1. A Geospatial Analysis of Freestanding and Hospital Emergency Department Accessibility via Public Transit
- Author
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Jeremiah D. Schuur, Lucas C. Carlson, and Olesya Baker
- Subjects
Adult ,Male ,Geospatial analysis ,Medically Underserved Area ,lcsh:Medicine ,Transportation ,Health Services Accessibility ,03 medical and health sciences ,Underserved Population ,0302 clinical medicine ,Health care ,Humans ,Medicine ,030212 general & internal medicine ,Freestanding emergency departments ,Spatial Analysis ,Geography ,business.industry ,lcsh:R ,Population health ,Metropolitan statistical area ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,General Medicine ,Emergency department ,Brief Research Report ,Census ,Emergency Department Access ,Quality Improvement ,Metropolitan area ,United States ,Public transport ,Emergency Medicine ,Household income ,Female ,Health disparities ,Emergency Service, Hospital ,business ,Demography - Abstract
Author(s): Carlson, Lucas C.; Baker, Olesya N.; Schuur, Jeremiah D. | Abstract: Introduction: Emergency departments (ED) are an important source of care for underserved populations and represent a significant part of the social safety net. In order to explore the effect of freestanding emergency departments (FSED) on access to care for urban underserved populations, we performed a geospatial analysis comparing the proximity of FSEDs and hospital EDs to public transit lines in three United States (U.S.) metropolitan areas: Houston, Denver, and Cleveland.Methods: We used publicly available U.S. Census data, public transportation maps obtained from regional transit authorities, and geocoded FSED and hospital ED locations. Euclidean distance from each FSED and hospital ED to the nearest public transit line was calculated in ArcGIS. We calculated the odds ratio (OR) of an FSED, relative to a hospital ED, being located within 0.5 miles (mi) of a public transit line using logistic regression, adjusting for population density and median household income and with error clustered at the metropolitan statistical area (MSA) level.Results: The median distance from FSEDs to public transit lines was significantly greater than from hospital EDs across all three markets. In Houston, Denver, and Cleveland, the median distance between FSEDs and public transit lines was greater than from hospital EDs by 1.0 mi, 0.2 mi, and 1.6 mi, respectively. The OR of a public transit line being located within 0.5 mi of an FSED, as compared with a hospital ED, across all three MSAs was 0.21 (95% confidence interval [CI], 0.13–0.34) unadjusted and 0.20 (95% CI, 0.11–0.40) adjusted for population density and median household income.Conclusion: In comparison with hospital EDs, FSEDs are located farther from public transit lines and are less likely to be within walking distance of public transportation. These findings suggest that FSEDs are unlikely to directly increase access to care for patients without private means of transportation. Further research is necessary to explore both the direct and indirect impact of FSEDs on access to care, potentially through effects on hospital ED crowding and overall healthcare expenditures, as well as the ultimate role and responsibility of FSEDs in improving access to care for underserved populations.
- Published
- 2019