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      Geographic Disparities in Patient Travel for Dialysis in the United States : Incremental Travel for Dialysis Patients

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          Abstract

          To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients.

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          GIS and health care.

          S. McLafferty (2002)
          GIS and related spatial analysis methods provide a set of tools for describing and understanding the changing spatial organization of health care, for examining its relationship to health outcomes and access, and for exploring how the delivery of health care can be improved. This review discusses recent literature on GIS and health care. It considers the use of GIS in analyzing health care need, access, and utilization; in planning and evaluating service locations; and in spatial decision support for health care delivery. The adoption of GIS by health care researchers and policy-makers will depend on access to integrated spatial data on health services utilization and outcomes and data that cut across human service systems. We also need to understand better the spatial behaviors of health care providers and consumers in the rapidly changing health care landscape and how geographic information affects these dynamic relationships.
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            Geographic access to health care for rural Medicare beneficiaries.

            Marcia Hart, Leighton Chan, Christopher D Goodman (2005)
            Patients in rural areas may use less medical care than those living in urban areas. This could be due to differences in travel distance and time and a utilization of a different mix of generalists and specialists for their care. To compare the travel times, distances, and physician specialty mix of all Medicare patients living in Alaska, Idaho, North Carolina, South Carolina, and Washington. Retrospective design, using 1998 Medicare billing data. Travel time was determined by computing the road distance between 2 population centroids: the patient's and the provider's zone improvement plan codes. There were 2,220,841 patients and 39,780 providers in the cohort, including 6,405 (16.1%) generalists, 24,772 (62.3%) specialists, and 8,603 (21.6%) nonphysician providers. There were 20,693,828 patient visits during the study. The median overall 1-way travel distance and time was 7.7 miles (interquartile range 1.9-18.7 miles) and 11.7 minutes (interquartile range 3.0-25.7 minutes). The patients in rural areas needed to travel 2 to 3 times farther to see medical and surgical specialists than those living in urban areas. Rural residents with heart disease, cancer, depression, or needing complex cardiac procedures or cancer treatment traveled the farthest. Increasing rurality was also related to decreased visits to specialists and an increasing reliance on generalists. Residents of rural areas have increased travel distance and time compared to their urban counterparts. This is particularly true for rural residents with specific diagnoses or those undergoing specific procedures. Our results suggest that most rural residents do not rely on urban areas for much of their care.
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              Travel time to dialysis as a predictor of health-related quality of life, adherence, and mortality: the Dialysis Outcomes and Practice Patterns Study (DOPPS).

              Takashi Akiba, Rajiv Saran, Shunichi Fukuhara … (2008)
              Longer travel time to the dialysis unit creates a substantial burden for many patients. This study evaluated the effect of self-reported 1-way travel time to hemodialysis on mortality, health-related quality of life (HR-QOL), adherence, withdrawal from dialysis therapy, hospitalization, and transplantation. Prospective observational cohort. Patients enrolled in the Dialysis Outcomes and Practices Patterns Study who completed a patient questionnaire (n = 20,994). One-way travel time to hemodialysis treatment, categorized as 15 or less, 16 to 30, 31 to 60, and longer than 60 minutes. Covariates included demographics, comorbid conditions, serum albumin level, time on dialysis therapy, and country. HR-QOL was examined by using a linear mixed model. Cox proportional hazards regression was used to examine associations with mortality, withdrawal from dialysis therapy, hospitalization, and transplantation. Longer travel time was associated with greater adjusted relative risk (RR) of death (P = 0.05 for overall trend). Adjusted HR-QOL subscales were significantly lower for those with longer travel times compared with those traveling 15 minutes or less. There were no associations of travel time with withdrawal from dialysis therapy (P = 0.6), hospitalization (P = 0.4), or transplantation (P = 0.7). The questionnaire nonresponse rate was substantial, and nonresponders were older, with more comorbid conditions. Travel time was assessed by using a single nonvalidated question. Longer travel time is associated significantly with greater mortality risk and decreased HR-QOL. Exploring opportunities to decrease travel time should be incorporated into the dialysis clinical routine.
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                Author and article information

                Journal
                Title: The Journal of Rural Health
                Abbreviated Title: The Journal of Rural Health
                Publisher: Wiley
                ISSN: 0890765X
                Publication date Created: April 2013
                Publication date (Print): April 2013
                Publication date (Electronic): April 11 2013
                Page: n/a
                Affiliations
                [1 ]Prima Health Analytics; Boston; Massachusetts
                [2 ]Chronic Disease Research Group; Minneapolis; Minnesota
                [3 ]Dialysis Center of Lincoln; Lincoln; Nebraska
                [4 ]Amgen Inc.; Thousand Oaks; California
                [5 ]Kochevar Research Associates; Charlestown; Massachusetts
                [6 ]Rollins School of Public Health; Emory University; Atlanta; Georgia
                Article
                DOI: 10.1111/jrh.12022
                PubMed ID: 24088208
                SO-VID: 341a892e-eacd-4478-a9c7-5f23e6970edb
                Copyright © © 2013
                License:

                http://doi.wiley.com/10.1002/tdm_license_1.1

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