Geographic Access to Treatment for VHA Patients with Multiple Sclerosis

Cowper Ripley DC, Culpepper WJ, Hoffman PM, Litt ER, McDowell TY. Geographic Access to Treatment for VHA Patients with Multiple Sclerosis. Poster session presented at: VA HSR&D National Meeting; 2009 Feb 12; Baltimore, MD.

Objectives: (1) To identify veterans who access VHA facilities for multiple sclerosis (MS) treatment in the MS-CoE East catchment area (VISN 1-11), and to merge the identified veterans with workload data sets to obtain socio-demographics, medical diagnoses, and utilization information; and (2) To use Geographic Information System (GIS) tools to ascertain geographic access to specialty treatment for veterans with MS. Methods: The design is a retrospective, observational study of all MS patients currently seeking treatment in VHA facilities within the MSCoE-East network. We define veterans’ access as travel time (in minutes) to VHA facilities with MS specialty care. Using GIS mapping tools, the location of patients in relation to MS specialty care are displayed by VISNs. We used 30, 60, 90, and 120 minute travel-time bands around each MS specialty site. Results: More than one-third of patients have to travel more than two hours to specialty care (34.8%). Access appears poorest in VISN 9 where only 7% are within 30 minutes and 85.7% reside more than two hours from a MS specialty site. VISN 3 and VISN 5 show greater accessibility to specialty care than other VISNs. Only a small percentage of MS patients in VISN 3 (1.0%) and VISN 5 (3.8%) are more than two hours from specialty care. More than 40% in both VISNs reside within 30 minutes of MS specialty care. Implications: This project demonstrates that availability of and accessibility to MS specialty care varies widely across VISNs within the MSCoE-East catchment area. Our method can be used to select the best candidate for placement of new specialty clinics, once other facility characteristics are taken into consideration. Ultimately, future research will use methods developed in this project to access geographic variability and potential access gaps for the national MS System of Care. Findings from this study provide baseline data for establishing initial benchmark criteria for the Quality Indicator of an annual MS specialty visit. Impacts: Results from this project can impact recommendations for health care management and delivery of care to MS patients, as well as other patient populations, by identifying geographically underserved areas and providing data-driven estimates of improved patient access for candidate sites.