The impact of nurse practitioner regulations on population access to care.

BACKGROUND: By 2025, experts estimate a significant shortage of primary care providers in the United States, and expansion of the nurse practitioner (NP) workforce may reduce this burden. However, barriers imposed by state NP regulations could reduce access to primary care. PURPOSE: The objectives of this study were to examine the association between three levels of NP state practice regulation (independent, minimum restrictive, and most restrictive) and the proportion of the population with a greater than 30-min travel time to a primary care provider using geocoding. METHODS: Logistic regression models were conducted to calculate the adjusted odds of having a greater than 30-min drive time. FINDINGS: Compared with the most restrictive NP states, states with independent practice had 19.2% lower odds (p = .001) of a greater than 30-min drive to the closest primary care provider. DISCUSSION: Allowing NPs full autonomy to practice may be a relatively simple policy mechanism for states to improve access to primary care.

Safety performance analysis of horizontal curves in urban areas.

While numerous studies have examined horizontal curve risk factors in rural areas, there is only one study for urban areas. Moreover, previous studies have used limited datasets, which tend to generate an intrinsic bias on results either by the sample size or due to a lack of understanding of all the risk factors associated with curve safety. This study aims to narrow this knowledge gap in three aspects: it focuses on urban areas; it uses a large novel GIS dataset of about 25,000 urban curves; and it expands the traditional curve risk factor pool by examining the spatial relationship of curves to adjacent curves and intersections. Using this curve dataset and six years of statewide fatal and injury crash data in the state of Florida, the study develops customized safety performance functions (SPFs) for urban curves based on different spatial relationships of curves to intersections. The results confirm that the traditional risk factors for rural curves, such as traffic volume, curve radius and length, speed limit, functional classification, and the number of lanes, also apply to curves in urban areas. However, the new finding is that curve safety in urban areas is affected by the proximity of curves to adjacent curves and intersections. The curves with intersections and isolated curves (with no adjacent nearby curves) are at high risk. There are also risk factor differences between single and dual-centerline roads. We also observed differences between the travel directions on divided roadway curves, but these differences will require more research.