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J Allergy Clin Immunol. 2015 Sep;136(3):610-8. doi: 10.1016/j.jaci.2015.01.030. Epub 2015 Mar 17.

The effect of geographic access on severe health outcomes for pediatric asthma.

Author information

1
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga.
2
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga. Electronic address: nserban@isye.gatech.edu.
3
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga; School of Public Policy, Georgia Institute of Technology, Atlanta, Ga.
4
Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.

Abstract

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.

KEYWORDS:

Geographic access; pediatric asthma; severe health outcomes

PMID:
25794659
DOI:
10.1016/j.jaci.2015.01.030
[Indexed for MEDLINE]

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