Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration

Culpepper, William J.; Cowper-Ripley, Diane; Litt, Eric R.; McDowell, Tzu-Yun; Hoffman, Paul M.

doi:10.1682/jrrd.2009.10.0173

Cited by 23 publications

(21 citation statements)

References 18 publications

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“…This strategy may improve access to specialists for veterans in remote or rural areas [20]. Similarly, distance‐to‐facility data also could be used to identify areas of the country where additional VA MS specialty clinics would improve access for the greatest number of individuals [21].…”

Section: Discussionmentioning

confidence: 99%

Access to Multiple Sclerosis Specialty Care

Turner

Chapko

Yanez

et al. 2013

PM&R

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Section: Discussionmentioning

confidence: 99%

Access to Multiple Sclerosis Specialty Care

Turner

Chapko

Yanez

et al. 2013

PM&R

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“…Geospatially fluent analytic approaches can crucially inform analyses of health care systems (71, 72). Detailing local densities and “types” (epidemiologic, physiologic or demographic) of data using GIS methodologies is fundamental to understanding current and future health resource needs.…”

Section: Examples Of Gis Techniques In the Renal Literaturementioning

confidence: 99%

Geographic information systems and chronic kidney disease: racial disparities, rural residence and forecasting

Rodriguez

Hotchkiss

O’Hare

2012

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The dynamics of health and health care provision in the United States vary substantially across regions, and there is substantial regional heterogeneity in population density, age distribution, disease prevalence, race and ethnicity, poverty and the ability to access care. Geocoding and geographic information systems (GIS) are important tools to link patient or population location to information regarding these characteristics. In this review, we provide an overview of basic GIS concepts and provide examples to illustrate how GIS techniques have been applied to the study of kidney disease, and in particular to understanding the interplay between race, poverty, rural residence and the planning of renal services for this population. The interplay of socioeconomic status and renal disease outcomes remains an important area for investigation and recent publications have explored this relationship utilizing GIS techniques to incorporate measures of socioeconomic status and racial composition of neighborhoods. In addition, there are many potential challenges in providing care to rural patients with chronic kidney disease including long travel times and sparse renal services such as transplant and dialysis centers. Geospatially fluent analytic approaches can also inform system level analyses of health care systems and these approaches can be applied to identify an optimal distribution of dialysis facilities. GIS analysis could help untangle the complex interplay between geography, socioeconomic status, and racial disparities in chronic kidney disease, and could inform policy decisions and resource allocation as the population ages and the prevalence of renal disease increases.

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“…Distance to VA facilities has previously been studied, using informatics approaches as geographic information system (GIS) tools to map VA patients and their access to specialty care [30,31]. However, these studies have not included a focus on the OEF-OIF population [32].…”

Section: Discussionmentioning

confidence: 99%

Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

Elnitsky

Andresen

Clark

et al. 2013

BMC Health Serv Res

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BackgroundThe U.S. Department of Veterans Affairs (VA) implemented the Polytrauma System of Care to meet the health care needs of military and veterans with multiple injuries returning from combat operations in Afghanistan and Iraq. Studies are needed to systematically assess barriers to use of comprehensive and exclusive VA healthcare services from the perspective of veterans with polytrauma and with other complex health outcomes following their service in Afghanistan and Iraq. These perspectives can inform policy with regard to the optimal delivery of care to returning veterans.MethodsWe studied combat veterans (n = 359) from two polytrauma rehabilitation centers using structured clinical interviews and qualitative open-ended questions, augmented with data collected from electronic health records. Our outcomes included several measures of exclusive utilization of VA care with our primary exposure as reported access barriers to care.ResultsNearly two thirds of the veterans reported one or more barriers to their exclusive use of VA healthcare services. These barriers predicted differences in exclusive use of VA healthcare services. Experiencing any barriers doubled the returnees’ odds of not using VA exclusively, the geographic distance to VA barrier resulted in a 7 fold increase in the returnees odds of not using VA, and reporting a wait time barrier doubled the returnee’s odds of not using VA. There were no striking differences in access barriers for veterans with polytrauma compared to other returning veterans, suggesting the barriers may be uniform barriers that predict differences in using the VA exclusively for health care.ConclusionsThis study provides an initial description of utilization of VA polytrauma rehabilitation and other medical care for veteran returnees from all military services who were involved in combat operations in Afghanistan or Iraq. Our findings indicate that these veterans reported important stigmatization and barriers to receiving services exclusively from the VA, including mutable health delivery system factors.

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Using geographic information system tools to improve access to MS specialty care in Veterans Health Administration

Cited by 23 publications

References 18 publications

Access to Multiple Sclerosis Specialty Care

Access to Multiple Sclerosis Specialty Care

Geographic information systems and chronic kidney disease: racial disparities, rural residence and forecasting

Access to the US Department of Veterans Affairs health system: self-reported barriers to care among returnees of Operations Enduring Freedom and Iraqi Freedom

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