Impact of Geographic Proximity to Cardiac Revascularization Services on Service Utilization

Gregory, Patrice M.; Malka, Edmond S.; Kostis, John B.; Wilson, Alan C.; Arora, Jasmine K.; Rhoads, George G.

doi:10.1097/00005650-200001000-00006

Cited by 87 publications

(77 citation statements)

References 33 publications

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“…[61][62][63][64][65][66][67][68][69][70][71] Several studies have found that women who lived farther away from facilities were less likely to undergo mammography than those who lived closer to facilities. [72][73][74][75][76] Contrary to those results, a study of the relationship between distance or travel time and adherence to screening mammography recommendations in rural Michigan failed to find an association.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Mammography Facility Locations and Stage of Breast Cancer at Diagnosis in Chicago

et al. 2008

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In the United States, despite substantial investment in public health initiatives to promote early detection of breast cancer through screening mammography, the proportion of female breast cancers that have advanced beyond the localized stage by the time of diagnosis remains high. Our objective in this exploratory study was to investigate whether stage of breast cancer at diagnosis among Chicago residents is associated with characteristics of the neighborhoods in which proximate mammography facilities are located. Those characteristics may influence likelihood of utilizing the service routinely and partly explain differences in stage at diagnosis. We used a retrospective cohort design and combined 3 years of data from the Illinois State Cancer Registry (ISCR) with information on locations of mammography facilities, public transportation service, crime, and area demographic and economic characteristics. Using a Geographic Information System (GIS), we identified the five facilities located nearest to each case's residence. Estimates of the association between characteristics of mammography facility locations and breast cancer stage at diagnosis were obtained using the partial proportional odds regression model. We found that the number of homicides in areas in which the nearest mammography facilities were located was associated with increased odds of later stage diagnosis. This effect was independent of age, race, and residential area education and income. We found no effect on stage of distance, public transportation service, or measures of neighborhood social similarity. The "spatial dynamics" of health may involve geographies beyond the immediate neighborhood. The results of our study suggest that areas in which the nearest mammography facilities are located may be one such geography. We hope that this study will spark research interest in the impact of health service locations on utilization.

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Section: Discussionmentioning

confidence: 99%

Characteristics of Mammography Facility Locations and Stage of Breast Cancer at Diagnosis in Chicago

et al. 2008

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“…31 Most studies of the association between distance and health care utilization have examined this relationship among residents of rural areas or large regions such as states that include areas of varying rurality. [32][33][34][35][36] Intraurban variation in the spatial accessibility of mammography and other health care services and its effect on residents' utilization is not well understood. 37 Facilities providing low-or no-fee screening mammography may be particularly important resources for midlife women (ages 40-64) residing in economically disadvantaged neighborhoods.…”

Section: Introductionmentioning

confidence: 99%

Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

Zenk

Tarlov²,

Sun³

2006

J Urban Health

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Recent research suggests living in an economically disadvantaged neighborhood is associated with decreased likelihood of undergoing mammography and increased risk of late-stage breast cancer diagnosis. Long distances and travel times to facilities offering low-or no-fee mammography may be important barriers to adherence to mammography screening recommendations for women living in economically disadvantaged urban neighborhoods, in which African-Americans are disproportionately represented. The purpose of this study was to examine whether the spatial distribution of facilities providing low-or no-fee screening mammography in Chicago, Illinois, is equitable on the basis of neighborhood socioeconomic and racial characteristics. We found that distance and travel times via automobile and public transportation to facilities generally decrease as neighborhood poverty increases. However, we also found that the strength of the association between neighborhood poverty level and two of the spatial accessibility measures-distance and public transportation travel time-is less strong in African-American neighborhoods. Among neighborhoods with the greatest need for facilities (i.e., neighborhoods with the highest proportions of residents in poverty), African-American neighborhoods have longer travel distances and public transportation travel times than neighborhoods with proportionately fewer African-American residents. Thus, it appears that the spatial accessibility of low-and no-fee mammography services is inequitable in Chicago. In view of persistent social disparities in health such as breast cancer outcomes, these findings suggest it is important for researchers to examine the spatial distribution of health resources by both the socioeconomic and racial characteristics of urban neighborhoods.

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“…We offer these GIS techniques as an alternative to the current practice of arbitrarily locating new facilities on the basis of perceptions about patient demand. These findings may be applicable when planning the locations for future healthcare services for other chronic diseases requiring regular medical follow-up such as diabetes, cardiovascular disease, cancer, and chronic respiratory illnesses (13)(14)(15)(16)(17)(18)20,25).…”

Section: Discussionmentioning

confidence: 97%

“…However, the use of GIS techniques to determine the optimal location of a healthcare facility with the goal of optimizing patient access is limited (12,18,20,25). Given Canada's vast size and relatively sparse population, GIS techniques have the potential to inform decisions on location of healthcare facilities including planning for clinics to care for people with chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

A Novel Technique to Optimize Facility Locations of New Nephrology Services for Remote Areas

Ayyalasomayajula

Wiebe

Hemmelgarn

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Travel distance to healthcare facilities affects healthcare access and utilization. Using the example of patients with kidney disease and nephrology services, we investigated the feasibility and utility of using geographic information system (GIS) techniques to identify the ideal location for new clinics to improve care for patients with kidney disease, on the basis of systematically minimizing travel time for remote dwellers.Design, setting, participants, & measurements Using a provincial laboratory database to identify patients with kidney disease and where they lived, we used GIS techniques of buffer and network analysis to determine ideal locations for up to four new nephrology clinics. Service-area polygons for different travel-time intervals were generated and used to determine the best locations for the four new facilities that would minimize the number of patients with kidney disease who were traveling Ͼ2 hours. ResultsWe studied 31,452 adults with living in Alberta, Canada. Adding the four new facilities would increase the number of patients living Ͻ30 minutes from a clinic by 2.2% and reduce the number living Ͼ120 minutes away by 72.5%. Different two-and three-clinic scenarios reduced the number of people living Ͼ120 minutes away by as much as 65% or as little as 32%, emphasizing the importance of systematic evaluation.Conclusions GIS techniques are an attractive alternative to the current practice of arbitrarily locating new facilities on the basis of perceptions about patient demand. Optimal location of new clinical services to minimize travel time might facilitate better patient care.

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Impact of Geographic Proximity to Cardiac Revascularization Services on Service Utilization

Abstract: Even across a relatively small geographic area, shorter distance to services and availability of services at the nearest hospital were strongly related to increased utilization of cardiac revascularization services.

Cited by 87 publications

References 33 publications

Characteristics of Mammography Facility Locations and Stage of Breast Cancer at Diagnosis in Chicago

Characteristics of Mammography Facility Locations and Stage of Breast Cancer at Diagnosis in Chicago

Spatial Equity in Facilities Providing Low- or No-Fee Screening Mammography in Chicago Neighborhoods

A Novel Technique to Optimize Facility Locations of New Nephrology Services for Remote Areas

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