Using GIS to Plan Specialty Health Services for Veterans: The Example of Acute Stroke Care

Ripley, Diane Cowper; Litt, Eric R.; Jia, Huanguang; Vogel, William; Wang, Xinping; Wilson, Lauren K.; Phipps, Michael; Harner, Jo Ann; Graham, Glenn D.

doi:10.4236/jgis.2014.63018

Cited by 5 publications

(4 citation statements)

References 4 publications

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“…The RUCA system classifies US census tracts based on population density, urbanization, and commuting patterns to larger urban centers 21,22 . We defined RUCA codes of 1.0 or 1.1 as urban and all other RUCA codes as rural to align with VHA policies and prior research 21–23 …”

Section: Methodsmentioning

confidence: 99%

Rural‐urban trends in health care utilization, treatment, and mortality among US veterans with congestive heart failure: A retrospective cohort study

Aboumrad

Peritz

Friedman

et al. 2023

The Journal of Rural Health

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PurposeTo compare longitudinal rates of health care utilization, evidence‐based treatment, and mortality between rural and urban‐dwelling patients with congestive heart failure (CHF).MethodsWe used electronic medical record data from the Veterans Health Administration (VHA) to identify adult patients with CHF from 2012 through 2017. We stratified our cohort using left ventricular ejection fraction percentage at diagnosis (<40% = reduced ejection fraction [HFrEF]; 40%‐50% = midrange ejection fraction [HFmrEF]; >50% = preserved ejection fraction [HFpEF]). Within each ejection fraction cohort, we stratified patients into rural or urban groups. We used Poisson regression to estimate annual rates of health care utilization and CHF treatment. We used Fine and Gray regression to estimate annual hazards of CHF and non‐CHF mortality.FindingsOne‐third of patients with HFrEF (N = 37,928/109,110), HFmrEF (N = 24,447/68,398), and HFpEF (N = 39,298/109,283) resided in a rural area. Rural compared to urban patients used VHA facilities at similar or lower annual rates for outpatient specialty care across all ejection fraction cohorts. Rural patients used VHA facilities at similar or higher rates for primary care and telemedicine‐delivered specialty care. They also had lower and declining rates of VHA inpatient and urgent care use over time. There were no meaningful rural‐urban differences in treatment receipt among patients with HFrEF. On multivariable analysis, the rate of CHF and non‐CHF mortality was similar between rural and urban patients in each ejection fraction cohort.ConclusionsOur findings suggest the VHA may have mitigated access and health outcome disparities typically observed for rural patients with CHF.

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Section: Methodsmentioning

confidence: 99%

Rural‐urban trends in health care utilization, treatment, and mortality among US veterans with congestive heart failure: A retrospective cohort study

Aboumrad

Peritz

Friedman

et al. 2023

The Journal of Rural Health

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“…Clinic rurality was defined based on the residence of the majority of the patients attending the clinic using Rural Urban Commuting Area (RUCA) codes. 37 The clinic's Census region was defined as Midwest, Northeast, South, or West by mapping the county code of the facility to the 2014 and 2015 Area Health Resource Files.…”

Section: Methodsmentioning

confidence: 99%

Association of Team-Based Care and Continuity of Care with Hospitalizations for Veterans with Comorbid Mental and Physical Health Conditions

et al. 2021

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BACKGROUND: Integrating mental health in primary care settings is associated with improved screening and detection of mental illness. In 2010, the Veterans Health Administration launched a patient-centered medical home (PCMH) model nationally across all clinical sites that integrated mental health into primary care-the Patient Aligned Care Team (PACT) initiative. Team-based delivery of continuous primary and mental health care, as found in effective collaborative care models, is thought to be crucial to managing veterans with mental health disorders. The association between clinic implementation of specific aspects of PACT and clinical outcomes of veterans with mental health disorders remains unknown. OBJECTIVE: To examine the association between clinic implementation of team-based care and continuity of care and subsequent hospitalizations among veterans with mental health disorders. DESIGN: Retrospective cohort study. PATIENTS: A total of 1,444,942 veterans with comorbid mental health disorders and physical health conditions receiving primary care in 831 VA PACT clinics in fiscal year (FY) 2015. MAIN MEASURES: We examined the clinic-level implementation of team-based care and continuity of care in the clinic where veterans received their primary care. Our primary outcome was any hospitalization in the VA or feebased service in FY2016. We examined the impact of clinic-level implementation of team-based care and continuity of care on having a hospitalization, adjusting for patient demographic, clinical characteristics, and facility characteristics. KEY RESULTS: Veterans receiving care in clinics with the greatest versus lowest quartile of implementation of teambased care had lower rates of hospitalization (8.8% vs. 12.3%; adjusted OR = 0.92, 95% CI 0.85-0.99, p < 0.035). There was not a statistically significant association between clinic-level implementation of continuity of care and hospitalization. CONCLUSIONS: Veterans receiving care in clinics with greater implementation of team-based care had statistically significant lower rates of hospitalization.

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“…Numerous studies have used GIS to address access to care issues for different patient populations, such as acute stroke, multiple sclerosis, and traumatic injuries (Cowper Ripley et al, 2017;Culpepper et al, 2010;Nykiforuk & Flaman, 2011;Ripley et al, 2009Ripley et al, , 2014Ripley et al, , 2015. Other work has described planning health services for populations of patients with specific medical conditions (Culpepper et al, 2010;Ripley et al, 2009Ripley et al, , 2014Ripley et al, , 2015. We discuss the process and utility of using GIS to visually represent and categorize U.S. counties by varying levels of need for the TWV program.…”

mentioning

confidence: 99%

“…Utilizing county-level data and geographic information system (GIS) to quickly visualize county suicide prevention need can be invaluable in facilitating conversations with stakeholders to narrow down a list of possible intervention communities, framing the conversation around community risk and need, not just community readiness (Lyseen et al, 2014;Nykiforuk & Flaman, 2011). Numerous studies have used GIS to address access to care issues for different patient populations, such as acute stroke, multiple sclerosis, and traumatic injuries (Cowper Ripley et al, 2017;Culpepper et al, 2010;Nykiforuk & Flaman, 2011;Ripley et al, 2009Ripley et al, , 2014Ripley et al, , 2015. Other work has described planning health services for populations of patients with specific medical conditions (Culpepper et al, 2010;Ripley et al, 2009Ripley et al, , 2014Ripley et al, , 2015.…”

mentioning

confidence: 99%

Reducing rural veteran suicides: Navigating geospatial and community contexts for scaling up a national Veterans Affairs program

Kreisel

Wilson

Schneider

et al. 2021

Suicide & Life Threat Behav

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Objective To develop and use planning maps to prioritize and facilitate county‐level recruitment for Together With Veterans (TWV), community‐based rural Veteran suicide prevention program. Method Choropleth maps were created for 49 U.S. states, with four mutually exclusive categories indicating eligibility for the TWV program and increasing levels of need assigned to each county based on (a) percent Veterans Health Administration enrollees residing in rural communities, (b) percent population that are Veterans, and (c) crude suicide mortality rate. Results Of 3113 counties, 78.2% were eligible for TWV and 25.8% met our highest priority definition. A national map and state map were provided to demonstrate final products used to engage stakeholders. A table of recommendations for creating and using planning maps was provided for future projects to reference. Conclusions Geographic information system (GIS) is useful for identifying and prioritizing counties that may benefit most from a rural Veteran suicide prevention program. Choropleth maps allow for dissemination of information about county suicide risk and need for suicide prevention to community members, researchers, and others with a vested interest in suicide reduction. The maps are one tool among many which can support decision‐makers in focusing available resources on populations with the most need.

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Using GIS to Plan Specialty Health Services for Veterans: The Example of Acute Stroke Care

Cited by 5 publications

References 4 publications

Rural‐urban trends in health care utilization, treatment, and mortality among US veterans with congestive heart failure: A retrospective cohort study

Rural‐urban trends in health care utilization, treatment, and mortality among US veterans with congestive heart failure: A retrospective cohort study

Association of Team-Based Care and Continuity of Care with Hospitalizations for Veterans with Comorbid Mental and Physical Health Conditions

Reducing rural veteran suicides: Navigating geospatial and community contexts for scaling up a national Veterans Affairs program

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