Article

OBJECTIVE: 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). DESIGN: A retrospective cohort study was carried out in
South Carolina among employee health plan and Medicaid insurance recipients.
PARTICIPANTS: Two years of outpatient claimant data
were evaluated from patients (N=243) aged >/=18 years who were hospitalized
between 2010 and 2012. INTERVENTIONS: Travel distances were estimated by
geocoding provider and patient address information onto street network files.
MAIN OUTCOME MEASURES: 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. RESULTS: 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. CONCLUSIONS: 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.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS