title: Does Spatial Access to Primary Care Affect Emergency Department Utilization for Nonemergent Conditions?
abstract: To examine the contributions of individual- and neighborhood-level spatial access to care to the utilization of emergency departments (EDs) for preventable conditions through implementation of novel local spatial access measures.
  
  
  
  Emergency department admissions data are from four HealthLNK member hospitals in Chicago from 2007 to 2011. Primary care physician office and clinic locations were obtained from the American Medical Association and the City of Chicago.
  
  
  
  Multilevel logit regression was used to model the relationship between individual- and neighborhood-level attributes and preventable ED use.
  
  
  
  Emergency department admissions data were classified based on the primary diagnosis for each encounter. Spatial access to care indices were generated in ArcGIS, and values were extracted at each ZIP code centroid to match patients' ZIP codes.
  
  
  
  Beyond sociodemographic factors such as gender and race, patients living in medically underserved areas (MUAs) and areas with lower spatial access to primary care clinics had higher odds of preventable ED use.
  
  
  
  Preventable ED use can be associated with sociodemographic characteristics, as well as spatial access to primary care services. This study reveals potential for using local measures of spatial accessibility for preventable ED analyses.
authors.affiliation: Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Chicago, IL.
authors.forename: Jamie
authors.initials: J
authors.lastname: Fishman
authors.affiliation: Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Chicago, IL.
authors.forename: Sara
authors.initials: S
authors.lastname: McLafferty
authors.affiliation: Department of Medicine, University of Illinois College of Medicine at Chicago, Chicago, IL.
authors.forename: William
authors.initials: W
authors.lastname: Galanter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012737:Sex Factors; D012959:Socioeconomic Factors; D062206:Spatial Analysis; D014481:United States; D055815:Young Adult
keywords: 
  GIS
  ; Spatial access; preventable ED admissions