The case study series presents maps for five complete States—North Carolina, Oregon, Pennsylvania, Utah, and Washington—and Southern California. These States were chosen because they represent areas where RTI's Integrated Delivery System Research Network (IDSRN) partners are located. RTI chose to use IDSRN States because partners could facilitate contact with major health systems and State and local agencies necessary for collecting information for this Atlas. The RTI IDSRN partners included in this atlas are Providence Health System (Washington, Oregon, and California), Intermountain Health Care (Utah), University of Pittsburgh Medical Centers (Pennsylvania), and the University of North Carolina (UNC) Health Care (North Carolina). Facilities owned and operated by the IDSRN partners are highlighted on some of the maps in the case study series.
The case studies are geared toward understanding the regionalization of emergency services in each State and how this might pertain to the hospital and nursing home services being provided. For each State, geographic information system (GIS) analyses were used to synthesize and analyze the distribution of nursing home and hospital facilities relative to the State's resident population, together with county and State geopolitical boundaries and boundaries for Emergency Management (EM), Emergency Medical Services (EMS), Hazardous Materials (HAZMAT), and Trauma Coordination regions. The maps are in different scales, some depicting an entire State and others focusing on regions or cities within a State. It is worth noting that many States use different names for these regions even though the function is the same, and we have preserved these names when possible. For example, in North Carolina trauma regions are called regional advisory committees (RACs). For a more complete explanation of how these regions were chosen and a brief description of each, refer to the Overview section of this Atlas.
The case study series shows how analyses beyond simple mapping of the distribution of available health services can assist local and regional planners in assessing issues of concordance relevant to preparedness and response in disaster situations.
Each State case study consists of a series of maps exploring six themes:
1. The overview map, Nursing Homes and Hospitals Serving the Resident Population, depicts the size and location of hospitals and nursing homes relative to the urban population. The percentage of the population living in an urban area is displayed by census tract. Areas in dark blue correspond to a high proportion of urban residents (90 percent or more), and areas in yellow correspond to a low proportion (less than 10 percent). The symbols for hospitals and nursing homes are graduated in size: the largest symbol represents a large number of beds (500 or more for hospitals and 200 or more for nursing homes), and the smallest symbol represents a small number (fewer than 100 for hospitals and fewer than 50 for nursing homes).
2. The Major Cities maps provide a closer view of several large metropolitan centers. As in the State-level maps, the percentage of the population living in an urban area is displayed by census tract, along with the size and location of nursing homes and hospitals. These city maps are useful for looking at the distribution of resources in areas with a high density of nursing homes and hospitals.
3. The series of four maps showing HAZMAT Response, Trauma Coordination, Emergency Medical Services, and Emergency Management regions explores how different types of emergency services are regionalized in a State. All counties in each region are the same color. If the State has named or numbered the regions for administrative purposes, those designations are included on the map.
4. The map of Relative Facility Location by County highlights counties that contain nursing homes strategically located in rural areas with no hospital. The map identifies counties with high levels of hospital care: counties colored light blue have one or more nursing homes and a tertiary care hospital, counties colored dark purple have a nursing home and no hospital, and counties marked with hatching have neither nursing homes nor hospitals.
5. The map of Relative Facility Location and Red Cross Chapters depicts counties with nursing homes and no hospitals relative to the Red Cross chapters operating in each State. This map arose from in-person focus groups with staff from nursing homes. Administrators consistently mentioned the Red Cross as an invaluable resource in the event of an emergency.
6. The EMS Region maps examine, by EMS region, the size and location of nursing homes and hospitals relative to the location of the population aged 65 or older. The EMS regions were chosen for this analysis because they are the entities through which daily emergency services are coordinated, and they therefore have the jurisdiction to direct private resources, such as hospitals and ambulances, during an emergency. While several States refer to these regions as "EMS regions," some States have different designations. For example, Oregon calls these "Area Trauma Advisory Board (ATAB) regions," and Pennsylvania refers to some areas as "Emergency Health Services (EHS) regions." Each map is supported by both a table totaling indicators of facility capacity for counties in the EMS region and a population pyramid showing the sex and age distribution for the region's population.
Each page in a case study includes the following:
Several map pages have additional information, such as a population pyramid or a table listing the facility capacity for a specific region. The titles and legends are consistent across maps so that readers can compare resource availability and configuration in different States.
Several limitations should be noted for the maps included in this case study series. First, these static maps represent the most recent data available at production (January through July 2005; please refer to Appendix A for details). There are lags in the data, requiring that the maps be periodically updated.
The American Hospital Association (AHA) data were collected from hospitals responding to the AHA's annual survey; data for nonreporting facilities are not included in the maps and tables. The Centers for Medicare & Medicaid Services (CMS) report data on Skilled Nursing Facilities and Nursing Facilities (SNFs/NFs) with which it has completed reimbursement transactions. These data are considered comprehensive but do not include an area's newly added facilities.
There are also possible errors in geocoding (the process of assigning a latitude-longitude coordinate to an address). Sometimes, geocoding programs cannot find a perfect match for an address, and the latitude-longitude coordinates may be slightly inaccurate. Although these errors are not usually apparent in small-scale maps, such as those depicting an entire State, they are more noticeable in large-scale maps, such as those of major cities or EMS regions. We have made every effort to minimize these geocoding errors.
In addition, States are continually revising and reconfiguring service regions in consideration of experiences with care provision and new legislation and programs. These maps represent the most recent information available.
Finally, these maps only depict hospitals and nursing homes. Other residential treatment facilities, such as assisted living facilities and long-term care hospitals, which may provide services during a public health emergency, are not included.