Patient Travel Patterns Research Articles

Patient Travel Patterns and Concordance With Geographic Market Boundaries.

Patient Travel Patterns and Concordance With Geographic Market Boundaries.

Carbon footprint reduction associated with a surgical outreach clinic

BackgroundHealthcare systems generate substantial carbon footprints that may be targeted to decrease greenhouse gas emissions. Outreach clinics may represent tools to assist in this reduction by optimizing patient related travel. Therefore, we sought to estimate the carbon footprint savings associated with a head and neck surgery outreach clinic.MethodsThis study was a cross-sectional survey of patient travel patterns to a surgical outreach clinic compared to a regional cancer treatment centre from December 2019 to February 2020. Participants completed a self-administered survey of 12 items eliciting travel distance, vehicle details, and ability to combine medical appointments. Canadian datasets of manufacturer provided vehicular efficiency were used to estimate carbon emissions for each participant. Geographic information systems were used for analyses.ResultsOne hundred thirteen patients were included for analysis. The majority of patients (85.8%) used their own personal vehicle to travel to the outreach clinic. The median distance to the clinic and regional centre were 29.0 km (IQR 6.0–51.9) and 327.0 km (IQR 309.0–337.0) respectively. The mean carbon emission reduction per person was therefore 117,495.4 g (SD: 29,040.0) to 143,570.9 g (SD: 40,236.0). This represents up to 2.5% of an average individual’s yearly carbon footprint. Fewer than 10% of patients indicated they were able to carpool or group their appointments.ConclusionSurgical outreach clinics decrease carbon footprints associated with patient travel compared to continued care at a regional centre. Further research is needed to determine possible interventions to further reduce carbon emissions associated with the surgical care of patients.Graphical abstract

Accessing surgical care for esophageal cancer: patient travel patterns to reach higher volume center.

While better outcomes at high-volume surgical centers have driven the regionalization of complex surgical care, access to high-volume centers often requires travel over longer distances. We sought to evaluate the travel patterns among patients undergoing esophagectomy to assess willingness of patients to travel for surgical care. The California Office of Statewide Health Planning database was used to identify patients who underwent esophagectomy between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed esophagectomy to get to a higher volume center, was assessed. Overall 3,269 individuals underwent an esophagectomy for cancer in 154 hospitals; only five hospitals were high volume according to Leapfrog standards. Median travel time to a hospital that performed esophagectomy was 26 minutes (IQR: 13.1-50.7). The overwhelming majority of patients (85%) bypassed the nearest providing hospital to seek care at a destination hospital. Among patients who bypassed a closer hospital, only 36% went to a high-volume hospital. Of the 2,248 patients who underwent esophagectomy at a low-volume center, 1,491 patients had bypassed a high-volume hospital. Of the remaining 757 patients who did not bypass a high-volume hospital, half of the individuals would have needed to travel less than an additional hour to reach a high-volume center. Nearly two-thirds of patients undergoing an esophagectomy for cancer received care at a low-volume center; 85% of patients either bypassed a high-volume hospital or would have needed to travel less than an additional hour to reach a high-volume center.

Defining general practitioner and population catchments for spatial equity studies using patient enrolment data in Waikato, New Zealand

The enhanced-two-step-floating-catchment-area (E2SFCA) method is a popular measure of the spatial accessibility of healthcare such as general practitioner (GP) services. However, the key step of defining appropriate GP and population catchment sizes is often overlooked. Applications of E2SFCA methods use a range of catchment sizes, most of which are arbitrarily defined due to a lack of real-world data to inform this decision. The use of inappropriate catchment sizes may under- or over-estimate spatial accessibility in some areas. In this paper patient enrolment data is used to determine appropriate GP and population catchment sizes in the Waikato, central North Island, region of New Zealand. A range of thresholds were tested, including: 100, 95, 90, 85, 75, and 65 percent of enrolled patients. Initial results suggest that catchment sizes vary across rural and urban areas. Further, incorporating variable data-driven population catchments recognises patient travel patterns and appears to improve spatial accessibility results in a mixed urban-rural context, although further modification may be necessary. This study has demonstrated an effective approach to defining appropriate GP and population catchments for use with the E2SFCA method, where access to patient enrolment data is available.

Patient access to opioid substitution treatment pharmacy and medical service providers in South Australia: geospatial mapping.

This cross-sectional study geospatially maps patient access to opioid substitution treatment (OST) pharmacy and medical providers in South Australia (SA), Australia. De-identified data from a total of 2935 public and private OST patients (1092 public cases and 1843 private cases) were included in the study. Geospatial mapping of OST patient locations, their dosing community pharmacy and prescriber was undertaken. The geospatial modelling methods used in this study presents an application whereby information about patient travel patterns to reach OST providers can be used as a tool for treatment service planning.

Reducing the impact of distance on hematopoietic cell therapy patients.

74 Background: Hematopoietic Cell Therapy (HCT) patients experience unique travel challenges and high out-of-pocket costs due to the highly specialized care required. We conducted a mixed methods study to understand current patient support programs in Ontario and other jurisdictions and a cost analysis to inform the development of recommendations to reduce the impact of remoteness on HCT patients and caregivers. Methods: Qualitative information on patient transportation and accommodation supports was gathered through informal and structured input from fourteen Ontario Regional Cancer Program Directors, Hematologists, Patient and Family Advisory Council and Aboriginal Navigators. An environmental scan of medical travel assistance programs within Ontario and in other jurisdictions was performed. A scoping literature review was conducted of published studies focused on inequities in receipt of cancer care in countries with Universal Health care. HCT patient travel patterns to each of the transplant facilities in Ontario were obtained from analysis of Cancer Care Ontario data holdings. Results: We concluded that travel assistance for cancer patients in Ontario varies considerably across the province, and that Ontario lags behind other jurisdictions in Canada and internationally. The scoping literature review revealed that patients who live far from specialist centres, for some diseases, have later stage at diagnosis, less timely access to specialist care, poorer outcomes, lower patient experience scores, and make treatment decisions based on distance. From the analysis of travel patterns for HCT patients, provincially 4 – 79% of patients travel for HCT based on their location (see table below). Conclusions: This study highlights the need to better support HCT patients in Ontario. As a result, a proposal to support accommodations for HCT patients was developed and approved by the Ontario government for implementation in 2018/19.[Table: see text]

Hospital Distribution and Patient Travel Patterns for Congenital Cardiac Surgery in the United States

Several countries have regionalized congenital heart surgery (CHS). Before considering regionalization in the US, the current landscape must be understood. This investigation characterized the network of US hospitals providing CHS, including hospital locations and patient travel patterns. Patients ≤18 years undergoing CHS were identified in 2012 State Inpatient Databases from 39 states. Cases were stratified by the RACHS-1 method (high-risk defined as RACHS-1 categoris 4 to 6). Hospital and patient locations were identified. Patients were mapped to hospitals where they underwent surgery. A total of 153 hospitals across 36 states performed ≥1 RACHS-1 case (19,064 operations). Of these, 101 hospitals (66%) were located within 25 miles of another hospital. Median annual RACHS-1 case volume was 90 (range, 1 to 797), with 55 hospitals performing ≤50 cases. A total of 111 hospitals (73%) performed ≥1 high-risk case. Of these, 39 (35%) performed ≤10 high-risk cases/year. Overall mortality rate was 3.5% (n= 666), with risk-adjusted mortality being lowest at hospitals in the highest-volume quartile (≥150 cases/year). About 25% of patients (n= 4,012) traveled >100 miles, with most traveling to hospitals within the highest-volume quartile; 53% of patients (n= 8,376) bypassed the nearest CHS hospital. Mortality was not associated with travel distance. We identified more US hospitals performing CHS than has been previously described. Many are small-volume and are in close proximity to one another. Patients are already traveling long distances to hospitals within the highest-volume quartile. These data help define the current landscape of CHS and associated considerations regarding regionalization.

A new generation of Primary Care Service Areas or general practice catchment areas

AbstractPrimary Care is fundamental to a well‐functioning health system. Various geographical small areas including specialized geographies such as Primary Care Service Areas (PCSAs) are used to measure primary care relevant outcomes and services, or to target interventions. PCSAs are small areas, the majority of patients resident in which obtain their primary care services from within the geography. The extent of this self‐sufficiency of use is measured by the Localization Index (LI). PCSAs have been built in the US, Australia and Switzerland using an allocation algorithm, which, while simple and easy to implement, may require the use of various ad‐hoc parameters. In this article we propose an optimization based approach to creating PCSAs, ‐ an approach which has previously been used to generate labour flow regions in Ireland. The approach is data driven, thus requiring a minimal number of ad‐hoc parameters. We compared the resulting PCSAs (or `rPCSAs') with PCSAs generated using the traditional allocation algorithm. We found that rPCSAs were generally larger, offered greater LIs and reflected patient travel patterns better than traditional PCSAs. Accounting for the larger size of rPCSAs showed that rPCSAs offered better LIs than similar sized traditional PCSAs.

Colonoscopy resource availability and colonoscopy utilization in Ontario, Canada

ABSTRACTObjectiveEvidence of long wait times for colonoscopy and regional variations in colonoscopy utilization have raised concerns that the availability of colonoscopy resources may be insufficient to meet current needs. This study described colonoscopy resource availability in Ontario, Canada, evaluated regional variations in colonoscopy resource availability and utilization, and examined the association between colonoscopy resource availability and colonoscopy utilization.
 ApproachThis is a population-based cross-sectional study of colonoscopy resource availability in Ontario, Canada from 2007 to 2013 using linked administrative health databases from the Institute for Clinical Evaluative Sciences (ICES). We defined the catchment areas for colonoscopy resources using physician networks that were built upon existing patient flow patterns, with comparisons to observed colonoscopy patient travel patterns to ensure the networks reflected colonoscopy referral patterns in the province. Colonoscopy physicians were identified from physician billing data. Network-level colonoscopy availability was measured in terms of physician density, specialty, and quality, use of private colonoscopy clinics, and distance that patients travel for colonoscopy. Network-level age- and sex-standardized colonoscopy utilization rates were calculated for 2007 to 2013. Associations between colonoscopy resource availability and colonoscopy utilization were analyzed using Spearman’s rank correlation.
 Results The availability of colonoscopy resources in Ontario increased between 2007 and 2013. Physician density increased from 8.7 full-time equivalent (FTE) physicians per 100,000 residents in 2007 to 9.4 FTE per 100,000 residents in 2013. The proportion of colonoscopy physicians who achieved the recommended colonoscopy completion and polypectomy rates increased from 60% to 77%, and 28% to 53%, respectively. Use of private colonoscopy clinics also increased. In 2007, 21% of colonoscopies were completed in private clinics, and by 2013, that proportion increased to 30%. Across Ontario, we observed strong geographic variation in these measures of colonoscopy resource availability as well as in the utilization of colonoscopy. Colonoscopy utilization was positively correlated with physician availability (r=0.48, p=0.001), physician quality (r=0.6, p<0.0001) and use of private clinics for colonoscopy (r=0.5, p=0.001).
 ConclusionThe availability of colonoscopy resources improved in Ontario between 2007 and 2013. However, the geographic variation in resource availability and findings that higher colonoscopy resource availability is associated with higher colonoscopy utilization suggest that certain areas of the province may be under-resourced. These areas may be appropriate targets for efforts to improve colonoscopy capacity in Ontario.

Influence of Socioeconomic Status on Distance Traveled and Care After Stroke

Vital to maintaining an efficient delivery of services is an understanding of patient travel patterns during an acute ischemic stroke. Socioeconomic status may influence access to stroke care, including transportation and admission to different facility types. We analyzed all acute ischemic stroke admissions between 2003 and 2007 through the Discharge Abstract Database, a national database containing patient-level sociodemographic, diagnostic, procedural, and administrative information across Canada. Socioeconomic status was defined in neighborhood quintiles according to Statistics Canada. Distances between patients and facilities were derived from postal codes. A principal diagnosis of ischemic stroke was identified using the International Classification of Diseases (versions 9 and 10). Analysis of variance and regression analyses were performed with adjustment for demographic characteristics. Admitted to acute care institutions were 243 410 patients with ischemic stroke. Mean patient age was 72.8 and 49.5% were male; 44.2% traveled beyond their closest center, amounting to an average 7.2 km additional distance traveled. Socioeconomic status quintile had minimal effect on travel patterns, with the lowest socioeconomic status accessing the closest center most frequently (odds ratio, 1.19; 95% confidence interval [CI], 1.13-1.16). Increased utilization of the closest hospital occurred with academic (odds ratio, 6.90; 95% CI, 6.69-7.11) or high-volume (odds ratio, 1.93; 95% CI, 1.88-1.98) facilities. Older patients (β=0.28; 95% CI, 0.27-0.28), expert destination facility (β=0.13; 95% CI, 0.12-0.14), and ambulance use increased travel beyond the closest center. Patients tend to choose care facilities based on hospital expertise; investment promoting improved regional facilities may be of greatest benefit to patients. Socioeconomic status has little bearing on travel patterns associated with stroke in Canada. These findings may assist in allocating funding to centers and improving patient care.

Where Do Graduating Pediatric Residents Seek Practice Positions?

To profile the characteristics of areas that graduating pediatric residents target in their job searches and to explore whether residents applying to primary care markets with higher pediatrician supplies experience job-search difficulty. A national random sample of 500 graduating categorical pediatric residents was surveyed. The communities that the pediatric residents targeted for jobs were linked to local-area characteristics by using Dartmouth Primary Care Service Areas (PCSAs), which are discrete markets that represent patient travel patterns for primary care services. PCSA population and providers were characterized by using data from the 2000 US Census and American Medical Association/American Osteopathic Association Physician Masterfiles. A total of 308 graduating residents (62%) completed the survey. Of the respondents, 136 (44%) applied for general-practice positions. The characteristics of the PCSAs that residents applied to differed from the PCSAs without an application. Residents' first-choice areas had higher ratios of general pediatricians, had higher median household incomes, and were more likely to be urban areas. Residents applying to higher-supply areas were significantly more likely to report moderate or considerable difficulty in their job searches than were residents applying to lower-supply areas. Residents applying to medium- and higher-supply areas sent out more total applications for positions and received lower starting salaries than did residents applying to lower-supply areas. Residents continue to prefer high-supply areas in their job searches, despite experiencing greater search difficulty in these areas. Current targeted incentives and market forces are unlikely to redress geographic variation in pediatrician supply.

Hospital service areas – a new tool for health care planning in Switzerland

BackgroundThe description of patient travel patterns and variations in health care utilization may guide a sound health care planning process. In order to accurately describe these differences across regions with homogeneous populations, small area analysis (SAA) has proved as a valuable tool to create appropriate area models. This paper presents the methodology to create and characterize population-based hospital service areas (HSAs) for Switzerland.MethodsWe employed federal hospital discharge data to perform a patient origin study using small area analysis. Each of 605 residential regions was assigned to one of 215 hospital provider regions where the most frequent number of discharges took place. HSAs were characterized geographically, demographically, and through health utilization indices and rates that describe hospital use. We introduced novel planning variables extracted from the patient origin study and investigated relationships among health utilization indices and rates to understand patient travel patterns for hospital use. Results were visualized as maps in a geographic information system (GIS).ResultsWe obtained 100 HSAs using a patient origin matrix containing over four million discharges. HSAs had diverse demographic and geographic characteristics. Urban HSAs had above average population sizes, while mountainous HSAs were scarcely populated but larger in size. We found higher localization of care in urban HSAs and in mountainous HSAs. Half of the Swiss population lives in service areas where 65% of hospital care is provided by local hospitals.ConclusionHealth utilization indices and rates demonstrated patient travel patterns that merit more detailed analyses in light of political, infrastructural and developmental determinants. HSAs and health utilization indices provide valuable information for health care planning. They will be used to study variation phenomena in Swiss health care.

Introducing Manufacturing Efficiency Tools to the Endoscopy Suite: How the Toyota Model Helps Drive Endoscopes

Background: Processes in medicine evolve slowly. The manufacturing industry has for many years employed a variety of tools to assess and enhance efficiency. Adaptation of manufacturing tools to the endoscopy suite may improve efficiency. Methods: The rapid processes improvement workshop (RPIW) is a manufacturing industry tool designed to break down production processes into individual parts in order to identify and correct inefficiencies in motion and material use. We applied this technique to routine outpatient procedures performed in our endoscopy unit in an effort to decrease patient waiting times and improve patient flow. Two week-long workshops examined patient travel patterns, nurse and patient walking distances, resource allocation and equipment standardization. Patient travel times, patient cycle times, nurse walking distances, and number of procedures performed per room per day were measured before and after RPIW recommendations were implemented. No new technologies were incorporated during the study interval and the physician portion of the procedures was not changed. Follow-up measurements were made at 60 days to determine if gains were maintained. Results: See Table 1. Incorporation of RPIW recommendations reduced patient waiting and admission times, patient stays, room turn-over times and nursing travel times to the degree that two additional procedures could be added to each room per day. Improvements were largely sustained at 60 days. Conclusion: Industry productivity tools can help improve efficiencies, reduce patient waiting times and potentially increase endoscopy revenue.