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Author List:
Cowper DC (VA HSR&D (RORC))
Vogel WB (VA HSR&D (RORC))
Wu SS (VA HSR&D (RORC))
Reker DM (VA HSR&D (RORC))
Marshall C (VA PM&RS Service)
Ripley BA (VA PSSG, ADUSH)
Objectives:
(1) to assess whether VHA’s current and potential TBI patient population has proximal access to specialized treatment services; (2) to offer recommendations to VHA planners where additional centers may be located and (3) identify access benefits with recommended added treatment facilities.
Methods:
Data for this analysis came from the VA Patient Treatment File (PTF), FY1998 – FY2002. Only TBI patients with an inpatient episode of care are examined. Expected TBI patients were obtained using the VHA Enrollment population and TBI age and gender adjusted incidence rates from CDC. Patients’ ZIP code from the PTF was extracted and merged with the Planning System Support Group (PSSG) Zip Code file to obtain the latitude and longitude of the zip code centroid. VACO Physical Medicine &Rehabilitation Service (PM&RS) helped to identify the Lead and Secondary TBI Centers in the VHA. GIS software ArcMap, Network Analyst and Spatial Analysis were used to create travel time bands around existing TBI Centers and to identify potential gaps in service via queries and selection parameters for both current and potential patients.
Results:
Patients outside of the 120 and 240 minute travel time bands were identified and aggregated to the county level. Travel times were used to parallel VA’s target of veterans residing within 120 minutes of specialty care and 240 minutes of tertiary care. Maricopa County, Arizona (Phoenix) emerged in both the current and potential patient population as a prime candidate for specialized TBI services.
Implications:
These analyses identify existing utilization and potentially unmet need for specialty services for TBI and the existing specialty providers of these services.
Impacts:
Studying access to care through GIS analyses is currently very timely due to many service connected veterans with TBI returning from the Middle East conflicts. Geographic analyses can provide strategic planning information to policy makers to address current and future needs for specialized services.
