AANA Foundation and AANA Joint Research Program

What are healthcare executives’ perceptions of CRNA anesthesia? How do they value the cost of care provided by CRNAs/nurse anesthesiologist in their institutional settings (by type of hospital, location by state, location by rural versus city)?

• Has patient access to care (surgical, obstetrical, endoscopy, dental, and pain management) improved in states that have opted out of physician supervision?
• Has legislative adoption of the APRN consensus model result in an increased scope of practice for APRNs?
• How do legislators and other key decision-makers perceive the influence of CRNAs/nurse anesthesiologists (or APRNs) and what can be done in the policy arena to be more effective and influential?
• What is the most efficient and cost-effective model of various patient, provider, and payer mixes?
• What are the outcomes of patients cared for in exclusively CRNA/nurse anesthesiologist-staffed Veterans Affairs (VA) health care facilities as compared with VA facilities using other anesthesia staffing models?

• Determine the impact (i.e. cost effectiveness and quality) of nurse anesthesia care regarding:
  • Hospital readmissions
  • Per-patient Medicare costs
  • Quality outcome as measured by (choose quality measure)
  • Geographical variation of [per patient Medicare costs/delivery of another (service)/per capita CRNA/nurse anesthesiologist or physician anesthesiologist population] by [state/Medicare service area)
  • Identify how payment claims for CRNA/nurse anesthesiologist services vary among state Medicare and Medicaid service areas in pain management
• Examine the variability of the CRNA’s/nurse anesthesiologist’s scope of practice in each state
• Examine the impact that limiting CRNA/nurse anesthesiologist scope of practice would have on cost and access
• Assess CRNA/nurse anesthesiologist practice patterns (specialty anesthesia services) identified by locale
• Explore how the implementation of health reform (i.e. ACSs/other share savings plans/payment innovations) may affect CRNA/nurse anesthesiologist practice and reimbursement

• Examine the comparative effectiveness of healthcare providers performing specific procedures including central line insertions, ultrasound, and arterial-line placements
• Evaluate the impact of teamwork and hand offs related to patient safety
• Assess the role of the CRNA/nurse anesthesiologist regarding surgical site infections
• Determine the top 10 activities anesthesia providers can do to reduce administrative costs while upholding optimal patient safety
• Analyze the current literature detailing the competency and technical skills of CRNAs/nurse anesthesiologists
• Assess the impact that clinical relationships have between healthcare providers on improving patient care (Supervision—medical direction of CRNAs/nurse anesthesiologists for cases involving intubation, etc.)
• Identify which situations or scenarios enable CRNAs/nurse anesthesiologists to be or become the best patient advocate: mass casualty, incident preparedness and the role of CRNAs
• Describe role that RNs play in continuous epidural infusion
• Determine if changes in surgical scheduling impact non-routine events (error prevention)
• Determine the cost and quality of anesthesia services based on the type of organizational arrangements of the anesthesia practice (solo, group, faculty practice arrangements, salaried etc.) that influence compensation, retention in practice, age at retirement, and professional satisfaction
• Analyze the potential impact of the restructuring of organizations and reimbursement of the nurse anesthesia care given different health reform options (ex. Bundled payment, ACOs)
• Assess the impact of the differences in patient characteristics, practice settings, practice arrangements, case complexity, and types of procedures on safety and quality
• Create demonstration projects to evaluate innovative practice models that may improve care and the practice of nurse anesthesia in the future
• Explore various models of practice arrangements and environments that may led to an ideal practice environment based on cost and outcomes

• Analyze the comparative effectiveness of different types of innovative educational models for the preparation of nurse anesthetists on student satisfaction and performance and ultimately on performance measures reflecting safety, quality of care, and health outcomes for patients served
• Determine the value of the clinical doctorate (assess the measurable difference)
• Examine the current design of the DNP curriculum for “best practices” in DNP education
• Determine if critical thinking skills can be taught, measured, and/or predicted
• Assess the effectiveness of simulation on student education as well as on continuing education, maintenance, and competency for CRNAs/nurse anesthesiologists
• Examine the effectiveness of current criteria for admission into a nurse anesthesia program, including applicant’s behavior, attitude, and other factors that could be used as a way to help educators measure maturity and identify promising individuals for leadership positions