Bell Nathaniel, Kidanie Tsion, Cai Bo, Krause James S
College of Nursing, University of South Carolina, Columbia, SC.
Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.
Arch Phys Med Rehabil. 2017 Feb;98(2):341-346. doi: 10.1016/j.apmr.2016.09.130. Epub 2016 Oct 27.
To assess whether travel distances between patients and providers predict the frequency in which outpatient health care services are accessed after spinal cord injury (SCI).
A retrospective cohort study was carried out in South Carolina among employee health plan and Medicaid insurance recipients.
Research center.
Two years of outpatient claimant data were evaluated from patients (N=243) aged ≥18 years who were hospitalized between 2010 and 2012.
Travel distances were estimated by geocoding provider and patient address information onto street network files.
Variation in service utilization use was assessed using negative binomial regression. Outpatient visits for physical medicine and rehabilitation, physician and specialty clinic, radiology, internal medicine, behavioral mental health, and "other" were evaluated.
Longer travel distances were statistically significant predictors of decreased physician/specialty clinic (relative risk [RR]=.87; 95% confidence interval [CI], .79-.96) and physiotherapy (RR=.57; 95% CI, .46-.71) utilization, with mixed findings for other providers. Secondary analyses in which differences in service use were analyzed using census-defined classifications of urban and rural status did not demonstrate any geographic pattern.
There are significant geographic variations in the use of select outpatient services among SCI populations across the state that are related to longer travel distances. That these patterns were only visible when using travel distance models as opposed to census-based classifications of urban and rural status adds support to augmenting routine data collection and surveillance with spatial analytical models.
评估患者与医疗服务提供者之间的出行距离是否能预测脊髓损伤（SCI）后门诊医疗服务的就诊频率。
在南卡罗来纳州对员工健康计划和医疗补助保险接受者进行了一项回顾性队列研究。
研究中心。
对2010年至2012年期间住院的年龄≥18岁的患者（N = 243）的两年门诊索赔数据进行了评估。
通过将医疗服务提供者和患者的地址信息地理编码到街道网络文件中来估计出行距离。
使用负二项回归评估服务利用的差异。对物理医学与康复、内科医生及专科门诊、放射科、内科、行为心理健康和“其他”的门诊就诊情况进行了评估。
出行距离较长在统计学上是医生/专科门诊利用率降低（相对风险[RR]=0.87；95%置信区间[CI]，0.79 - 0.96）和物理治疗利用率降低（RR = 0.57；95% CI，0.46 - 0.71）的显著预测因素，其他医疗服务提供者的结果不一。使用人口普查定义的城乡状况分类分析服务使用差异的二次分析未显示任何地理模式。
全州脊髓损伤人群在某些门诊服务的使用上存在显著的地理差异，这与出行距离较长有关。与基于人口普查的城乡状况分类相比，这些模式仅在使用出行距离模型时可见，这为用空间分析模型加强常规数据收集和监测提供了支持。
