Table 2.

Perspectives on Task Shifting by World Bank Income Classification

Task Shifting	Total	Low- and Middle-Income Country, Mean (SD)	High-Income Country, Mean (SD)	B-Coefficient	Standard Error	95% Confidence Interval		P Value
Should require competency-based certification	1.85 (0.76)	1.79 (0.70)	1.93 (0.83)	–0.06	0.04	–0.14	0.02	0.15
Should require standardized training endorsed by a governing organization	1.95 (0.81)	1.86 (0.75)	2.06 (0.87)	–0.08	0.04	–0.15	0.00	0.04
Should require maintenance of certification	1.97 (082)	1.87 (0.76)	2.10 (0.87)	–0.08	0.04	–0.16	–0.01	0.03
Is significantly better than the option of no neurosurgical care	2.17 (0.97)	2.13 (0.93)	2.23 (1.04)	–0.03	0.03	–0.09	0.04	0.40
Should be allowed only after the provider consults a formally trained neurosurgeon (in person or via electronic/telemedicine consultation)	2.22 (0.93)	2.07 (0.88)	2.43 (0.96)	–0.10	0.03	–0.17	–0.04	0.001
Can improve health care coverage by making more efficient use of the human resources already available	2.30 (0.93)	2.29 (0.89)	2.31 (0.95)	0.01	0.03	–0.06	0.73	0.86
Should be a priority where human resources are scarce	2.31 (0.96)	2.30 (0.95)	2.32 (0.97)	–0.01	0.03	–0.07	0.06	0.86
Has major safety concerns	2.31 (0.99)	2.27 (1.01)	2.37 (0.95)	–0.02	0.03	–0.09	0.04	0.43
Can quickly increase capacity while training and retention programs are expanded	2.41 (1.01)	2.28 (1.00)	2.58 (1.02)	–0.07	0.03	–0.13	–0.01	0.02
Should be limited to emergency surgical procedures	2.42 (1.10)	2.22 (1.11)	2.69 (1.03)	–0.10	0.03	–0.15	–0.04	<0.001
Can address the global shortage of neurosurgery providers	2.54 (1.06)	2.52 (0.99)	2.55 (1.11)	0.01	0.03	–0.05	0.72	0.84
Is significantly worse than specialist neurosurgical care	2.58 (1.04)	2.62 (1.04)	2.52 (1.05)	0.02	0.03	–0.03	0.08	0.42
Is professionally disruptive, because these new roles will encroach on specialties where professionals invest great time and resources into their training	2.60 (1.03)	2.47 (1.04)	2.76 (0.99)	–0.07	0.03	–0.13	–0.01	0.02
Causes a major reduction in quality of care	2.64 (1.02)	2.61 (1.04)	2.69 (1.00)	–0.02	0.03	–0.08	0.04	0.56
Will reduce the cost of health worker training	2.65 (1.08)	2.64 (1.12)	2.66 (1.02)	0.00	0.03	–0.06	0.05	0.91
Will reduce the cost of care for patients	2.76 (1.11)	2.70 (1.16)	2.85 (1.03)	–0.03	0.03	–0.08	0.03	0.29
Should not be allowed. Resources should focus only on expanding the training programs for formal, certified neurosurgical positions	2.76 (1.16)	2.58 (1.15)	2.76 (1.16)	–0.08	0.03	–0.13	–0.03	0.003
Should be limited to general practitioners and general surgeons; nonphysician providers should not be allowed	2.77 (1.12)	2.68 (1.11)	2.91 (1.11)	–0.05	0.03	–0.10	0.01	0.09
Should be limited to general surgeons	2.86 (1.09)	2.66 (1.09)	3.13 (1.02)	–0.10	0.03	–0.15	–0.04	0.001
Is necessary only in more rural and/or district hospitals in my country	2.89 (1.23)	2.61 (1.13)	3.27 (1.26)	–0.11	0.02	–0.15	–0.06	<0.001
Is necessary in my country	2.97 (1.33)	2.68 (1.23)	3.38 (1.36)	–0.10	0.02	–0.14	–0.06	<0.001
Will result in similar patient outcomes	3.14 (1.17)	3.11 (1.17)	3.17 (1.17)	–0.01	0.03	–0.06	0.04	0.69

SD, standard deviation.