The effect of geographic access on severe health outcomes for pediatric asthma - 04/09/15
, Julie Swann, PhD a, b, Anne Fitzpatrick, PhD, RN, CPNP, MSCR cAbstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : Geographic access, pediatric asthma, severe health outcomes
Abbreviation used : ED
Plan
| Supported in part by a grant from the National Science Foundation (CMMI-0954283) and by a seed grant from the Institute of People and Technology (IPaT) and Children's Healthcare of Atlanta awarded in 2013. |
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| Disclosure of potential conflict of interest: E. Garcia, N. Serban, and J. Swann have received research support from the National Science Foundation (CMMI-0954283), the Institute of People and Technology, and Children's Healthcare of Atlanta. A. Fitzpatrick has received research support from the National Science Foundation, the Institute of People and Technology, and the National Institutes of Health (National Heart, Lung, and Blood Institute and National Institute for Health Research) and has received consultancy fees from MedImmune, Merck (Scientific Advisory Board), GlaxoSmithKline (Scientific Advisory Board), Genentech, and Boehringer Ingelheim. |
Vol 136 - N° 3
P. 610-618 - septembre 2015 Retour au numéro
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