GRAND RAPIDS HEALTH CARE
ACCESS PROGRAM (GRHCAP)
Clinic Access and Utilization in Kent County, Michigan
Fred J. De Jong, MAPA, MSW, Ph.D., ACSW, Professor of Research and
Statistics, Calvin College, Federal Evaluator, GRHCAP
Lauren B. Vander Plas, BSW Program, Calvin College, Mapping Specialist,
GRHCAP
September 5, 2007
For inquiries, contact Dr. F. De Jong, fdejong@calvin.edu
*
ACKNOWLEDGEMENTS
This mapping project owes its success to many instrumental people involved in its conception and
production. We would like to especially thank Dr. Neil Carlson, Center for Social Research,
Calvin College, for his invaluable technical assistance role with software access and training,
research design, data management, and map production.
Mr. Rich Zandstra played an important and necessary role as consortium liaison. We thank Rich
for persistently gathering the data from Consortium member organizations, as well as your
presence and insight throughout the project.
We acknowledge Mr. Jim Smedes, Kent County Health Department, as author of the original Kent
County mapping report and for his insights in the research design and technical aspect of map
creation.
This project was under the leadership of Cherry Street Health Services. We want to thank
Executive Director Chris Shea and Director of Operations Kathy Sather for their leadership as
well as their oversight and understanding throughout the duration of this project.
1
TABLE OF CONTENTS
Acknowledgements………………………………………………....………………page 1
Map Index……………….…………………………………………. ………………page 3
GRHCAP Mapping Project ……………………………………………………… page 4
Introduction and Background
Methodology
List of Organization Participants
Measures
Clinic Utilization and Catchment Area……………………………………………page 8
Clinic Utilization by Sub-Populations……………………………………………. page 12
Low-Income Population
African American Population
Hispanic Population
Aged (65 and older) Population
Diagnoses Served by Clinics.....................................................................................page 26
Distance to Closest Clinic versus Patient Preferred Clinic in Kent County……page 32
Appendices…………………………………………………………………………. page 36
Appendix A: Mapping Data Distribution Guidelines
Appendix B: GRHCAP Clinic Mapping Project Data Collection Guide
Appendix C: Excerpt from “Target Areas, Low-Income Analysis, Population Change and Medical
Shortage Area”, Clinic Mapping Project Report,, Task Force on Health Care for People of Color,
Kent County Health Department, November 2005
2
MAPS INDEX
Kent County Clinics’ Location, 2005………………………………………………. page 7
Clinic Utilization in Kent County, 2005……………………………………………. page 10
Clinic Catchment Areas, 2005……………………………………………………… page 11
Kent County Population with Household Income of $20,000 or less……………….page 14
Low-Income Patient Utilization of Kent County Clinics, 2005……………………..page 15
Kent County African American Population…………………………………………page 18
African American Patient Utilization of Kent County Clinics, 2005………………. page 19
Kent County Hispanic Population………………………………………………….. page 20
Hispanic Patient Utilization of Kent County Clinics, 2005………………………… page 21
Kent County Aged Population……………………………………………………… page 24
Aged Patient Utilization of Kent County Clinics, 2005……………………………. page 25
Kent County Clinic Utilization by Patients with Asthma, 2005……………………. page 28
Kent County Clinic Utilization by Patients with Depression, 2005…………………page 29
Kent County Clinic Utilization by Patients with Diabetes, 2005……………………page 30
Kent County Clinic Utilization by Patients with Hypertension, 2005……………… page 31
Average Distance Traveled to Clinic, 2005………………………………………… page 34
Additional Distance Traveled to Patient Preferred Clinic: Kent County, 2005…….. page 35
3
Clinic Access and Utilization in Kent County, Michigan
GRHCAP Mapping Project
Introduction and Background
The Clinic Access and Utilization Mapping Project is a product of long term collaboration
beginning in 2002 between major stakeholders in the Grand Rapids, Michigan, health care
delivery system. The Consortium’s goals address unmet needs of the underserved population for
health related needs. The consortium also advocates for and supported the formation of a county
health coverage plan (Kent Health Plan), an access project focusing primarily on residents of the
designated Medically Underserved Population (Project Access), the creation of a standing county
Task Force on Health Care for People of Color as well as multi-agency/manufacturer initiative to
improve access to affordable and free pharmaceuticals. A federal award in 2005 from the Health
and Rehabilitation Service Administration (HHS) for a Healthy Community Access Program
provided resources and staff for multiple initiatives over a three year period, one of which is the
Mapping Project.
This second mapping report updates much of the first set of maps with more recent patient
utilization data, an current list of participating clinics, the addition of 4 targeted diagnoses first
identified in the GRHCAP proposal, a count of patient visits by selected diagnoses and an
analysis of distance traveled to patients’ clinic of choice.
Methodology
In the summer of 2007, researchers associated with Calvin College received patient level data
from Metropolitan Hospital, Saint Mary’s HealthLink health centers, Spectrum Health and
Cherry Street Health Services for each of their participating clinics. Twenty-two clinics
participated in the study. Only one clinic (Sparta) is located outside of the Grand Rapids City
limits. See Map of Kent County Clinic locations on page 8.
The data request process entailed requests to each health system to contribute 11 variables
regarding all clinic patients in 2005. These data included patient id number, address, age, date of
birth, race, payer type, visit count, and number of visits for asthma, depression, diabetes, and
hypertension.
Originally the data were not contributed in a uniform format by which we could join the datasets.
Several decision rules provide guidance when merging health system data sets.
• First, data which included duplicate patient IDs numbers were eliminated.
• Some duplicates clients between multiple clinics are unavoidable. Each organization
uses their own id numbers. If a patient saw two clinics from two different
organizations, the patient would be duplicated within the dataset, creating some table
percentages in this report to exceed 100%.
• If a person went to two different clinics within the same system, we recorded the
clinic included in the patient’s last duplicate record within the dataset.
4
•
If the patient had two different payer types within the same record or within duplicate
records, priority was given to commerical, then non-commerical, followed by
Medicare.
Clinic patient addresses were than geocoded upon the merging of the contributed data sets from
the GRHCAP. Gecoding is a process by which address level data is assigned coordinates by
which to map the data. REGIS, the regional geographic information systems most updated street
level data, was used to match addresses to geographic coordinates, which was supplemented by a
similar process using Tele Atlas, a software service from a commercial geocoding company.
The original data set consisted of 64,657 clients. However some of these addresses were missing
information and unable to geocode. Of those with proper addresses (N=63850), the match rate
for geocoding was 98%, an excellent result, producing a sample size for mapping of 62570. A
large number of these addresses were excluded due to being located outside of Kent County,
reducing the sample size for the project is 57,255.
After patient addresses were geocoded to include coordinates, these data was then used to place
addresses into census block groups. Census block groups are a geographic system used by the
United State Census Bureua, which they define as “A subdivision of a census tract (or, prior to
2000, a block numbering area), a block group is the smallest geographic unit for which the
Census Bureau tabulates sample data. A block group consists of all the blocks within a census
tract with the same beginning number.” No unit of data collection below Census block groups
were used in order to protect patient privacy.
Data from Geolytics Census Projections 2007 was used for comparing patient data to population
data. Our analysis uses percent of total population for a given research question to display clinic
utilization. We chose this metric instead of absolute numbers to show a greater sense of the
impact clinics’ are having on the particular sub-populations living in particular areas. Also
general maps are used to give background to high concentration area in which to guide the
readers interpretation of the clinic utilization maps.
5
List of Organizational Participants
Metropolitation Hospital
• Breton Health Center
Cherry Street Health Services:
• Belknap Commons Health Center
• Burton Health Center
• Cherry Street Medical
• Cherry Street Optical
• Creston Health Center
• Ferguson Adult Health Center
• Grand Rapids Pediatrics
• Ottawa Hills Health Center
• The Salvation Army Booth Family Services
• Westside Health Center
• Union High School Health Center
• Traveling School Medical Program
Saint Mary’s Healthlinks Health Centers
• Heartside Health Center
• McAuley Health Center
• Browning Claytor Health Center
• Catherine’s Care Center
• Clinica Santa Maria
• Sparta Health Center
• Wege Family Practice
• Wege Internal Medicine
Spectrum Health
• Residency Practice
• Internal Medicine
• OB/Gyn
6
Kent County Clinics'
Location, 2005
Sparta
North Kent County
Mark
Division
13 Mile
Greater Grand Rapids
Ann
Knapp
Pla
inf
ie
ld
Creston
Catherines Care Center
Leonard
Maryland
Union HS
Coi
t
e
M
on
ro
City of Grand Rapids
296
Leonard
Pine
Covell
W
alk
er
3 Mile
2 Miles
Alpine
Richmond
96
Fuller
1
Turner
0.5
side
Hill
Alpine
State
12 Mile
Bristol
Walker 0
Riv
er
Sparta Health
Fuller
Orchard
3 Mile
Leffingwell
Gardner
Dean Lake
13 Mile
Westside
Bu
tte
rw
or
th
O Brien
Clinica Santa Maria
131
o
Colrain
Alger
Ne
lso
n
32nd
0
36th
0.45 0.9
Elmwood
Breton
Oke
mo
s
Kalamazoo
Byron Center
Metro
Spectrum
Ottawa Hills
Plymouth
Prairie
Clyde Park
CSHS
Burton
Eastern
Organizations
Burton
Burlingame
Porter
Burton
Adams
Boston
Madison
Lee
Browning Claytor
Breton
Wyoming
ag
Chi c
East Grand Rapids
Hall
Division
Gr
an d
vil
le
Freeman
Franklin
Robinson
Lak
e
Fuller
Fr
on
t
Ionia
College
Belknap Commons
196
Spectrum
Residency
Bridge
GR Peds
Michigan
& InternalMed
OB/GYN
Lake Michigan
Pearl
Fulton
Ferguson McAuley
Salvation Army
Cherry St
Heartside Wealthy Wege
1.8
32nd
Kentwood
2.7
Miles
StMarys
Medical Shortage Area
Data Source: GRHCAP Clinic Utilzation Data 2005 & Geolytics Population Projections 2007
DeJong & VanderPlas, Calvin College, 2007
7
Mapping Section #1: Clinic Utilization and Catchment Area
The high level of utilization of the clinics indicates excellent access for the general population to
the clinics. The total number of patients within the mapping dataset is 57,255, which is 9.5% of
the projected 604,370 population of Kent County for 2005. The first map in this section, Clinic
Utilization in Kent County, shows the proportion of patients from a particular block group with
the total population of the block group. These percentages range from .5% to 50% of block group
total population.
Although a small proportion of patients will be double counted if they use more than one clinic,
the total number served is very near to the total low-income population in Kent County. Table 1
shows the numbers of Kent County patients for each clinic. Among the 22 reporting clinics,
Cherry Street Health Clinic and Wege Family Practice report the highest utilization at over 7,000
patients each in 2005.
Clinic Catchment Area
The map entitled, Clinic Catchment Area illustrates the area from which each clinic draws 60%
of its patients, which is the same proportion used in the original mapping study. The larger the
shaded area the greater the dispersion of a clinic’s patients. The catchment area was found by
using ArcGIS select by location method in which locations are selected from a particular range,
the range continued to increase until it met the threshold of 60%.
8
Table 1: Kent County Patients by Clinic, 2005
Clinics
Cherry Street Health Services
Belknap Commons HC
Total Patients
24340
1026
Burton HC
1039
Cherry St HC
7304
Creston HC
240
Ferguson Adult HC
1463
Grand Rapids Pediatrics
4397
Ottawa Hills HC
285
Salvation Army
628
School Medical Program
1524
Union High School HC
747
Westside HC
5687
Saint Mary’s HealthLinks
22578
Browning Claytor HC
1853
Catherine's Care Center
1867
Clinica Santa Maria
4237
Heartside HC
1077
McAuley HC
451
Sparta HC
2392
Wege Family Practice
7094
Wege Internal Medicine
3607
Spectrum Health
5181
Internal Medicine
1947
Residency Practice
619
OB/GYN
2615
Metropolitan
5156
Breton HC
5156
Grand Total
57255
9
Kent County
Clinic Utilization
in Kent County,
2005
Patients Per Total Population
Percent
0.5% - 2.5%
2.6% - 5%
5.1% - 7.5%
7.6% - 10%
10.1% - 15%
15.1% - 20%
20.1% - 25%
25.1% - 51%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
10
Catchment Area
By Clinic
Cherry Street
Creston
Ferguson
Salvation Army
Ottawa
Westside
Union
Burton
Breton
Clinica Santa Maria
Wege Family Practice
Saint Mary's
Spectrum Catchment
Cherry St Catchment
Metro
City of Grand Rapids
Clinic
Grand Rapids Pediatrics
Belknap
Catherine's Care Center
Heartside
Sparta
Browning Claytor
Wege Internal Medicine
Spectrum Internal Med
Spectrum OB/GYN
McAuley
Spectrum Residency
Data Source: GRHCAP Clinic Utilzation Data 2005 & Geolytics Population Projections 2007
DeJong & VanderPlas, Calvin College, 2007
11
Mapping Section #2: Clinic Utilization by Sub-Populations
Clinic Utilization by Low-Income Population
Kent County’s clinics largely serve patients with household incomes at or below the poverty
threshold. The 22 clinics differ in the manner of accounting for household income among
patients. Consequently, the only way to report patient income status across all clinics is to use a
broad category of payer type called “non-commercial”. Non-commercial payer types include
self-pay, charity care, Kent Health Plan and Medicaid, which in the clinic context constitutes lowincome clinic patients. Table 2 shows the number of patients utilizing the various payer types.
The majority of patients (57%) use non-commercial payer types. Graph 1 also shows the breakdown of low-income utilization at the various clinic systems. For purposes of mapping, a patient
may only have one payer source. The decision rule is that those patients seen at multiple clinics
within an organization or those using multiple types of pay, commercial insurance was given
priority followed by non-commercial and ending with those paying with Medicare.
Census counts of those with commercial insurance, Medicaid, and other payer types are not
readily available to the public. Therefore the mapping project used the Census population’s
projections data available, using household income to define low-income population. A
household income of $20,000 or less was used the measure of low-income: a number just lower
than the $20,650 poverty line for a family of four (U.S. Department of Health & Human Services,
2007).
The map entitled Kent County Population with household income of $20,000 or less gives a
background understanding to where high and low percentages of the low-income population
reside within Kent County. The map of Low Income Utilization of Kent County then shows the
proportion of low-income clinic patients to the low-income population.
Graph 1: Low Income Clinic Utilization by System, 2005
Low Income Clinic Utilization By System, 2005
N=32,428
Cherry Street Health
Services
33%
Metropolitan Hospital
50%
Spectrum Health
Saint Mary's HealthLink
11%
6%
12
Table 2: Low-income Patient Clinic Utilization: Primary Payer Type by Clinic, 2005
Clinics
Cherry Street Health Services
Belknap Commons HC
% of
Clinic
Total
Noncommercial**
6721
27.61%
196
19.10%
Commercial
% of
Clinic
Total
Grand
Total
1285
5.28%
24340
121
11.79%
1026
% of Clinic
Total
Medicare
16320
67.05%
709
69.10%
Burton HC
272
26.18%
764
73.53%
3
0.29%
1039
Cherry St HC
1410
19.30%
5497
75.26%
394
5.39%
7304
Creston HC
61
25.42%
179
74.58%
0
0.00%
240
Ferguson Adult HC
312
21.33%
819
55.98%
331
22.62%
1463
Grand Rapids Pediatrics
2521
57.33%
1869
42.51%
3
0.07%
4397
285
Ottawa Hills HC
99
34.74%
186
65.26%
0
0.00%
Salvation Army
48
7.64%
577
91.88%
3
0.48%
628
School Medical Program
189
12.40%
1332
87.40%
2
0.13%
1524
Union High School HC
217
29.05%
527
70.55%
3
0.40%
747
Westside HC
1396
24.55%
3861
67.89%
425
7.47%
5687
2910
56.44%
1824
35.38%
422
8.18%
5156
2910
56.44%
1824
35.38%
422
8.18%
5156
862
16.64%
3486
67.28%
833
16.08%
5181
Internal Medicine
115
5.91%
1260
64.71%
572
29.38%
1947
Residency Practice
378
61.07%
82
13.25%
159
25.69%
619
OB/GYN
369
14.11%
2144
81.99%
102
3.90%
2615
Metropolitan Hospital
Breton HC
SpectrumHealth
Saint Mary’s HealthLink
10399
46.06%
10798
47.83%
516
2.29%
22578
Browning Claytor HC
503
27.15%
1147
61.90%
45
2.43%
1853
Catherine's Care Center
1614
86.45%
204
10.93%
29
1.55%
1867
Clinica Santa Maria
547
12.91%
3604
85.06%
21
0.50%
4237
Heartside HC
17
1.58%
909
84.40%
34
3.16%
1077
McAuley HC
201
44.57%
233
51.66%
9
2.00%
451
Sparta HC
1059
44.27%
1074
44.90%
40
1.67%
2392
7094
Wege Family Practice
3969
55.95%
2771
39.06%
160
2.26%
Wege Internal Medicine
2489
69.00%
856
23.73%
178
4.93%
3607
20892
36.49%
32428
56.64%
3056
5.34%
57255
Grand Total
**Non-commercial includes Medicaid, Charity Care, Self-Pay or Kent County Health Plan
13
Kent County
Population with
Household
Income of
$20,000 or less
Kent County
Low-Income Population
Per Total Population
Percent
0% - 1%
1.01% - 2%
2.01% - 4%
4.01% - 8%
8.01% - 10%
10.01% - 15%
15.01% - 20%
20.01% - 41%
Clinics
Medical Shortage Area
0
2
4
0
0.5
1
8
Miles
12
City of Grand Rapids
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
14
Low Income
Patient Utilization
of Kent County
Clinics, 2005
Kent County
Low-Income Patients
Per Low-Income Population
PercentofPoorPatsofPop
3.33% - 15%
15.01% - 30%
30.01% - 45%
45.01% - 60%
60.01% - 75%
75.01% - 90%
90.01% - 150%
150.01% - 764.71%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
15
Clinic Utilization by African American and Hispanic Populations
The Mapping Project’s initial impetus from the Task Force for Health Care for People of Color
focused on the unmet health-related needs of underserved populations. The original mapping
project emphasized the access and utilization rates to health clinics of Kent County’s African
American and Hispanic residents, since these two groups constitute the largest, minority groups
in the county and disproportionately present the underserved and uninsured population.
Race was coded into seven groups: non-Hispanic white, African American or Black, Hispanic,
American Indian or Alaskan Native, Asian Native Hawaiian, or Other. The mapping project only
used those who self-identified as African American/Black or Hispanic. Geolytics Census data
also provided projected numbers of African American and Hispanics living in each block group.
As seen in Table 3, of the patients seen at all clinics 36% are African American and 57% are
Hispanic patients. In comparing the patients to the general population, the African American
patients(N=14,019) make up 25% of the projected 57,689 Kent County African American
population. Similarly, the Hispanic patients (N=15,276) make up 27% of the 57,643 projected
Hispanic population for Kent County.
Again, the maps showing the Kent County African American and Hispanic Populations give
background to the maps of clinic utilization by these different groups.
Graph 2-3: Clinic Utilization by African Americans and Hispanics by System, 2005
African American Clinic Utilization
by System, 2005
Hispanic Clinic Utilization
by System, 2005
N=14,019
N=15,276
Cherry Street
Health Services
25%
13%
12%
50%
Metropolitan
Hospital
38%
53%
Spectrum
Health
Cherry Street
Health
Services
Metropolitan
Hospital
Spectrum
Health
Saint Mary's
HealthLink
6%
16
3%
Table 3: Client Race by Clinic, 2005
Clinics
6965
% of
Clinic
Total
28.62%
8010
% of
Clinic
Total
32.91%
7533
% of
Clinic
Total
30.95%
1832
% of
Clinic
Total
7.53%
Belknap Commons HC
346
33.72%
97
9.45%
502
48.93%
81
7.89%
Burton HC
102
9.82%
847
81.52%
72
6.93%
18
1.73%
1039
2426
33.21%
2858
39.13%
1351
18.50%
669
9.16%
7304
Cherry Street Health Services
Cherry St HC
African
American
Hispanic
White
Other
Total
Count
1026
24340
Creston HC
112
46.67%
7
2.92%
41
17.08%
80
33.33%
240
Ferguson Adult HC
643
43.95%
163
11.14%
576
39.37%
81
5.54%
1463
4397
Grand Rapids Pediatrics
992
22.56%
670
15.24%
2535
57.65%
200
4.55%
Ottawa Hills HC
221
77.54%
20
7.02%
10
3.51%
34
11.93%
285
Salvation Army
252
40.13%
65
10.35%
194
30.89%
117
18.63%
628
1524
School Medical Program
624
40.94%
590
38.71%
219
14.37%
91
5.97%
Union High School HC
159
21.29%
169
22.62%
369
49.40%
50
6.69%
747
1088
19.13%
2524
44.38%
1664
29.26%
411
7.23%
5687
Westside HC
Metropolitan Hospital
1648
31.96%
464
9.00%
2376
46.08%
668
12.96%
5156
1648
31.96%
464
9.00%
2376
46.08%
668
12.96%
5156
1909
36.85%
931
17.97%
2200
42.46%
141
2.72%
5181
Internal Medicine
751
38.57%
204
10.48%
956
49.10%
36
1.85%
1947
Residency Practice
181
29.24%
95
15.35%
318
51.37%
25
4.04%
619
OB/GYN
977
37.36%
632
24.17%
926
35.41%
80
3.06%
2615
Breton HC
Spectrum Health
Saint Mary’s Healthlinks
3497
15.49%
5871
26.00%
7614
33.72%
5596
24.79%
22578
Browning Claytor HC
1090
58.82%
129
6.96%
307
16.57%
327
17.65%
1853
Catherine's Care Center
46
2.46%
39
2.09%
283
15.16%
1499
80.29%
1867
Clinica Santa Maria
26
0.61%
4059
95.80%
57
1.35%
95
2.24%
4237
1077
Heartside HC
473
43.92%
91
8.45%
475
44.10%
38
3.53%
McAuley HC
112
24.83%
44
9.76%
238
52.77%
57
12.64%
451
11
0.46%
964
40.30%
1004
41.97%
413
17.27%
2392
1383
19.50%
432
6.09%
3632
51.20%
1647
23.22%
7094
356
9.87%
113
3.13%
1618
44.86%
1520
42.14%
3607
14019
24.49%
15276
26.68%
19723
34.45%
8237
14.39%
57255
Sparta HC
Wege Family Practice
Wege Internal Medicine
Grand Total
17
Kent County
African
American
Population
Kent County
African American Population
Per Total Population
Percent
0%
0.01% - 1%
1.01% - 2%
2.01% - 5%
5.01% - 7%
7.01% - 10%
10.01% - 25%
25.01% - 92.71%
Clinics
Medical Shortage Area
0
2
4
0
0.5
1
8
Miles
12
City of Grand Rapids
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
18
African American
Patient Utilization
of Kent County
Clinics, 2005
Kent County
African American Patients
Per African American Population
Percent
0% - 5%
5.01% - 10%
10.01% - 20%
20.01% - 30%
30.01% - 40%
40.01% - 50%
50.01% - 60%
60.01% - 800%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
19
Kent County
Kent County
Hispanic
Population
Hispanic Population
Per Total Population
0.42% - 1%
1.01% - 3%
3.01% - 5%
5.01% - 10%
10.01% - 20%
20.01% - 30%
30.01% - 40%
40.01% - 96%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2006 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
20
Hispanic Patient
Utilization of Kent
County Clinics,
2005
Kent County
Hispanic Patients
Per Hispanic Population
Percent
0% - 5%
5.1% - 10%
10.1% - 15%
15.1% - 20%
20.1% - 30%
30.1% - 40%
40.1% - 50%
50.1% - 177.6%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
21
Clinic Utilization by Aged
Chronic health conditions and acute care episodes prompt many low income older persons to use
Kent County’s clinics. Low income aged persons with modest fixed incomes can find themselves
ineligible for Medicaid while they live in their own homes and experience outpatient expenses
outside of Medicare’s coverage. Unaddressed health care needs can become disabling and lead to
added pain, decreased function and eventually institutionalization. Mapping the aged for the first
time in this project recognizes this important need and target population for clinic services.
Each participating clinic contributed a data set including patient age. These ages were then put
into 4 different categories: 0 to 15 years old, 16 to 44 years old, 45 to 64 years old, 65 and older.
Table 4 shows patient age by clinic in 2005. Saint Mary’s and Cherry Street Health Services
clinic systems provide care to the largest numbers of elderly.
The map entitled Kent County Aged Population shows the percentage of those 65 years and old
living in a particular area. Geolytics Census projection data provided the population of those 65
years and older in each block group. The map entitled Aged Patient Utilization of Kent County
Clinics, 2005 shows the ratio of Aged Patients to the Aged Population of Kent County.
22
Table 4: Patient Age by Clinic, 2005
Clinics
9887
% of
Clinic
Total
40.62%
9444
% of
Clinic
Total
38.80%
3974
% of
Clinic
Total
16.33%
1035
% of
Clinic
Total
4.25%
Belknap Commons HC
103
10.04%
491
47.86%
374
36.45%
58
5.65%
1026
Burton HC
680
65.45%
294
28.30%
57
5.49%
8
0.77%
1039
7304
Cherry Street Health Services
Cherry St HC
0 to 14
15 to 44
45 to 64
65 and
older
Grand
Total
24340
2186
29.93%
3122
42.74%
1615
22.11%
381
5.22%
Creston HC
2
0.83%
237
98.75%
1
0.42%
0
0.00%
240
Ferguson Adult HC
0
0.00%
521
35.61%
713
48.74%
229
15.65%
1463
3592
81.69%
805
18.31%
0
0.00%
0
0.00%
4397
0
0.00%
282
98.95%
3
1.05%
0
0.00%
285
266
42.36%
362
57.64%
0
0.00%
0
0.00%
628
1338
87.80%
41
2.69%
134
8.79%
11
0.72%
1524
Grand Rapids Pediatrics
Ottawa Hills HC
Salvation Army
School Medical Program
14
1.87%
551
73.76%
171
22.89%
11
1.47%
747
Westside HC
Union High School HC
1706
30.00%
2738
48.14%
906
15.93%
337
5.93%
5687
Metropolitan Hospital
1114
21.61%
2173
42.15%
1258
24.40%
611
11.85%
5156
Breton HC
1114
21.61%
2173
42.15%
1258
24.40%
611
11.85%
5156
13
0.25%
3667
70.78%
1139
21.98%
362
6.99%
5181
1947
Spectrum Health
Internal Medicine
0
0.00%
949
48.74%
762
39.14%
236
12.12%
Residency Practice
1
0.16%
254
41.03%
245
39.58%
119
19.22%
619
12
0.46%
2464
94.23%
132
5.05%
7
0.27%
2615
4758
21.07%
8570
37.96%
6063
26.85%
3187
14.12%
22578
425
22.94%
852
45.98%
465
25.09%
111
5.99%
1853
1
0.05%
747
40.01%
800
42.85%
319
17.09%
1867
2077
49.02%
1608
37.95%
417
9.84%
135
3.19%
4237
OB/GYN
Saint Mary's Healthlink
Browning Claytor HC
Catherine's Care Center
Clinica Santa Maria
Heartside HC
0
0.00%
500
46.43%
555
51.53%
22
2.04%
1077
McAuley HC
12
2.66%
254
56.32%
180
39.91%
5
1.11%
451
Sparta HC
Wege Family Practice
Wege Internal Medicine
Grand Total
753
31.48%
957
40.01%
447
18.69%
235
9.82%
2392
1490
21.00%
2891
40.75%
1801
25.39%
912
12.86%
7094
0
0.00%
761
21.10%
1398
38.76%
1448
40.14%
3607
15772
27.55%
23854
41.66%
12434
21.72%
5195
9.07%
57255
23
Kent County
Aged Population
(65 years and
older)
Kent County
Aged Population
Per Total Population
Percent
2.57% - 5%
5.01% - 7.5%
7.51% - 10%
10.01% - 12.5%
12.51% - 15%
15.01% - 18%
18.01% - 20%
20.01% - 40.12%
Clinics
Medical Shortage Area
0
2
4
0
0.5
1
8
Miles
12
City of Grand Rapids
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
24
Aged Patient
Utilization of Kent
County Clinics,
2005
Kent County
Aged Patients
Per Aged Population
Percent
0% - 3%
3.01% - 5%
5.01% - 8%
8.01% - 12%
12.01% - 18%
18.01% - 25%
25.01% - 40%
40.01% - 60%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
25
Mapping Section #3 Diagnoses Served by Clinic, 2005
Part of the federal HRSA award to the GRHCAP concentrated evaluation on four diagnoses
common for clinic visits: asthma, depression, diabetes, and hypertension. All four diagnoses
have established regimens for care and treatment, posing clear quality benchmarks for clinic use.
Mapping visits by diagnosis supplements this effort, demonstrating where patients with these
diagnoses live and at which clinics they seek treatment.
Providers were asked to give numbers of total visits per patient as well as numbers of four
prominent diagnoses. However, some data sets were given with just the first four diagnoses of a
visit. From this list we were then able to code for those which were of the diagnoses we requested
and then use these numbers in order to calculate the total number of visits for each diagnoses by
patient.
Similar to low-income measures, census data on various diagnoses is not available to the public,
therefore in our analysis we were unable to use a population comparison group for the ratio. We
instead used the proportion of total visits for diagnoses by block group over the total number of
visits for that block group, this ratio provides a picture of those places which are drawing large
percentages of a particular diagnoses.
Graph 4: Percent of Diagnoses Visits by System, 2005
Percent of Diagnoses Visits by System, 2006
Percent of Total Visits
14.00%
12.00%
10.00%
8.00%
Asthma
6.00%
Depression
4.00%
Diabetes
2.00%
Hypertension
0.00%
Cherry Street Metropolitan
Health Services
Hospital
Spectrum
Health
Saint Mary's
HealthLink
Graph 4 illustrates the broad distribution of clinic visits for these 4 diagnoses. The frequency of
visits for each diagnoses is quite consistent across clinic systems. Hypertension and diabetes
compete for the largest proportion of clinic visits, while asthma and depression alternate as third
and fourth ranked in proportion of clinic visits. Table 4 gives the number of visits by clinic for
each diagnosis, also the table gives the total visits for each of the clinics. Each of the maps shows
the ratio patients with a particular diagnosis over totals patients.
26
Table 5: Patient Visits by Diagnosis by Clinic, 2005
Clinics
Cherry Street Health Services
Asthma
Visits
% of
Clinic
Total
Depression
Visits
% of
Clinic
Total
Diabetes
Visits
% of
Clinic
Total
Hypertension
Visits
% of
Clinic
Total
Total
Clinic
Visits
3356
3.84%
1965
2.25%
7934
9.08%
10094
11.55%
87381
Belknap Commons HC
67
2.50%
104
3.88%
343
12.79%
293
10.93%
2681
Burton HC
236
6.15%
100
2.61%
129
3.36%
43
1.12%
3837
Cherry St HC
849
3.02%
514
1.83%
3488
12.41%
4100
14.59%
28108
Creston HC
28
4.44%
41
6.50%
2
0.32%
0
0.00%
631
Ferguson Adult HC
450
5.25%
318
3.71%
2239
26.14%
3376
39.41%
8567
Grand Rapids Pediatrics
916
6.19%
15
0.10%
20
0.14%
35
0.24%
14793
Ottawa Hills HC
49
5.72%
17
1.99%
8
0.93%
5
0.58%
856
2605
Salvation Army
50
1.92%
30
1.15%
9
0.35%
23
0.88%
School Medical Program
26
1.16%
0
0.00%
0
0.00%
2
0.09%
2241
Union High School HC
123
6.74%
31
1.70%
1
0.05%
1
0.05%
1826
Westside HC
562
2.65%
795
3.74%
1695
7.98%
2216
10.44%
21236
275
1.37%
166
0.83%
1701
8.48%
1468
7.32%
20065
Metropolitan Hospital
Breton HC
275
1.37%
166
0.83%
1701
8.48%
1468
7.32%
20065
219
1.00%
420
1.92%
1131
5.18%
1292
5.92%
21836
Internal Medicine
155
2.01%
300
3.89%
925
12.00%
975
12.64%
7711
Residency Practice
24
1.06%
47
2.08%
144
6.37%
277
12.25%
2262
OB/GYN
40
0.34%
73
0.62%
62
0.52%
40
0.34%
11863
Saint Mary's Healthlinks
1049
1.49%
929
1.32%
7196
10.22%
5154
7.32%
70388
Browning Claytor HC
77
1.39%
71
1.28%
281
5.08%
447
8.08%
5530
Catherine's Care Center
0
0.00%
6
0.12%
2391
48.28%
104
2.10%
4952
Clinica Santa Maria
123
0.96%
39
0.30%
660
5.13%
342
2.66%
12864
Heartside HC
85
2.96%
57
1.98%
309
10.76%
352
12.26%
2872
McAuley HC
0
0.00%
0
0.00%
0
0.00%
0
0.00%
1561
Spectrum Health
Sparta HC
38
0.59%
78
1.20%
301
4.64%
141
2.17%
6490
Wege Family Practice
287
1.31%
444
2.03%
1375
6.27%
1340
6.11%
21915
439
3.09%
234
1.65%
1879
13.23%
2428
17.09%
14204
4899
2.45%
3480
1.74%
17962
9.00%
18008
9.02%
199670
Wege Internal Medicine
Grand Total
27
Kent County
Clinic Utilization
by Patients with
Asthma, 2005
Kent County
Patients with Asthma
Per Total Patients
Percent
0%
0.1% - 1%
1.1% - 1.5%
1.6% - 2%
2.1% - 2.5%
2.6% - 3%
3.1% - 5%
5.1% - 16.1%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
28
Kent County
Clinic Utilization
by Patients with
Depression, 2005
Kent County
Patients with Depression
Per Total Patients
Percent
0%
0.1% - 0.5%
0.6% - 1%
1.1% - 1.5%
1.6% - 2%
2.1% - 2.5%
2.6% - 3%
3.1% - 8.6%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
29
Kent County
Utilization by
Patients with
Diabetes, 2005
Kent County
Patients with Diabetes
Per Total Patients
Percent
0%
0.1% - 2%
2.1% - 4%
4.1% - 6%
6.1% - 8%
8.1% - 10%
10.1% - 12%
12.1% - 25.8%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
30
Kent County Clinic
Utilization by
Patients with
Hypertension, 2005
Kent County
Patients with Hypertension
Per Total Patients
Percent
0% - 2%
2.1% - 4%
4.1% - 6%
6.1% - 8%
8.1% - 10%
10.1% - 12%
12.1% - 15%
15.1% - 33.1%
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
31
Mapping Section #4 Distance to Closest Clinic versus Patient Preferred Clinic
in Kent County, 2005
Distance and means of transportation influence access to outpatient health care. The GRHCAP
Consortium, following the leadership of Kent County Health Department, is addressing issues of
public transportation to health care providers. The Mapping Project illustrates the numbers of
people whose access to needed care could be affected by distance.
The distance to a clinic was calculated using ArcGIS mapping program, which calculated the
Euclidian distance (straight line) between two points. After patient addresses were geocoded, two
calculations were made. First, the program calculates the distance in miles from a patient’s home
address to the clinic he/she visited. Second, the program calculates the distance in miles from a
patient’s home address to the clinic in closest distance was calculated. The distance does not take
into account streets and speed limits, but it does show on average how far patients’ are traveling
to clinics.
Table 6 shows the average distance that patient live from the clinic they visit. The first map
entitled Average Distance to Kent County Clinics, 2005 shows the average distance patients live
from a clinic. The map entitled Additional Distance traveled to Patient Preferred Clinic: Kent
County, 2005 shows the average difference in distance been the clinic the patient visited and the
clinic closest.
Mean additional distance traveled to preferred clinic rather than to the closest clinic concentrates
in the northwest corner of the county, in the southwest corner of the county and west of Grand
Rapids. In the northwest corner of the county, the closest clinic is Sparta, which is not the
preferred clinic for some. On the west side, rural residents who are not Hispanic may be by
passing Clinica Santa Maria.
32
Table 6: Average Euclidean Distance to Clinic
Clinics
Cherry Street Health Services
Belknap Commons HC
Burton HC
Cherry St HC
Creston HC
Ferguson Adult HC
Grand Rapids Pediatrics
Ottawa Hills HC
Salvation Army
Union High School HC
Westside HC
Metropolitan Hospital
Breton HC
Spectrum Health
Internal Medicine
Residency Practice
OB/GYN
Saint Mary’s Healthlinks
Browning Claytor HC
Catherine's Care Center
Clinica Santa Maria
Heartside HC
McAuley HC
Sparta HC
Wege Family Practice
Wege Internal Medicine
Grand Total
33
Average
Distance
to Clinic
4.19
4.55
1.43
3.79
2.52
4.16
6.26
2.40
3.98
3.86
3.77
5.47
5.47
4.44
4.33
5.13
4.37
5.23
2.73
8.44
2.52
2.05
4.75
9.93
5.18
6.01
4.75
Kent County
Average Distance
to Kent County
Clinics, 2005
Average Distance to Clinic
Miles
0.6 - 1.0
1.1 - 2.0
2.1 - 5.0
5.1 - 7.5
7.6 - 10.0
10.1 - 15.0
15.1 - 20.0
20.1 - 29.4
Clinics
Medical Shortage Area
City of Grand Rapids
0
2
4
0
0.5
1
8
Miles
12
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
34
Additional Distance
to Patient Preferred
Clinic:
Kent County, 2005
Kent County
Average Difference
in Distance Between
Clinic Visited and Closest Clinic
Miles
0.00 - 1.00
1.01 - 1.50
1.51 - 2.00
2.01 - 2.50
2.51 - 3.00
3.01 - 3.50
3.51 - 4.50
4.51 - 7.67
Clinics
Medical Shortage Area
0
2
4
0
0.5
1
8
Miles
12
City of Grand Rapids
Grand Rapids
96
296
196
131
2
3
Miles
Data Sources: GRHCAP Clinic Utilization Data 2005 & Geolytics Population Projections 2007
DeJong & Vander Plas, Calvin College, 2007
35
Appendix A: Mapping Data Distribution Guidelines
36
Appendix A
Mapping data Distribution Guidelines
Data Users
1. Maps and analysis of the consolidated clinics’ population will be available, in the form of a
report, to consortium members. Permission to release or otherwise publicize the report and/or
results of the analysis of consolidated data is covered under guideline 3, below.
2. Maps and analysis of individual clinic data will be available in the report to consortium members
according to clinic affiliation.
3. Consortium members and non members who request the use of any and all mapping data
pertaining to clinics for which they have no affiliation or for data from the consolidated clinic
population will require the approval of all consortium members to use such mapping data. All
requests must specify in detail the intended use of the data.
Data Type
4. Released maps will not contain any personal patient data.
5. Minimum unit of analysis for released data sets is census block group.
Data Requests
6. Review of requests and decisions to release data by GRHCAP Consortium Board or its delegate.
7. KCHD will assess a fee to cover costs for non-consortium requests and requests from Consortium
members for additional map or report reproductions.
Teresa Branson, KCHD
Jim Dischinger-Smedes KCHD
Fred DeJong, Ph.D., Evaluator
Richard Zandstra, GRHCAP
37
Appendix B: GRHCAP Clinic Mapping Project Data Collection
Guide
38
Appendix B: GRHCAP Clinic Mapping Project Data Collection Guide
Mapping Project
Client-level data to be collected in order to complete the maps and analysis is enumerated in row
10, with a sample record in row 11. Codes for variables (optional) are number 1-19. The data
fields for House Number, Street Name, Street Direction, and Street Type is an optional address
form that splits the combined street address into separate fields. Income is also an optional field. If
data from different clinics is submitted in one file, make sure there are separate workbooks, or
preferably, a clinic code.
Field List: Bold font=Necessary data Normal Font=Optional data
FIELDS
SAMPLE RECORD
Address
City
700 Fuller Ave NE Grand Rapids
Zip Code
49503
Race
1
Gender
1
FIELDS cont.
SAMPLE RECORD cont.
Age
28
DOB
2/11/1966
Payer Type
1
Clinic Code
SMHC-Clinicia
2005 Visits
3
FIELDS cont.
SAMPLE RECORD cont.
Asthma visits
1
Depression visits Diabetes visits
2
2
Hypertension Visits
2
FIELDS cont.
SAMPLE RECORD cont.
House Number
700
Street Name
Fuller
Street Direction
NE
Street Type
Ave
Income
29000
Variable Coding
1
2
3
4
Address
City
Zip Code
Race/Ethnicity
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Race/Ethnicity cont.
Gender
Age
Date of Birth
Payer Type
Clinic Code or Name
2005 visits
Asthma visits*
Depression visits*
Diabetes visits*
Hypertension visits*
House Number
Street Name
Street Type
Street Direction
Income
Full street address
5 digit
Non-hispanic white=1
Asian=5
Female=1
In years
mm/dd/yyyy
Commercial=1
Black or African American=2 Hispanic=3 American Indian/
Alaska Native=4
Native Hawaiian=6
Other=7
Male=2
Medicaid, charity care, self-pay, KHP=2
Medicare=3
Number of asthma visits
Number of depression visits
Number of diabetes visits
Number of hypertension visits
Optional
Optional
Optional
Optional
Optional
*This does not need to be the primary diagnosis to be counted as a visit
Notes:
1. Records: There is no client name entered, but the records are for unique clients. There will be
duplicate addresses (spouses, siblings, etc.).
2. Address: Most recent address
39
3. 2005 Visits: All visits, regardless of address change
4. Optional address variables: Break the address down helps in the quality control of address
placement.
40
Appendix C: Excerpt from “Target Areas, Low-Income Analysis,
Population Change and Medical Shortage Area”, Clinic Mapping
Project Report,, Task Force on Health Care for People of Color,
Kent County Health Department, November 2005
The full report can be accessed online at:
http://www.accesskent.com/Health/HealthDepartment/Publications/taskforce/Appe
ndix_A_Clinic_Mapping_Project_Report_2005.pdf
or by contacting Jim Smedes at the Kent County Health Department
jim.smedes@kentcounty.org
41