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.

Assessing multimodal school travel safety in North Carolina.

School transportation has been the subject of numerous federal and state policies since the early twentieth century-the Safe Routes to School program is the most recent example. However, few recent studies have thoroughly analyzed the risks and costs associated with different modes of transportation to school. Our descriptive study assessed the injury and fatality rates and related safety costs of different modes of school transportation using crash and exposure data from North Carolina, USA from 2005 to 2012. We found that riding with a teen driver is the most dangerous mode on a per trip basis with injury rates 20 times higher and fatality rates 90 times higher than school buses, which had the lowest injury rates. Non-motorized modes had per trip injury rates equivalent to school buses but per trip fatality rates were 15 times higher than for school buses. The economic costs of school travel-related injuries and fatalities for walking, biking, and teen drivers were substantially higher than other modes. This research has important policy implications because it quantified the risks of different school travel modes which allows policymakers to consider how safety investments can reduce risks. Decades of effort by schools, communities, and the government have made school buses a very safe mode and endeavored to reduce risks to teen drivers. This study highlighted the need for these same actors to reduce the risks of injury for walking and bicycling. As more improvements are made to infrastructure around schools, repeated studies of this type will allow practitioners to examine whether the improvements help mitigate the risks.

Assessing the distribution of safe routes to school program funds, 2005-2012.

BACKGROUND: The federal Safe Routes to School (SRTS) program was launched in 2005 to increase the safety of, and participation in, walking and biking to school. PURPOSE: This study assesses how SRTS funds were allocated to public and private schools and communities and whether there were demographic or locational differences between schools that benefited from SRTS funding and those that did not receive SRTS awards. METHODS: The study analyzes all SRTS projects awarded between 2005 and 2012 (N=5532) by using descriptive statistics to profile SRTS funding amounts and purposes, and to compare demographic and neighborhood characteristics of schools with and without SRTS programs. Analysis was conducted in 2013. RESULTS: The average SRTS award was $158,930 and most funding was spent on infrastructure (62.8%) or combined infrastructure and non-infrastructure (23.5%) projects. Schools benefiting from the SRTS program served higher proportions of Latino students and were more likely to be in higher-density areas. Few differences existed in neighborhood demographics, particularly educational attainment, work-trip commute mode, and median household income. CONCLUSIONS: Schools benefiting from the SRTS program are more urban and have higher Latino populations but are otherwise comparable to U.S. public schools. This suggests that disadvantaged areas have had access to the SRTS program.