Using spatially adaptive floating catchments to measure the geographic availability of a health care service: Pulmonary rehabilitation in the southeastern United States

A spatially adaptive floating catchment is a circular area that expands outward from a provider location until the estimated demand for services in the nearest population locations exceeds the observed number of health care services performed at the provider location. This new way of creating floating catchments was developed to address the change of spatial support problem (COSP) by upscaling the availability of the service observed at a provider location to the county-level so that its geographic association with utilization could be measured using the same spatial support. Medicare Fee-for-Service claims data were used to identify beneficiaries aged >= 65 years who received outpatient pulmonary rehabilitation (PR) in the Southeastern United States in 2014 (n = 8798), the number of PR treatments these beneficiaries received (n = 132,508), and the PR providers they chose (n = 426). The positive correlation between PR availability and utilization was relatively low, but statistically significant (r = 0.619, p < 0.001) indicating that most people use the nearest available PR services, but some travel long distances. SAFCs can be created using data from health care systems that collect claim-level utilization data that identifies the locations of providers chosen by beneficiaries of a specific health care procedure.