Does Spatial Access to Primary Care Affect Emergency Department Utilization for Nonemergent Conditions?

Jamie Fishman, Sara McLafferty, William Galanter

Research output: Contribution to journalArticlepeer-review


Objective: To examine the contributions of individual- and neighborhood-level spatial access to care to the utilization of emergency departments (EDs) for preventable conditions through implementation of novel local spatial access measures. Data Sources/Study Setting: Emergency department admissions data are from four HealthLNK member hospitals in Chicago from 2007 to 2011. Primary care physician office and clinic locations were obtained from the American Medical Association and the City of Chicago. Study Design: Multilevel logit regression was used to model the relationship between individual- and neighborhood-level attributes and preventable ED use. Data Collection/Extraction Methods: Emergency department admissions data were classified based on the primary diagnosis for each encounter. Spatial access to care indices were generated in ArcGIS, and values were extracted at each ZIP code centroid to match patients' ZIP codes. Principal Findings: Beyond sociodemographic factors such as gender and race, patients living in medically underserved areas (MUAs) and areas with lower spatial access to primary care clinics had higher odds of preventable ED use. Conclusions: Preventable ED use can be associated with sociodemographic characteristics, as well as spatial access to primary care services. This study reveals potential for using local measures of spatial accessibility for preventable ED analyses.

Original languageEnglish (US)
Pages (from-to)489-508
Number of pages20
JournalHealth Services Research
Issue number1
StatePublished - Feb 2018


  • GIS
  • Spatial access
  • preventable ED admissions

ASJC Scopus subject areas

  • Health Policy


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