Abstract
Objective
To assess whether travel distances between patients and providers predict the frequency
in which outpatient health care services are accessed after spinal cord injury (SCI).
Design
A retrospective cohort study was carried out in South Carolina among employee health
plan and Medicaid insurance recipients.
Setting
Research center.
Participants
Two years of outpatient claimant data were evaluated from patients (N=243) aged ≥18
years who were hospitalized between 2010 and 2012.
Interventions
Travel distances were estimated by geocoding provider and patient address information
onto street network files.
Main Outcome Measures
Variation in service utilization use was assessed using negative binomial regression.
Outpatient visits for physical medicine and rehabilitation, physician and specialty
clinic, radiology, internal medicine, behavioral mental health, and “other” were evaluated.
Results
Longer travel distances were statistically significant predictors of decreased physician/specialty
clinic (relative risk [RR]=.87; 95% confidence interval [CI], .79–.96) and physiotherapy
(RR=.57; 95% CI, .46–.71) utilization, with mixed findings for other providers. Secondary
analyses in which differences in service use were analyzed using census-defined classifications
of urban and rural status did not demonstrate any geographic pattern.
Conclusions
There are significant geographic variations in the use of select outpatient services
among SCI populations across the state that are related to longer travel distances.
That these patterns were only visible when using travel distance models as opposed
to census-based classifications of urban and rural status adds support to augmenting
routine data collection and surveillance with spatial analytical models.
Keywords
List of abbreviations:
CI (confidence interval), PEBA (Public Employee Benefit Authority), RFA (Revenue and Fiscal Affairs), RR (relative risk), SC (South Carolina), SCI (spinal cord injury)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 27, 2016
Footnotes
Supported in part by a pilot grant from the South Carolina Spinal Cord Injury Research Fund (SCRIF # 2014 P-01).
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
