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Evaluating Measures of Geographic Accessibility to Health Care In Urban Diabetics Living in Cuyahoga County

Liu, Constance Wei-fang
http://rave.ohiolink.edu/etdc/view?acc_num=case1200713083

Abstract Details

2008, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
This dissertation evaluated the association between measures of geographic accessibility and attendance at primary care visits in a sample of poor, urban, diabetic patients that received care from a large health care network in Cuyahoga County (MetroHealth System, or MHS). Study Design: The study had three aims. In the first two aims, we assessed associations between Euclidean distance from home to clinic and attendance to primary care clinic in our study sample, then used a subsample of Medicaid patients selected by a stratified random process to evaluate a novel measure of geographic accessibility (“Activity Density of Clinic Location”, or ADCL) based on “activity space”, or the subset of locations where individuals conduct their daily lives. The outcome of interest was attendance at primary health care visits (1=attended/0=missed) scheduled between July and December of 2006. Data was drawn from the electronic medical records (EMR) of the study sample and responses to a cross-sectional phone survey of the subsample. Multivariate logistic regression was used to evaluate associations between geographic accessibility and attendance after adjusting for transportation, demographics, and clinical characteristics. In Aim 3, we conducted contextual analysis of archival information and text from interviews with MHS decision-makers to describe how siting decisions were made by MHS in expanding its primary health care system from 1992 to 2005. Principal Findings: Distance was not associated with attendance at primary care visits in this sample, even after adjusting for demographic, clinical, and transportation-related factors. After rigorous adjustment for confounders, a 1 unit increase in ADCL was associated with a 7% decrease in probability of attending a visit (OR=0.93; 95% CI 0.87-1.00) in our sample of Medicaid patients, although the association was marginally significant (p=0.05). In our case study, MHS leaders, motivated by an altruistic mission and a strategy of solidifying its patient referral networks, based the siting of community health centers on patient location and the location of neighborhood centers of activity. Conclusions: Our activity-space based measure appeared to measure aspects of geographic accessibility in urban areas distinct from distance, and may have better distinguished individual differences in geography. Future studies should evaluate similar measures, address effect modification, and explore how health systems can use such information to address geographic issues in their patient populations.
Duncan Neuhauser (Advisor)
162 p.
geographic accessibility; health care access; measures; activity space; distance; urban space; diabetes; chronic illness

Recommended Citations

Citations

  • Liu, C. W.-F. (2008). Evaluating Measures of Geographic Accessibility to Health Care In Urban Diabetics Living in Cuyahoga County [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1200713083

    APA Style (7th edition)

  • Liu, Constance. Evaluating Measures of Geographic Accessibility to Health Care In Urban Diabetics Living in Cuyahoga County. 2008. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1200713083.

    MLA Style (8th edition)

  • Liu, Constance. "Evaluating Measures of Geographic Accessibility to Health Care In Urban Diabetics Living in Cuyahoga County." Doctoral dissertation, Case Western Reserve University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=case1200713083

    Chicago Manual of Style (17th edition)

case1200713083
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© 2008, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.