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Geographic Information Science Study. A literature about why...

Geographic Information Science Study.

A literature about why spatial accessibility measures are important (i.e., they've been linked with various population health outcomes), how the measures have been developed and improved over time, etc. I attached related articles and a doc file that compares different method. Thanks in advance!

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Predicting Late-stage Breast Cancer Diagnosis and Receipt of Adjuvant Therapy Applying Current Spatial Access to Care Methods in Appalachia Joseph Donohoe, PhD, * Vince Marshall, MS, w Xi Tan, PhD, z Fabian T. Camacho, MA, MS, y Roger Anderson, PhD, y and Rajesh Balkrishnan, PhD y Purpose: The 2-step foating catchment area (2SFCA) method o± measuring access to care has never been used to study cancer dis- parities in Appalachia. First, we evaluated the 2SFCA method in relation to traditional methods. We then examined the impact o± access to mammography centers and primary care on late-stage breast cancer diagnosis and receipt o± adjuvant hormonal therapy. Methods: Cancer registries ±rom Pennsylvania, Ohio, Kentucky, and North Carolina were linked with Medicare data to identi±y the stage o± breast cancer diagnosis ±or Appalachia women diagnosed between 2006 and 2008. Women eligible ±or adjuvant therapy had stage I, II, or III diagnosis; mastectomy or breast-conserving sur- gery; and hormone receptor–positive breast cancers. Geographically weighted regression was used to explore nonstationarity in the demographic and spatial access predictor variables. Results: Over 21% o± 15,299 women diagnosed with breast cancer had late-stage (stages III–IV) diagnosis. Predictors included age at diagnosis [odds ratio (OR) = 0.86; P < 0.001], insurance status (OR = 1.32; P < 0.001), county primary care to population ratio (OR = 0.95; P < 0.001), and primary-care 2SFCA score (OR = 0.96; P = 0.006). Only 46.9% o± eligible women received adjuvant hor- monal therapy, and predictors included comorbidity status (OR = 1.18; P = 0.047), county economic status (OR = 1.32; P = 0.006), and mammography center 2SFCA scores (OR = 1.12; P = 0.021). Conclusions: Methodologically, the 2SFCA method o±±ered the greatest predictive validity o± the access measures examined. Sub- stantively, rates o± late-stage breast cancer diagnosis and adjuvant hormonal therapy are substandard in Appalachia. Key Words: Appalachia, spatial access, breast cancer, adjuvant therapy, 2SFCA method ( Med Care 2015;53: 980–988) T he Appalachia region o± the United States has reduced health outcomes and treatment patterns across a number o± diseases, including breast cancer. 1–3 Because many areas o± Appalachia have lower socioeconomic status 4 and occupy rural, mountainous terrain, reduced access to care is o±ten implicated in the region’s cancer disparities. 5 Spatial access to care is traditionally measured using either provider to population ratios or by computing the travel time between patient and provider. 6 However, both methods have limitations. Provider to population ratios use ²xed geographic boundaries (eg, counties) that do not refect actual patient behaviors, whereas travel time ±ails to account ±or supply and demand ±actors. 7 More recently, the 2-step foating catchment area (2SFCA) method was developed to overcome these limitations. 8 Despite its improvement over traditional measures o± spatial access to care, the 2SFCA method has never been used to study cancer outcomes or treatment patterns in Appalachia. We recently evaluated the impact o± di±±erent 2SFCA parameter options when measuring access to mammography centers and primary care physicians in Appalachia. Here, we used a linked central cancer registry and Medicare dataset across 4 Appalachian states to evaluate the relationship between spatial access to care and 2 important clinical indicators ±or breast cancer—late-stage diagnosis and receipt o± adjuvant hormonal therapy. Late-stage breast cancer diagnosis leads to ±ewer treatment options and increased mortality 9 and is more prevalent in lower socioeconomic, rural, and black populations. 10–12 Ad- juvant hormonal therapy is recommended ±or hormone receptor–positive patients a±ter either breast-conserving surgery or mastectomy. 13,14 Lower socioeconomic status is also asso- ciated with reduced rates o± adjuvant hormonal therapy. 15 First,we±ocusedonthemethodological aspects o± spatial access to care by evaluating the predictive ability o± the 2SFCA method compared with traditional spatial access approaches. We then ±ocused on the substantive clinical outcomes o± in- terest in the Appalachia region. We used geographically weighted regression (GWR) to examine whether the infuence o± demographic or spatial access predictor variables on stage o± breast cancer diagnosis or receipt o± adjuvant hormonal therapy di±±ered throughout the study region. METHODS This research was approved by the institutional review board at the University o± Michigan. From the * Mountain-Paci²c Quality Health Foundation, Helena, MT; w College o± Pharmacy, University o± Michigan, Ann Arbor, MI; z School o± Pharmacy, West Virginia University, Morgantown, WV; and y Department o± Public Health Sciences, School o± Medicine, University o± Virginia, Charlottesville, VA. Supported by the National Cancer Institute and the NIH O±²ce on Women’s Health through Grant 1 R21 CA168479 (R.B., PI). The authors declare no confict o± interest. Reprints: Rajesh Balkrishnan, PhD, Department o± Public Health Sciences, School o± Medicine, University o± Virginia, P.O. Box 800717, Char- lottesville, VA 22908. E-mail: [email protected]. Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0025-7079/15/5311-0980 O RIGINAL A RTICLE 980 | Medical Care ± Volume 53, Number 11, November 2015 Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.
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Journal of Primary Care & Community Health 2016, Vol. 7(3) 149 –158 © The Author(s) 2016 Reprints and permissions: DOI: 10.1177/2150131916632554 Original Research Introduction Appalachia is largely rural, with 42% of its population clas- sified as rural compared with the national average of 20%. 1 Socioeconomically, the region has a lower per capita income and a higher poverty rate than the national average. 2 Access to adequate health care is an ongoing concern in Appalachia, largely due to the mountainous terrain, rural population distribution, and socioeconomic disparities. 3 Access to primary care services is especially important given primary care providers’ role as a gateway to health systems. 4 In Appalachia, regular primary care encounters have been shown to increase early cancer detection and reduce mortality. 5,6 In Appalachia Ohio, children with irreg- ular primary care visits had poorer general health outcomes, and the parents of those children reported that lack of access to primary care prevented regular contact. 6 Regular, quality primary care encounters can also counteract the negative effects that economic disparities have on heath, 7 a particu- larly important outcome given Appalachia’s generally reduced economic status. Accurately measuring access to primary care is impor- tant for guiding interventions in Appalachia regions that often lack adequate resources. Spatial access is one compo- nent of access to care—distinct from nonspatial factors such as insurance status or level of education—and its sta- tus is often a population-wide indicator, with the US Department of Health and Human Services Health Professional Shortage Areas (HPSA) designation being the most common. 8,9 One traditional measure of spatial access is a county provider to population ratio, which is the meth- odology used for the HPSA designation. 9 Another common strategy for measuring spatial access to care is to use 632554 JPC X X 10.1 7 /2150131916 325 4Journal of Primary Care & Com unity Health Donohoe et al research-article 2016 1 Mountain Pacific Quality Health, Helena, MT, USA 2 University of Michigan, Ann Arbor, MI, USA 3 West Virginia University, Morgantown, WV, USA 4 University of Virginia, Charlottesville, VA Corresponding Author: Rajesh Balkrishnan, School of Medicine, University of Virginia, Hospital West, PO Box 800717, Charlottesville, VA 22901-0793, USA. Email: [email protected] Spatial Access to Primary Care Providers in Appalachia: Evaluating Current Methodology Joseph Donohoe 1 , Vince Marshall 2 , Xi Tan 3 , Fabian T. Camacho 4 , Roger T. Anderson 4 , and Rajesh Balkrishnan 4 Abstract Purpose: The goal of this research was to examine spatial access to primary care physicians in Appalachia using both traditional access measures and the 2-step floating catchment area (2SFCA) method. Spatial access to care was compared between urban and rural regions of Appalachia. Methods: The study region included Appalachia counties of Pennsylvania, Ohio, Kentucky, and North Carolina. Primary care physicians during 2008 and total census block group populations were geocoded into GIS software. Ratios of county physicians to population, driving time to nearest primary care physician, and various 2SFCA approaches were compared. Results: Urban areas of the study region had shorter travel times to their closest primary care physician. Provider to population ratios produced results that varied widely from one county to another because of strict geographic boundaries. The 2SFCA method produced varied results depending on the distance decay weight and variable catchment size techniques chose. 2SFCA scores showed greater access to care in urban areas of Pennsylvania, Ohio, and North Carolina. Conclusion: The different parameters of the 2SFCA method—distance decay weights and variable catchment sizes—have a large impact on the resulting spatial access to primary care scores. The findings of this study suggest that using a relative 2SFCA approach, the spatial access ratio method, when detailed patient travel data are unavailable. The 2SFCA method shows promise for measuring access to care in Appalachia, but more research on patient travel preferences is needed to inform implementation. Keywords access to care, rural health, primary care, medical informatics, quality improvement
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Spatal AccessibiliTy Score Spatal AccessibiliTy Score Descripton References using score Two-sTep Foatng caTchmenT area 2S±CA ²he meThod consisTs of Two sTeps. Each sTep creaTes an area of coverage called caTchmenT. ²he Two caTchmenTs lay on Top of one anoTher or Foatng. ²he ³rsT sTep is concerned wiTh The supply and The second sTep is concerned wiTh The demand. ²he relatonship beTween supply and demand is de³ned by The graviTy models. MeThodology- STep1: GeneraTe a 30-minuTe drive tme zone (caTchmenT) wiTh respecT To The provider siTe. CompuTe The provider-To- populaton rato aT each provider locaton. STep2: GeneraTe anoTher 30- minuTe drive tme caTchmenT wiTh respecT To The populaton siTe. CompuTe The spatal accessibiliTy index for each populaton siTe. 2S±CA LimiTatons- IT doesn’T consider disTance decay wiThin caTchmenT area. Assuming ThaT all providers and populaton wiThin caTchmenT area are equal in access. McGrail, Ma´hew R. "Spatal accessibiliTy of primary healTh care utlising The Two sTep Foatng caTchmenT area meThod: an assessmenT of recenT improvemenTs." InTernatonal journal of healTh geographics 11.1 (2012): 1. Lian, Min, James STruThers, and Mario SchooTman. "Comparing GIS-based measures in access To mammography and Their validiTy in predictng neighborhood risk of laTe-sTage breasT cancer." PLoS One 7.8 (2012): e43000. Cheng, Yang, Jiaoe Wang, and Mark W. Rosenberg. "Spatal access To residental care resources in Beijing, China." InTernatonal journal of healTh geographics 11.1 (2012): 1. HawThorne, ²imoThy L., and Mei-Po Kwan. "Exploring The unequal landscapes of healThcare accessibiliTy in lower-income urban neighborhoods Through qualiTatve inquiry." Geoforum 50 (2013): 97-106. Dai, Dajun. "Black residental segregaton, disparites in spatal access To healTh care facilites, and laTe-sTage breasT cancer diagnosis in meTropoliTan DeTroiT." HealTh & place 16.5 (2010): 1038-1052. Enhanced Two-sTep Foatng caTchmenT area E2S±CA ²he meThod addresses The disTance decay problem in 2S±CA meThod by dividing caTchmenT area inTo several subzones and applying a discreTe Gaussian functon as The decay functon and weighTs To diµerenT Travel tme zones. MeThodology: GeneraTe Three drive tme zones, 0-10, 10- 20, Luo, Wei, and Yi Qi. "An enhanced Two-sTep Foatng caTchmenT area (E2S±CA) meThod for measuring spatal accessibiliTy To primary care physicians." HealTh & place 15.4 (2009): 1100-1107. Kanugant, Shalini, Ashoke Kumar Sarkar, and AjiT PraTap Singh. "Evaluaton of access To healTh care in rural areas using enhanced Two-sTep Foatng caTchmenT area (E2S±CA)
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