR Agenda Development and Methodology presentation.

The Original 24 Research Questions Submitted to HSR-AHC

Education
  • What are the effects of emotional intelligence testing and education on minority CRNA resident attrition in graduate nurse anesthesia programs prior to matriculation and during the didactic and clinical phase of the program?
  • What are the effects of a structured and ongoing CRNA preceptor faculty development program on CRNA resident attrition in graduate nurse anesthesia programs?
  • What antecedent knowledge and skills do residents of nurse anesthesia require to practice independently in a small rural hospital setting?

Education/Policy
  • What is the personal and societal rate of return to educating various health care providers (can include multiple types of ARNPs, PAs, AAs, MDs, etc.)?

Education Practice
  • What are the most common procedures being performed throughout the United States in various types of facilities, by various types of providers?
  • Does the recent non-surgical pain management specialty in nursing anesthesia increase access to underserved populations?

Policy
  • What is the projected vacancy rate of CRNAs in hospitals and surgery centers?
  • What are the workforce needs for anesthesia providers in the U.S. healthcare system in the next 10 years?
  • Does legislative adoption of the Advanced Practice Registered Nurse (APRN) consensus model result in an increased scope of practice for APRNs?
  • Has patient access to care (surgical, obstetrical, endoscopy, dental services, and pain management) improved in states that have opted out of physician supervision?
  • What is the most efficient and cost-effective model of various patient, provider, and payer mixes?
  • How do legislators and other key decision makers perceive the influence of CRNAs (or APRNs)? What can be done in the policy arena to be more effectual/influential?
  • What impact would the triple aim framework (access, quality, and affordability) have on CRNA-provided chronic pain management services in rural hospitals?

Policy/Practice
  • Outcomes in a Medical Direction Model versus a Medical Supervision Model of Anesthesia Delivery: a quality and cost analysis.
  • What are hospital administrators’ (CEOs, CFOs, CMOs, CNOs) perceptions of CRNA anesthesia services in their institutional settings? (Variations by type of hospital, location by state, location by rural versus city.)
  • Can the application of Geographic Information Systems (GIS) demonstrate both an economic as well as access expansion and savings by allowing all anesthesia providers to practice at full scope of practice?
  • How will the VA adoption of full scope of practice potentially affect access and economic burden in the VA health care system for primary care services (including anesthesia)?

Practice
  • What are the outcomes of trauma patients cared for in exclusively CRNA-staffed American College of Surgeons Level I trauma centers compared with Level I trauma centers using other anesthesia staffing models?
  • What are the outcomes of patients cared for in exclusively CRNA-staffed Veterans Affairs (VA) health care facilities compared with VA facilities using other anesthesia staffing models?
  • What are the morbidity and mortality rates for the 50 or 100 most common surgical procedures performed in the United States?
  • Does implementation of a Pre-anesthesia Evaluation Clinic reduce costs and improve patient satisfaction?
  • Do outcomes in the military model of independent CRNA practice support the expanded use of this model in the non-military anesthesia care setting?
  • What are the value-added services hospital administrators and stakeholders value most from an anesthesia practice group?
  • What dimensions of anesthesia practice are going to be critical in determining a CRNA’s readiness for rural anesthesia practice? What are the dimensions of rural anesthesia practice?