Geographic variation in spatial accessibility of U.S. healthcare providers.

摘要: Background Growing physician maldistribution and population demographic shifts have contributed to large geographic variation in healthcare access the emergence of advanced practice providers as contributors workforce. Current estimates accessibility physicians rely on outdated “provider per capita” that shortcomings. Purpose To apply state art methods estimate spatial non-physician clinician groups examine factors associated with higher accessibility. Methods We used a combination provider location, medical claims, U.S. Census data perform national study health accessibility. The National Plan Provider Enumeration System was along Medicare claims identify actively caring for patients 2014 including: primary care (i.e., internal medicine family medicine), specialists, nurse practitioners, chiropractors. For each ZIP code tabulation area, we estimated using Variable-distance Enhanced 2 step Floating Catchment Area method performed Getis-Ord Gi* analysis group. Generalized linear models were associations between characteristics accessibility. Results National patterns differed considerably. Accessibility most resembled specialists high urban locales, whereas relative concentrated upper Midwest. In our adjusted analyses independent very similar specialists–presence school county approximately 70% locales. Nurse practitioners both having rural locales. Conclusions The is viable approach measure at scale.