title: Spatial analysis to locate new clinics for diabetic kidney patients in the underserved communities in Alberta.
abstract: BACKGROUND
  Canadians with chronic diseases often live far away from healthcare facilities, which may compromise their level of care. We used a new method for selecting optimal locations for new healthcare facilities in remote regions.
  
  
  METHODS
  We used a provincial laboratory database linked to data from the provincial health ministry. From all patients with serum creatinine measured at least once between 2002 and 2008 in Alberta, Canada, we selected those with diabetes and an estimated glomerular filtration rate (eGFR) of 15-60 mL/min/1.73 m(2). We then used two methods to select potential locations for new clinics that would serve the greatest number of remote-dwelling patients: plots showing the unadjusted density of such patients per 100 km(2) and SatScan analysis presenting the prevalent clusters of patients on the basis of chronic kidney disease (CKD) rates (adjusted for population size).
  
  
  RESULTS
  We studied 32,278 patients with concomitant diabetes and CKD. A substantial number of patients (8%) resided >200 km from existing nephrologists' clinics. Density plots mapped with ArcGIS were useful for localizing a large cluster of underserved patients. However, objective assessment with SatScan technique and ArcGIS permitted us to detect additional clusters of patients in the northwest and southeast regions of Alberta--and suggested potential locations for new clinics in these areas.
  
  
  CONCLUSIONS
  Objective techniques such as SatScan can identify clusters of underserved patients with CKD and identify potential new facility locations for consideration by decision-makers. Our findings may also be applicable to patients with other chronic diseases.
authors: Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Labib Imran
authors: LI
authors: Faruque
authors: Bharati
authors: B
authors: Ayyalasomayajula
authors: Rick
authors: R
authors: Pelletier
authors: Scott
authors: S
authors: Klarenbach
authors: Brenda R
authors: BR
authors: Hemmelgarn
authors: Marcello
authors: M
authors: Tonelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000416:Alberta / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D003404:Creatinine / Q000097:blood*; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D005260:Female; D005919:Glomerular Filtration Rate; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D015995:Prevalence; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology*; D062206:Spatial Analysis
chemical_list: D003404:Creatinine