GIS applications in health service planning: Experiences of a publicly-funded mobile safety net provider

Use of geographic information system (GIS) applications in community health assessment are becoming more widespread, and GIS applications have great potential to improve effective and efficient health service planning, decision support, health resource allocation, and program evaluation. The Governor's Wellmobile Program, established in 1985 and administered by the University of Maryland's School of Nursing, is a health care services safety net provider for uninsured and underinsured residents across the state of Maryland. The program's four mobile health units extend access to preventive and primary care services to vulnerable populations who might otherwise rely solely on hospital emergency departments; in fiscal year 2008, services were provided to 7,500 underserved clients. Program goals include providing direct care services, assisting clients to identify resources for which they qualify, developing linkages with partners in communities targeted, and coordinating services with local healthcare and other service providers. At this point, due to resource constraints, fulfilling requests for Wellmobile services at new sites essentially means decreasing services offered at sites already established. How would a plan for Wellmobile service allocation based on GIS analysis and decision support compare to such a plan based on more traditional decision-making methodologies? ArcGIS 9.3 applications, including secondary analysis of demographic variables, small area analysis, multiple regression, model builder, and data visualization were used to identify areas likely to benefit from services provided by the Governor's Wellmobile Program. Resulting maps represent effective communication and decision support tools for allocating scarce healthcare resources.