Does Spatial Access to Primary Care Affect Emergency Department Utilization for Nonemergent Conditions?

Objective

To examine the contributions of individual‐ and neighborhood‐level spatial access to care to the utilization of emergency departments (s) for preventable conditions through implementation of novel local spatial access measures.

Data Sources/Study Setting

Emergency department admissions data are from four Health 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.

Study Design

Multilevel logit regression was used to model the relationship between individual‐ and neighborhood‐level attributes and preventable use.

Data Collection/Extraction Methods

Emergency department admissions data were classified based on the primary diagnosis for each encounter. Spatial access to care indices were generated in Arc, and values were extracted at each code centroid to match patients' codes.

Principal Findings

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 use.

Conclusions

Preventable 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 analyses.