Prima Health Analytics, Boston, Massachusetts.
J Rural Health. 2013 Fall;29(4):339-48. doi: 10.1111/jrh.12022. Epub 2013 Apr 11.
To estimate travel distance and time for US hemodialysis patients and to compare travel of rural versus urban patients.
Dialysis patient residences were estimated from ZIP code-level patient counts as of February 2011 allocated within the ZIP code proportional to census tract-level population, obtained from the 2010 U.S. Census. Dialysis facility addresses were obtained from Medicare public-use files. Patients were assigned to an "original" and "replacement" facility, assuming patients used the facility closest to home and would select the next closest facility as a replacement, if a replacement facility was required. Driving distances and times were calculated between patient residences and facility locations using GIS software.
The mean one-way driving distance to the original facility was 7.9 miles; for rural patients average distances were 2.5 times farther than for urban patients (15.9 vs. 6.2 miles). Mean driving distance to a replacement facility was 10.6 miles, with rural patients traveling on average 4 times farther than urban patients to a replacement facility (28.8 vs. 6.8 miles).
Rural patients travel much longer distances for dialysis than urban patients. Accessing alternative facilities, if required, would greatly increase rural patient travel, while having little impact on urban patients. Increased travel could have clinical implications as longer travel is associated with increased mortality and decreased quality of life.
估计美国血液透析患者的出行距离和时间，并比较农村和城市患者的出行情况。
根据 2010 年美国人口普查，从 2011 年 2 月的按比例分配给每个邮政编码的患者计数中估算透析患者的住所，按普查区人口比例分配。从医疗保险公共使用文件中获取透析设施地址。假设患者使用离家最近的设施，并在需要更换设施时选择下一个最近的设施作为更换设施，将患者分配到“原始”和“更换”设施。使用 GIS 软件计算患者住所和设施位置之间的驾驶距离和时间。
到原始设施的单程驾驶平均距离为 7.9 英里；农村患者的平均距离是城市患者的 2.5 倍（15.9 英里对 6.2 英里）。到更换设施的平均驾驶距离为 10.6 英里，农村患者到更换设施的平均距离是城市患者的 4 倍（28.8 英里对 6.8 英里）。
与城市患者相比，农村患者进行透析的出行距离要长得多。如果需要，访问替代设施将大大增加农村患者的出行，而对城市患者的影响很小。增加出行可能会产生临床影响，因为更长的出行与更高的死亡率和更低的生活质量相关。
