Online Program

Quantifying transportation shortages and using geomapping to assess risk of transportation barriers to health care access

Tuesday, November 5, 2013

Roy Grant, MA, Medical Affairs, Children's Health Fund, New York, NY
Grifin Goldsmith, MPH, Medical Affairs, Childen's Health Fund, New York, NY
Stephen Borders, PhD, Community Research Institute, Grand Valley State University, Grand Rapids, MI
Delaney Gracy, MD, MPH (Epidemiology), Medical Affairs, Children's Health Fund, New York, NY
Tracy Rostholder, MPH, Medical Affairs, Childen's Health Fund, New York, NY
Dennis Johnson, MPA, The Children's Health Fund, New York, NY
Geospatial access and transportation availability are important factors in child health care access. Nationally, 4% of children (9% with household incomes <$0,000) missed at least one health care appointment annually because transportation was not available. One-third later used a hospital emergency department. We developed and validated a tool, the Health Transportation Shortage Index (HTSI) to identify areas where transportation is a health care access barrier. In this study we computed a HTSI score for each county in Mississippi and Michigan to quantify risk. We geomapped each county, locating every federally qualified health center and rural health clinic (“clinic”) within the county. Euclidian distances to nearest clinic (including those in contiguous counties) were computed using geographic- and population-weighted centroids as starting points. A HTSI cut score was determined that correctly identified 75.2% of counties with 1 or 0 pediatricians and correspondingly few family practitioners (p<0.01); 87.0% of these counties had populations <30,000 (p<0.01); 78.8% had the highest poverty rates in their state (p<0.01); 76.4% had no fixed route transit system including 17.6% with no public transit resources (p<0.01). Population-weighted analysis best reflected travel distances. Geomapping revealed that clinic resources are well-located relative to population centers, with mean travel distances generally <7 miles for the county. The longest travel distances were in the most rural counties (p<0.01). Some rural residential areas were 20-34 miles from the nearest clinic, underscoring the importance of transportation to facilitate access. Supplementing HTSI scores with geomapping facilitates health planning for new health care and/or transit resources.

Learning Areas:

Program planning
Provision of health care to the public
Public health administration or related administration
Public health or related public policy
Public health or related research

Learning Objectives:
Describe a new algorithm to assess the degree to which transportation shortages may impede access to health care in a targeted geographic area Explain the role of geomapping with GIS software to assess the adequacy of geospatial access to health care services for targeted residential areas. Describe the special health care access problems of children and families in rural areas.

Keyword(s): Access, Geographic Information Systems

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator for this research and led the development of the Health Transportation Shortage Index that will be presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.