New Center to Study Barriers to Full Practice Authority and Guide Policy Changes

Columbia nursing school sets sights on expanding access to high-quality, safe healthcare.

A new research and innovation center established by Columbia University School of Nursing will study policies and barriers that limit advanced practice nurses in providing primary care as part of its ultimate goal to expand access to high-quality, safe healthcare.

The Center for Healthcare Delivery Research and Innovation (HDRI) will support cutting-edge research on healthcare systems in the United States and internationally, which is critical to expanding access to care, Lusine Poghosyan, Ph.D., MPH, RN, FAAN, executive director of the new center, says in a press release. She also is an Elise D. Fish Professor at Columbia School of Nursing and a professor of health policy and management at Columbia’s Mailman School of Public Health.

"The demand for primary care services in the U.S. is increasing exponentially, and the NP workforce, [which is] expected to almost double in near future, can help address this demand," Poghosyan says. "But several barriers at the federal, state, and organizational level limit NPs’ ability to provide primary care. Our research seeks to identify these policies and barriers, particularly in how they relate to patient care and outcomes."

The new center's trainees—five Ph.D. students and two postdoctoral fellows—are studying care for high-cost, high-needs patients and those with dementia and multiple chronic conditions, as well as the delivery of mental health services in primary care and community health centers.

"Our research focuses on how to build effective healthcare teams—communities in their own right—to take care of patients in critical situations and how to improve work environments in healthcare organizations to promote and support teamwork and ultimately patient care," says Poghosyan, a specialist in health policy and the healthcare workforce.

In a five-year, $3.6 million grant funded by the National Institute on Aging, Poghosyan and her HDRI team are looking at racial disparities in care among people with dementia who receive care from NP practices.

"Little is known about how to optimize primary care practices employing nurse practitioners, which often lack the organization and structure needed to ensure continuity of care and better outcomes for minority people with dementia," Poghosyan says. "And there’s little guidance on how to improve access to community resources to help."  

HDRI's research will help answer these and similar questions and will guide policy changes to support nurses, Poghosyan said. The center also will help investigators get research funding, and senior faculty will mentor junior researchers as they develop their own programs.

"The spotlight has never shone brighter on nurses as leaders," says Lorraine Frazier, Ph.D., dean of Columbia University School of Nursing and the senior vice president of Columbia University Irving Medical Center. "HDRI will help build the evidence we need to support the nursing workforce, and nurses themselves, while expanding access to high-quality healthcare."

Other projects underway include a five-year grant from the National Institute of Nursing Research to train nurse scholars on comparative and cost-effectiveness research and an Agency for Healthcare Quality and Research-funded study of social networks in medical homes and their impact on patient care and patient outcomes.

HDRI’s faculty and affiliated fellows include scholars from Columbia Nursing, Columbia's Mailman School of Public Health, ColumbiaDoctors, NewYork-Presbyterian Hospital, and other leading institutions across the U.S. and in Canada, Germany, and the United Kingdom.

The center’s research is funded by the National Institutes of Health, the Agency for Healthcare Research and Quality, the Robert Wood Johnson Foundation, and the National Council of State Boards of Nursing, among other organizations.