New Method for Assessing the Effect of Driving Distance to Hospital Care
Using OpenStreetMap Routing in Cardiovascular Research
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- healthcare access
- geographic mapping
- myocardial infarction
- percutaneous coronary intervention
Geography is a key determinant of access to health care. Patient outcomes cannot be improved if novel therapeutic and preventive strategies cannot be delivered to patients in a timely and equitable fashion.
We developed a new method to calculate driving distances to hospital care by integrating an open-source geographic database with a standard statistical software package to create a tool for outcomes research. We illustrate its application to cardiac care in Sweden; yet, the methodology is readily applicable to other geographical regions and other healthcare services.
Time to reperfusion in ST-segment–elevation myocardial infarction affects patient outcomes, and so guidelines recommend reperfusion be achieved within 120 minutes of symptom onset.1 Delayed percutaneous coronary intervention (PCI) has been associated with worse outcomes also in patients with non–ST-segment–elevation myocardial infarction.2 Furthermore, large distance to a center providing cardiac care could not only impede acute care but might also reduce access to other services, such as follow-up with a cardiac specialist, advanced cardiac testing, and cardiac rehabilitation.3 Therefore, it would be of value to assess geographic barriers to cardiac care, and link this data to clinical and quality of care registries.
We obtained map data for Sweden from the OpenStreetMap project (http://www.openstreetmap.org), set up a local OpenStreetMap Routing Machine (http://project-osrm.org),4 and programmed a custom R interface (code available in the Data Supplement) to obtain driving distance information from each zip code …