title: The effect of geographic access on severe health outcomes for pediatric asthma.
abstract: BACKGROUND
  Access to medical care and severe pediatric asthma outcomes vary with geography, but the relationship between them has not been studied.
  
  
  OBJECTIVE
  We sought to evaluate the relationship between geographic access and health outcomes for pediatric asthma.
  
  
  METHODS
  The severe outcome measures include emergency department (ED) visits and hospitalizations for children with an asthma diagnosis in Georgia and North Carolina. We quantify asthma prevalence, outcome measures, and factors included in the statistical model using multiple data sources. We calculate geographic access to primary and asthma specialist care using optimization models. We estimate the association between outcomes and geographic access in the presence of other factors using logistic regression. The model is used to project the reduction in severe outcomes with improvement in access.
  
  
  RESULTS
  The association between access and outcomes for pediatric asthma depends on the type of outcome measure, type of care, and variations in other factors. The expression of this association is also different for the 2 states. Access to primary care plays a larger role than access to specialist care in explaining Georgia ED visits, whereas the reverse applies for hospitalizations. In North Carolina access to both primary and specialist care are statistically significant in explaining the variability in ED visits.
  
  
  CONCLUSIONS
  The variation in the association between estimated access and outcomes affects the projected reductions of severe outcomes with access improvement. Thus applying one intervention would not have the same level of improvement across geography. Interventions must be tailored to target regions with the potential to deliver the highest effect to gain maximum benefit.
authors: H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga.
authors: Erin
authors: E
authors: Garcia
authors: H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga. Electronic address: nserban@isye.gatech.edu.
authors: Nicoleta
authors: N
authors: Serban
authors: H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Ga; School of Public Policy, Georgia Institute of Technology, Atlanta, Ga.
authors: Julie
authors: J
authors: Swann
authors: Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga.
authors: Anne
authors: A
authors: Fitzpatrick
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006297:Health Services Accessibility; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care
keywords: Geographic access; pediatric asthma; severe health outcomes