Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems
Racial Differences in Geographic Access to Medical Care as Measured by Patient Report and Geographic Information Systems
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DOI：
10.1097/mlr.0000000000000774
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发表时间：
2017-09-01
期刊：
影响因子：
3
通讯作者：
Pollack, Craig E.
中科院分区：
文献类型：
--
作者：
Wong, Michelle S.;Grande, David T.;Pollack, Craig E.
背景：地理可及性-到达医疗所需的旅行负担-是护理的一个重要方面。研究，通常依赖于地理信息系统（GIS）计算的旅行时间，发现了一些证据的种族差异的空间获得保健。然而，这些研究的有效性取决于旅行时间的准确性，患者race.Objectives：为了确定是否有种族差异时，比较患者报告和GIS计算的travel times.Research Design：数据来自费城地区前列腺癌访问研究（P-2访问），一个队列研究的男性诊断为局限性前列腺癌。我们对2136名男性进行了横断面分析，使用多变量线性混合效应模型来研究种族对患者报告和GIS计算的旅行时间差异的影响，以泌尿科和放射肿瘤学cancer providers.Results：患者报告的旅行时间平均长于GIS计算的时间。对于泌尿外科实践，黑人患者报告的中位旅行时间比GIS计算的旅行时间长12.7分钟，而白人长7.2分钟。在调整潜在的混杂因素，包括社会经济地位和汽车访问，黑人患者的差异显着大于白色patients（2.0分钟; 95%置信区间，0.58-3.44）。未来的研究，使用GIS计算的旅行时间，以检查种族差异的空间获得护理可能会考虑包括患者报告的旅行时间和控制的因素，可能会影响GIS计算的旅行时间的准确性。
Background: Geographic access-the travel burden required to reach medical care-is an important aspect of care. Studies, which typically rely on geographic information system (GIS) calculated travel times, have found some evidence of racial disparities in spatial access to care. However, the validity of these studies depends on the accuracy of travel times by patient race.Objectives: To determine if there are racial differences when comparing patient-reported and GIS-calculated travel times.Research Design: Data came from the Philadelphia Area Prostate Cancer Access Study (P-2 Access), a cohort study of men diagnosed with localized prostate cancer. We conducted cross-sectional analysis of 2136 men using multivariable linear mixed-effects models to examine the effect of race on differences in patient-reported and GIS-calculated travel times to urology and radiation oncology cancer providers.Results: Patient-reported travel times were, on an average, longer than GIS-calculated times. For urology practices, median patient-reported travel times were 12.7 minutes longer than GIS-calculated travel times for blacks versus 7.2 minutes longer for whites. After adjusting for potential confounders, including socioeconomic status and car access, the difference was significantly greater for black patients than white patients (2.0 min; 95% confidence interval, 0.58-3.44).Conclusions: GIS-calculated travel time may underestimate access to care, especially for black patients. Future studies that use GIS-calculated travel times to examine racial disparities in spatial access to care might consider including patient-reported travel times and controlling for factors that might affect the accuracy of GIS-calculated travel times.