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Multi-method Study Using Geospatial Mapping and Survey Analysis to

Determine Disparities in Access to Healthcare for Children with ASD


Catherine R. Shoff, PhD, MPH, Jean-G. Gehricke, PhD, Rolanda Maxim Gott, MD, Maureen Working collaboratively across
Dillon, MSW, Cassie Fox, MPH, Michelle Ocen, PhD, BCBA, Robin B. Steinberg-Epstein, MD, North America, to address the
physical health of children and
Donna S. Murray, PhD, Daniel Coury, MD & The ATN-AIR-P Health Disparities Working Group
adolescents with autism.
Introduction Methods/Analysis Summary
Among individuals with Autism Spectrum Disorders (ASD),
disparities in access to healthcare have been linked to low
socioeconomic status, racial and ethnic minorities, and Data presented from one site (UC Irvine) for discussion purposes Site surveys provided broad opinions of staff
residence in rural and under-resourced areas. However, little is regarding those patient groups they felt were
known about the specific barriers individuals with ASD face in
accessing care and the impact of specific geographic locations.
not being served
This multi-method study combines geospatial mapping using
hospital zip code level data with site surveys completed at 12 Surveys of patient demographics receiving
sites located across the United States, to display gaps in
services for children with ASD, and barriers to reaching these
care without geospatial data provide
individuals. insufficient context to develop detailed
interventions

General Methods / Subjects GIS mapping has the ability to devise more
specific interventions for specific patient
populations
The Autism Intervention Research Network on Physical Health
(AIR-P) conducted a multi-method study to understand the
needs of individuals at 14 autism diagnostic and treatment
centers within the United States (N = 12) and Canada (N=2).
First, a survey was conducted at each site to assess specific
local, clinical and patient characteristics in order to identify
barriers to healthcare delivery. Next, geospatial mapping was
conducted to determine whether individuals at high risk for
unmet healthcare needs in the hospitals defined catchment
Discussion
areas were accessing care at the ATN/AIR-P center.
Geographical Information System mapping software (GIS) was
used to create visual maps and tables that showed catchment
and service area based on zip codes provided by 11 ATN/AIR-P
Most programs are struggling with
sites across the United States, excluding the two Canadian sites determining health disparities and completing
and one US site, which did not provide zip codes. U.S. Census the site survey alone raised awareness of
data was used to identify zip codes where high-risk individuals
were not served. All zip codes were converted to ZCTA scores
health disparities and barriers to access. The
(ZIP Code Tabulation Areas), which are utilized by Census data. Areas with autism rates greater than 25 per UCI serves 121 zip codes following quote exemplifies this point: In
100,000 who receive services at UCI (autism rate is
Areas with high risk individuals (from U.S. census) were overlaid based on who goes to the center and is reported 16 areas served have greater than 14.5% of children living filling out this survey, it strikes us that we may
with hospital level data to create maps. Indicators used to per 100,000 population). below the poverty level
determine whether individuals are high-risk for not being able to
not even know if we are not reaching certain
access healthcare include 1) Federal Poverty Level, 2) Public groups or populations. How do we even
Insurance usage and 3) Area Deprivation Index (ADI). determine the extent of this problem for our
Specifically, we wanted to determine if there were individuals
site. Adding geospatial mapping to site
within our defined catchment areas who are unable to access surveys provides critical information about
care at the ATN/AIR-P clinics. Catchment Area is defined as a health disparities at individual sites and
geographical area from which a hospitals potential patients are
drawn. Service Area is defined as the area that actual patients
across health care networks.
with ASD and/or developmental disabilities seen at clinics in the
past year reside.

Collaborating with the AIR-P and ATN Acknowledgements


This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of
Researchers interested in utilizing ATN data for collaborative clinical research or in Health and Human Services (HHS) under cooperative agreement UA3 MC11054 Autism Intervention Research Network
learning more about secondary data analysis opportunities may contact on Physical Health. This information or content and conclusions are those of the author and should not be construed as
asatn.org/request/data the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. This work
was conducted through the Autism Speaks Autism Treatment Network serving as the Autism Intervention Research