title: A novel technique to optimize facility locations of new nephrology services for remote areas.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Bharati
authors.initials: B
authors.lastname: Ayyalasomayajula
authors.forename: Natasha
authors.initials: N
authors.lastname: Wiebe
authors.forename: Brenda R
authors.initials: BR
authors.lastname: Hemmelgarn
authors.forename: Aminu
authors.initials: A
authors.lastname: Bello
authors.forename: Braden
authors.initials: B
authors.lastname: Manns
authors.forename: Scott
authors.initials: S
authors.lastname: Klarenbach
authors.forename: Marcello
authors.initials: M
authors.lastname: Tonelli
mesh_terms: D000416:Alberta; D002908:Chronic Disease; D040362:Geographic Information Systems; D006297:Health Services Accessibility; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy; D009398:Nephrology; D013997:Time Factors; D014195:Travel