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!

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
|
www.lww-medicalcare.com Medical Care ± Volume 53, Number 11, November 2015
Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.

Journal of Primary Care & Community Health
2016, Vol. 7(3) 149 –158
© The Author(s) 2016
Reprints and permissions:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/2150131916632554 jpc.sagepub.com
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

Schootman
et al. Int J Health Geogr
(2016) 15:20
DOI 10.1186/s12942-016-0050-z
REVIEW
Emerging technologies to measure neighborhood conditions in public health:
implications for interventions and next steps
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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)