title: Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD.
abstract: BACKGROUND
  Limited accessibility to health care may be a barrier to obtaining good care. Few studies have investigated the association between access-to-care factors and COPD hospitalizations. The objective of this study is to estimate the association between access-to-care factors and health care utilization including hospital/emergency department (ED) visits and primary care physician (PCP) office visits among adults with COPD utilizing a nationally representative survey data.
  
  
  METHODS
  We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011-2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors, including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers, and federally qualified health centers.
  
  
  RESULTS
  Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp) (P=0.028). In contrast, an additional hospital per 100,000 persons increases the likelihood of hospital/ED visit by 0.8 pp (P=0.008). However, safety net facilities were not related to hospital utilizations. PCP office visits were not related to access-to-care factors.
  
  
  CONCLUSIONS
  Pulmonary care specialist availability was a key factor in reducing hospital utilization among adults with COPD. The findings of our study implied that an increase in the availability of pulmonary care specialists may reduce hospital utilizations in counties with little or no access to pulmonary care specialists and that since availability of hospitals increases hospital utilization, directing patients with COPD to pulmonary care specialists may decrease hospital utilizations.
authors.affiliation: Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA.
authors.forename: Minchul
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA.
authors.forename: Jinma
authors.initials: J
authors.lastname: Ren
authors.affiliation: OSF St Francis Medical Center, University of Illinois College of Medicine at Peoria, Peoria, USA; Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, USA.
authors.forename: William
authors.initials: W
authors.lastname: Tillis
authors.affiliation: Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA; Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, USA.
authors.forename: Carl V
authors.initials: CV
authors.lastname: Asche
authors.affiliation: Battelle Memorial Institute, Atlanta, GA, USA.
authors.forename: Inkyu K
authors.initials: IK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, Peoria, USA.
authors.forename: Carmen S
authors.initials: CS
authors.lastname: Kirkness
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006295:Health Resources / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015272:Pulmonary Medicine / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: COPD; hospital utilization; pulmonary specialist