Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act

Eliana Sullivan; Whitney E Zahnd; Jane M Zhu; Erin Kenzie; Mary Patzel; Melinda Davis

doi:10.1007/s11606-021-07229-y

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Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act

Journal article

Open access

Peer reviewed

Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act

Eliana Sullivan, Whitney E Zahnd, Jane M Zhu, Erin Kenzie, Mary Patzel and Melinda Davis

Journal of general internal medicine : JGIM, Vol.37(12), pp.2941-2947

01/03/2022

DOI: 10.1007/s11606-021-07229-y

PMCID: PMC9485404

PMID: 34981345

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Abstract

The 2018 MISSION Act sought to improve Veterans' access to primary care by allowing Veterans living more than 30 min from VA care to utilize non-VA clinics. The impact of this legislation may vary for rural compared to urban Veterans. Assess the extent to which the 2018 MISSION Act facilitates spatial access to primary care for Veterans living in rural versus urban Oregon. We identified locations of all VA and non-VA primary care clinics in Oregon then calculated 30-min drive-time catchment areas from census tract centroids to the nearest clinics. We compared measures of spatial access to primary care for Veterans in rural, micropolitan, and urban areas. American Community Survey data representing Oregon adults. Two measures of spatial access focusing on the number of clinics (supply), and an access index based on the two-step floating catchment area method (2SFCA) which accounts for number of clinics (supply) and population size (demand). Compared to only 13.0% of rural Veterans, 83.6% of urban Veterans lived within 30 min' drive time of VA primary care. Given the MISSION Act's eligibility criteria, 81.6% of rural Veterans and ~ 97% of urban and micropolitan Veterans had spatial access to primary care. When accounting for both supply and demand, rural areas had significantly higher access scores (p < 0.05) compared to urban areas. Using MISSION Act guidelines for Veteran access to primary care, rural compared to urban Veterans had less spatial access based on clinic number (supply), but more access when considering clinic number and population size (supply and demand). Geographic Information System (GIS) spatial techniques may help to assess changes in access to care. However, these methods do not incorporate all dimensions of access and work is needed to understand whether utilization and quality of care is improved.

Veterans

Rural

Primary care

Spatial access

Details

Title: Subtitle: Mapping Rural and Urban Veterans' Spatial Access to Primary Care Following the MISSION Act
Creators: Eliana Sullivan - Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA. sullelia@ohsu.edu
Whitney E Zahnd - Arnold School of Public Health, Rural & Minority Health Research Center, University of South Carolina, Columbia, SC, USA
Jane M Zhu - Division of General Internal Medicine, Oregon Health & Science University, Portland, OR, USA
Erin Kenzie - Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
Mary Patzel - Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
Melinda Davis - Oregon Health & Science University
Resource Type: Journal article
Publication Details: Journal of general internal medicine : JGIM, Vol.37(12), pp.2941-2947
DOI: 10.1007/s11606-021-07229-y
PMID: 34981345
PMCID: PMC9485404
NLM abbreviation: J Gen Intern Med
ISSN: 0884-8734
eISSN: 1525-1497
Grant note: OMAT #15529 / U.S. Department of Veterans Affairs
Language: English
Electronic publication date: 01/03/2022
Academic Unit: Health Management and Policy
Record Identifier: 9984221635602771

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