Doctoral Dissertation Research: Comparing Measures of Geographic Access to Health Care in an Urban Setting

博士论文研究：比较城市环境中地理获取医疗保健的措施

• 批准号: 0703397
• 负责人: Duncan Neuhauser
• 金额: $ 1.12万
• 依托单位: Case Western Reserve University
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-04-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=0703397&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Comparing; Measures

Distance is commonly used in policy and research as a measure of geographic access to health care. Studies of health care strongly suggest a link between distance and health care utilization in rural settings, but there is evidence to suggest that the distance measure is an unreliable predictor of health care access in urban settings. Activity space-based measures of geographic access, used in geography and the travel sciences, represent access as a function of the fixedness of an individual's routine in space and time, and their ability to travel from one activity to the next. These measures may better predict access for urban individuals who are more frequently constrained by lack of vehicular transportation, or are limited by other employment, economic or social considerations. The objective of this research is to evaluate distance and activity space-based measures as representations of the spatial dimensions of health care access in a poor, urban, diabetic population. Specific aims are: (1) to evaluate the relevancy of distance measures as a predictor of attendance to health care visits, (2) to validate distance measures against geographic measures based on the gold-standard activity-space, and (3) to evaluate the feasibility of global positioning system technology to facilitate data collection in this population. Dependent and independent variables will be obtained from electronic medical records (EMR) of diabetic patients that receive care in a large Cleveland health network, and from a cross-sectional survey of a subsample of those patients. A random sample of patients will also be asked to record information about their daily travel using global positioning system units. Measures of geographic access will be compared to evaluate how closely they correlate. Multivariate analysis will be used to determine the association between spatial access measures and attendance at scheduled health care visits.The study will bring focus to a poor, urban Cleveland population whose patterns of geographic access may be very different from the rural or car-owning populations that are the focus of existing geographic access research. The results of this study will clarify the interpretation of studies that use distance as a measure of geographic access, and may additionally guide the selection of measures in future studies carried out in the urban context. In terms of policy: The government often relies on distances equivalent to half-hour travel time to evaluate regional access to care, as in the designation of Health Professional Shortage Areas. This research may provide initial insight to how well this method identifies areas of poorer geographic access in urban areas, and how it might be improved. As a Doctoral Dissertation Research Improvement award, this award also will provide support to enable a promising student to establish a strong independent research career.

在政策和研究中，距离通常被用来衡量获得医疗保健的地理位置。对卫生保健的研究有力地表明，距离与农村地区的卫生保健利用之间存在联系，但有证据表明，距离测量不能可靠地预测城市卫生保健的可及性。在地理学和旅行科学中使用的基于活动空间的地理准入测量，将准入表示为个人在空间和时间上的固定程序的函数，以及他们从一项活动到另一项活动的旅行能力。这些措施可能会更好地预测城市个人的交通状况，这些人更经常受到缺乏车辆交通的限制，或者受到其他就业、经济或社会考虑的限制。这项研究的目的是评估距离和基于活动空间的测量作为贫困、城市、糖尿病人口中医疗保健获取的空间维度的代表。具体目标是：(1)评估距离测量作为卫生保健就诊的预测指标的相关性；(2)根据黄金标准活动空间，对照地理测量验证距离测量；以及(3)评估全球定位系统技术促进在这一人群中收集数据的可行性。因变量和自变量将从在大型克利夫兰健康网络中接受护理的糖尿病患者的电子病历(EMR)中获得，并从这些患者的子样本的横断面调查中获得。随机抽样的患者还将被要求使用全球定位系统单元记录他们的日常旅行信息。将对地理访问的衡量标准进行比较，以评估它们之间的关联程度。多变量分析将被用来确定空间准入措施与预定医疗就诊次数之间的关联。这项研究将把重点放在贫穷的克利夫兰城市人口身上，他们的地理准入模式可能与现有地理准入研究的重点-农村或拥有汽车的人群截然不同。这项研究的结果将澄清对使用距离作为地理准入衡量标准的研究的解释，并可能进一步指导未来在城市背景下开展的研究中对衡量标准的选择。在政策方面：政府经常依靠相当于半小时旅行时间的距离来评估地区获得医疗服务的情况，如卫生专业人员短缺地区的指定。这项研究可能会为这种方法识别城市地区地理通道较差的地区提供初步见解，以及如何改进。作为博士论文研究改进奖，该奖项还将提供支持，使有前途的学生建立一个强大的独立研究生涯。