All ETDs from UAB

Advisory Committee Chair

Stephen J O'Connor

Advisory Committee Members

Ramona Benkert

S Robert Hernandez

Robert Weech-Maldonado

Jeff Szychowski

Document Type


Date of Award


Degree Name by School

Executive Doctor of Science (DSc) School of Health Professions


The purpose of this study is to determine the productive efficiency of Nurse Practitioners (NP) in a Nurse Managed Center (NMC) in a highly restrictive Scope-of-Practice (SOP) state. NPs are skilled, cost effective and quality health care providers and are considered a highly competitive option for increasing access while reducing health care costs. However, it is not clearly known if NPs are the most productively efficient at delivering this reduced cost of health care. The theories of Complex Adaptive Systems (CAS) and Resource Based View (RBV) were used as a framework to develop the hypotheses that examined the productive efficiency of NPs. The research question of this study is “Which factors within the daily practice of NPs contribute to the productive efficiency in NMCs?” The study included the following variables: 1) Time for the NP to Assign CPT Code, 2) Additional Number of Secondary ICD Codes, 3) Patient Residency Status, 4) Age, 5) Gender and 6) Years of Experience for the NP. Data were collected from a NMC that is located in a state with highly restrictive SOP laws, employs only NPs and provides the full spectrum of primary care services. iv Years of Experience for NP was associated with lower times, Additional Number of ICD codes was associated with longer times and Gender was associated with lower times. This is consistent with the theories of CAS and RBV, where it is theorized that numerous factors are involved in creating an environment where efficiency can be achieved and competitive forces sustained. Furthermore, as these environments undergo change they affect other environments and thus, affect the productive efficiency of those other environments. This clarity can then be used with the theory of RBV to apply advanced and sophisticated allocation of resources to achieve the most efficient outcome possible, with an understanding that this allocation may have to be changed based on the situation at hand. This knowledge has implications for policy makers, payors, practitioners and administrative leadership.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.