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The effect of geographic access on severe health outcomes for pediatric asthma
Erin Garcia1, Nicoleta Serban1, Julie Swann2
1H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga.
Insights
Geographic access to medical care impacts severe pediatric asthma outcomes differently by state and care type. Tailored interventions are needed for optimal improvement in emergency department visits and hospitalizations.
Area of Science:
- Pediatric Pulmonology
- Health Services Research
- Geographic Epidemiology
Background:
- Geographic variations in medical care access and severe pediatric asthma outcomes are known.
- The specific relationship between geographic access and pediatric asthma health outcomes has not been previously studied.
Purpose of the Study:
- To evaluate the association between geographic access to healthcare and health outcomes in pediatric asthma patients.
- To determine how geographic access influences emergency department visits and hospitalizations for severe pediatric asthma.
Main Methods:
- Utilized multiple data sources to quantify asthma prevalence and severe outcomes (emergency department visits, hospitalizations) in Georgia and North Carolina.
- Employed optimization models to calculate geographic access to primary and specialist care.
- Applied logistic regression to estimate the association between outcomes and access, controlling for other factors.
Main Results:
- The relationship between access and pediatric asthma outcomes varied by outcome measure, care type, and state.
- In Georgia, primary care access influenced emergency department visits more, while specialist care access was more critical for hospitalizations.
- In North Carolina, both primary and specialist care access significantly explained variations in emergency department visits.
Conclusions:
- Geographic access and its association with pediatric asthma outcomes differ significantly across regions and care types.
- Projected reductions in severe asthma outcomes vary based on the tailored improvement of access.
- Interventions must be geographically tailored to maximize their effectiveness in improving pediatric asthma care.
Background:
Access to medical care and severe pediatric asthma outcomes vary with geography, but the relationship between them has not been studied.
Objective:
We sought to evaluate the relationship between geographic access and health outcomes for pediatric asthma.
Methods:
The severe outcome measures include emergency department (ED) visits and hospitalizations for children with an asthma diagnosis in Georgia and North Carolina. We quantify asthma prevalence, outcome measures, and factors included in the statistical model using multiple data sources. We calculate geographic access to primary and asthma specialist care using optimization models. We estimate the association between outcomes and geographic access in the presence of other factors using logistic regression. The model is used to project the reduction in severe outcomes with improvement in access.
Results:
The association between access and outcomes for pediatric asthma depends on the type of outcome measure, type of care, and variations in other factors. The expression of this association is also different for the 2 states. Access to primary care plays a larger role than access to specialist care in explaining Georgia ED visits, whereas the reverse applies for hospitalizations. In North Carolina access to both primary and specialist care are statistically significant in explaining the variability in ED visits.
Conclusions:
The variation in the association between estimated access and outcomes affects the projected reductions of severe outcomes with access improvement. Thus applying one intervention would not have the same level of improvement across geography. Interventions must be tailored to target regions with the potential to deliver the highest effect to gain maximum benefit.
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