title: Geographic Variation in Outpatient Health Care Service Utilization After Spinal Cord Injury.
abstract: OBJECTIVE
  To assess whether travel distances between patients and providers predict the frequency in which outpatient health care services are accessed after spinal cord injury (SCI).
  
  
  METHODS
  A retrospective cohort study was carried out in South Carolina among employee health plan and Medicaid insurance recipients.
  
  
  METHODS
  Research center.
  
  
  METHODS
  Two years of outpatient claimant data were evaluated from patients (N=243) aged ≥18 years who were hospitalized between 2010 and 2012.
  
  
  METHODS
  Travel distances were estimated by geocoding provider and patient address information onto street network files.
  
  
  METHODS
  Variation in service utilization use was assessed using negative binomial regression. Outpatient visits for physical medicine and rehabilitation, physician and specialty clinic, radiology, internal medicine, behavioral mental health, and "other" were evaluated.
  
  
  RESULTS
  Longer travel distances were statistically significant predictors of decreased physician/specialty clinic (relative risk [RR]=.87; 95% confidence interval [CI], .79-.96) and physiotherapy (RR=.57; 95% CI, .46-.71) utilization, with mixed findings for other providers. Secondary analyses in which differences in service use were analyzed using census-defined classifications of urban and rural status did not demonstrate any geographic pattern.
  
  
  CONCLUSIONS
  There are significant geographic variations in the use of select outpatient services among SCI populations across the state that are related to longer travel distances. That these patterns were only visible when using travel distance models as opposed to census-based classifications of urban and rural status adds support to augmenting routine data collection and surveillance with spatial analytical models.
authors.affiliation: College of Nursing, University of South Carolina, Columbia, SC. Electronic address: Nathaniel@sc.edu.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Bell
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.
authors.forename: Tsion
authors.initials: T
authors.lastname: Kidanie
authors.affiliation: Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC.
authors.forename: Bo
authors.initials: B
authors.lastname: Cai
authors.affiliation: Medical University of South Carolina, Charleston, SC.
authors.forename: James S
authors.initials: JS
authors.lastname: Krause
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006264:Health Benefit Plans, Employee / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013022:South Carolina; D013119:Spinal Cord Injuries / Q000628:therapy*; D014186:Transportation / Q000706:statistics & numerical data*; D014481:United States
keywords: Geographic information systems; Health services accessibility; Rehabilitation; Spinal cord injuries