A novel technique to optimize facility locations of new nephrology services for remote areas.

BACKGROUND AND OBJECTIVES Travel distance to healthcare facilities affects healthcare access and utilization. Using the example of patients with kidney disease and nephrology services, we investigated the feasibility and utility of using geographic information system (GIS) techniques to identify the ideal location for new clinics to improve care for patients with kidney disease, on the basis of systematically minimizing travel time for remote dwellers. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using a provincial laboratory database to identify patients with kidney disease and where they lived, we used GIS techniques of buffer and network analysis to determine ideal locations for up to four new nephrology clinics. Service-area polygons for different travel-time intervals were generated and used to determine the best locations for the four new facilities that would minimize the number of patients with kidney disease who were traveling >2 hours. RESULTS We studied 31,452 adults with living in Alberta, Canada. Adding the four new facilities would increase the number of patients living <30 minutes from a clinic by 2.2% and reduce the number living >120 minutes away by 72.5%. Different two- and three-clinic scenarios reduced the number of people living >120 minutes away by as much as 65% or as little as 32%, emphasizing the importance of systematic evaluation. CONCLUSIONS GIS techniques are an attractive alternative to the current practice of arbitrarily locating new facilities on the basis of perceptions about patient demand. Optimal location of new clinical services to minimize travel time might facilitate better patient care.

[1]  A. Bello,et al.  Quality of care and mortality are worse in chronic kidney disease patients living in remote areas. , 2011, Kidney international.

[2]  Donna M. Wilson,et al.  Living in a rural area with advanced chronic respiratory illness: a qualitative study. , 2010, Primary care respiratory journal : journal of the General Practice Airways Group.

[3]  G. Booth,et al.  The Geography of Diabetes in London, Canada: The Need for Local Level Policy for Prevention and Management , 2010, International journal of environmental research and public health.

[4]  J. Lawson,et al.  Rural/urban differences in health care utilization and place of death for persons with respiratory illness in the last year of life. , 2010, Rural and remote health.

[5]  Jennifer MacRae,et al.  Overview of the Alberta Kidney Disease Network , 2009, BMC nephrology.

[6]  M. Tonelli,et al.  Association between proximity to the attending nephrologist and mortality among patients receiving hemodialysis , 2007, Canadian Medical Association Journal.

[7]  Alka B. Patel,et al.  Determining geographic areas and populations with timely access to cardiac catheterization facilities for acute myocardial infarction care in Alberta, Canada , 2007, International Journal of Health Geographics.

[8]  P. Austin,et al.  Regional effects of satellite haemodialysis units on renal replacement therapy in non-urban Ontario, Canada. , 2007, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[9]  G. Halkett,et al.  Factors influencing the speed of cancer diagnosis in rural Western Australia: a General Practice perspective , 2007, BMC family practice.

[10]  M. Horner,et al.  Analyzing location-based accessibility to dental services: an Ohio case study. , 2007, Journal of public health dentistry.

[11]  M. Tonelli,et al.  Association between residence location and likelihood of kidney transplantation in Aboriginal patients treated with dialysis in Canada. , 2006, Kidney international.

[12]  G. Higgs.  Integrating multi-criteria techniques with geographical information systems in waste facility location to enhance public participation , 2006, Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA.

[13]  G. Higgs,et al.  A Pilot Study of Spatial Patterns in Referrals to a Multicentre Cancer Genetics Service , 2005, Public Health Genomics.

[14]  D. Quantz,et al.  Access and utilization of health services by British Columbia's rural Aboriginal population. , 2005, International journal of health care quality assurance incorporating Leadership in health services.

[15]  Katharine E Jong,et al.  Rural inequalities in cancer care and outcome , 2005, The Medical journal of Australia.

[16]  Richard J. T. Klein,et al.  Measuring progress in Healthy People 2010. , 2004, Healthy People 2010 statistical notes : from the Centers for Disease Control and Prevention/National Center for Health Statistics.

[17]  Bruce K Armstrong,et al.  Remoteness of residence and survival from cancer in New South Wales , 2004, The Medical journal of Australia.

[18]  M. Casey,et al.  Do Rural Elders Have Limited Access to Medicare Hospice Services? , 2004, Journal of the American Geriatrics Society.

[19]  Gary Higgs,et al.  The Use of Geographical Information Systems in Examining Variations in Sociodemographic Profiles of Dental Practice Catchments: A Case Study of a Swansea Practice , 2002, Primary dental care : journal of the Faculty of General Dental Practitioners.

[20]  M. Casey,et al.  Are rural residents less likely to obtain recommended preventive healthcare services? , 2001, American journal of preventive medicine.

[21]  M. Harrison,et al.  The impacts of distance to hospital on families with a child with a chronic condition. , 2001, Social science & medicine.

[22]  R. Pong.  Rural health research in Canada: at the crossroads. , 2000, The Australian journal of rural health.

[23]  K. Dansky,et al.  The use of health care services by people with diabetes in rural areas. , 1998, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[24]  M. Kelaher,et al.  The only constant is change , 2005 .

[25]  M. Casey,et al.  Rural beneficiaries with chronic conditions: does prevalence pose a risk to Medicare managed care? , 2000, Managed care quarterly.

[26]  Alan C. Wilson,et al.  Impact of geographic proximity to cardiac revascularization services on service utilization. , 2000, Medical care.

[27]  M. Guagliardo.  International Journal of Health Geographics Open Access Spatial Accessibility of Primary Care: Concepts, Methods and Challenges , 2022 .