Transportation Barriers to Health Care Access - Identifying High Risk Areas Roy Grant, MA

Transportation
    Barriers to
Health Care Access
Identifying High Risk Areas

             Roy Grant, MA
        Grifin Goldsmith, MPH

THE SCOPE OF THE PROBLEM

 Many studies cite lack of transportation as a barrier
  to health care access
   Most were studies of adults with chronic conditions (diabetes,
    kidney disease, congestive heart failure, etc.)

 Children’s Health Fund conducted national and
  regional research with professional survey partners
  to fill this gap
   Zogby International, 2000
   Marist College for Public Opinion, 2006
   Delta State University Delta Rural Poll, 2011

 Focus was on pediatric primary care access

NATIONAL DATA:
    USUAL SOURCE OF PEDIATRIC CARE

 10% of parents reported dif ficulty finding a usual source of
  pediatric care
    30% for residents of rural areas and small towns

 35% had to travel > 10 miles to usual source of pediatric care
    Mean distance was highest in rural areas, 15 miles

 53% lacked public transportation to get from home to the
  child’s usual source of care

 16% in rural areas and small towns identified a hospital
  emergency department (ED) as usual source of care

TRANSPORTATION & HEALTH CARE ACCESS

 Nationally 4% of children missed at least 1 health care
  appointment in the preceding 12 months because
  transportation was not available
   9% for children in low-income households

 31% later sought emergency care for the same condition
  associated with the missed health care appointment

 This translates to ~3 million children missing at least 1
  appointment/year because of transit limitations

 Associated with ~900,000 potentially preventable ED
  visits/year

AVAILABILIT Y OF TRANSPORTATION
        RESOURCES IN THE U.S.

39% did not have public transportation
 available in their community

11% did not own a working vehicle

Public transportation availability varied
 significantly by type of area of residence

Automobile ownership did not vary
 significantly by type of area of residence

TRANSPORTATION AVAILABILIT Y BY AREA
          OF RESIDENCE

FACTORS ASSOCIATED W/TRANSIT ACCESS
 BARRIERS & NO USUAL SOURCE OF CARE

Low income
 No automobile ownership

Limited or no public transit in community

Rural area of residence
 Health professional shortages
 Longest distances to health care sites

BASED ON THESE FACTORS
CHF DEVELOPED A NEW PLANNING TOOL

 The Health Transportation Shortage Index (HTSI) was
  designed to objectively score factors associated with
  transportation barriers to health care access

 Each item is scored using data from online sources

 Item scores are summed for a composite HTSI sco re

 The HTSI was validated and a cut-score was determined
  through geomapping with Census Bureau demographic
  data and hospital discharge data for ambulatory care
  sensitive condition-related ED use
   Metro Austin (Travis County ) & Houston (Harris County) Texas

APPLYING THE HTSI:
             MICHIGAN AND MISSISSIPPI
 Health Transpor tation Shor tage Index factors:
     Type of area…………………………………………………………..0 to 4 points
     Child poverty rate………………………………………………….0 to 3 points
     Public transportation availability………………………….0 to 3 points
     HPSA designation………………………………………………….0 to 2 points
     FQHC in area………………………………………………………….0 to 2 points
                                                       14 points
                                             Michigan   Mississippi
           Population*                   9,876,187      2,978,512
           Counties                            83           82
           HTSI Range                         1 – 13      1 – 13
           HTSI Mean                          5.988       8.037
           HTSI Median                        6.000       8.000
           HTSI Mode                          8.000       8.000
           *As of July 2011; Census Bureau

NEXT STEP: GEOMAPPING POPULATION
    AND HEALTH CARE RESOURCES
 Mapping done with ArcGIS software to analyze geospatial
  access

 Census Bureau population data mapped by census block

 Health clinic & hospital addresses mapped by longitude &
  latitude

 Population-weighted centroid better captured distance for
  health care access compared to geographic centroid

 Straight line (Euclidian) distance was calculated from
  population-weighted centroid to nearest health center and
  nearest hospital in the same or contiguous county
   Travel distances may be greater than straight -line distances

CALCULATING THE CENTER

Geographic Centroid   Population-Weighted Center

GEOGRAPHIC VS. POP-WEIGHTED

     Geographic   Pop-Weighted

MI & MS COUNT Y HTSI SCORES
   ( DOT S I N DI CATE H E A LT H C E N TE RS)

                         HTSI:
                         1 to 3
                         4 to 5
                         6 to 7
                         8+

WHAT’S UP WITH THE YELLOW?
          67,077 People
          Most populous in upper peninsula
          Home to Northern Michigan University
          (9000 students)
          Median income = $35,548

                                                 Detroit

WHAT’S UP WITH THE YELLOW?

   Part of Memphis metro area
  Highest median income in MS
                     $66,377

       Clarksdale

Part of Jackson metro area
  Median income $46,970
                                            Median income
                                            $44,946

                     Median income
                     $37,628
                                     Gulf Coast

HEALTH CENTERS (MICHIGAN)

HOSPITALS (MICHIGAN)

CALCULATING DISTANCE

MEAN DISTANCE BY POP-WEIGHTED &
     GEOGRAPHIC CENTROIDS

DISTANCE TO HEALTH CENTER
    STRATIFIED BY POP CATEGORY (MI)

URBAN-RURAL DICHOTOMOUS VARIABLE
           (MICHIGAN)

 A categorical urban-rural variable was created by combining
  coded county population categories
 Revealed significant urban -rural dif ference in risk for
  transportation as an access barrier

   Categories 1 – 3 (rural to small city)……..….RURAL (pop 50,000)

           MEAN HTSI SCORE FOR URBAN-RURAL POPULATIONS

APPLICATION: HEALTH CARE ACCESS
            IN MISSISSIPPI
           A HTSI score of 8=highest risk of access barriers

 In MS, 67% of counties scored in this high -risk range

 100% of these counties had limited public transpor tation
   No public transit: 17%; Limited public transit: 83%

 Mean child pover ty rate in these counties was 31 .8%

 In 75% of these high -risk counties major population centers were
  within 5 miles of a health center
   In the other 25% distances ranged from 6 to 14 miles

 Transpor t ser vices within a relatively narrow radius from health
  centers can meet most needs

 Outlying areas were up to 35 miles from a health center and require
  further transportation planning

QUESTIONS?

             Thanks!