Closing the distance gap: Evaluating patient travel distances in a community oncology practice.
Authors: Indurlal Puneeth , Deepak Divya , Hakimian David , Manjunath Rajini , Malhotra Rajat , Mirza Irfan Ahmed 
Published: September 2024

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Background:
Patient travel distance is an important factor influencing healthcare access, health equity and outcomes. The Rural-Urban Commuting Area (RUCA) classification system categorizes geographic areas based on urbanization and commuting patterns to measure accessibility to healthcare. We study the relationship between RUCA and patient travel distance for a multi-site community-based, medical oncology practice in north-west Chicagoland area.
Methods:
Using patient ZIP code data and practice locations (clinics) from April 2023 to March 2024, we calculated and compared the straight-line, one-way, patient-clinic travel distance (travel distance) for about 20,000 patients at 5 clinics, using geospatial analysis techniques. We grouped clinics based on location and population characteristics, applied the RUCA classification to patient ZIP codes, and compared travel distances by RUCA categories.
Results:
The median travel distance for patients was 5.0 miles, with 82% of patients traveling 10 miles or less, and 89% traveling 15 miles or less. Table 1 shows % of patients traveling and travel distance by RUCA categories. Median travel distances for urban metro, suburban metro, and suburban small-town clinics were 4.8mi, 10.8mi and 20.6mi (Kruskal Wallis H-test, p <0.001). Within 50 miles of each clinic, median travel distance for patients from urban ZIP codes (4.8 mi) was lower compared to metropolitan, micropolitan, small town and all other RUCA categories.
Conclusions:
Preliminary findings indicate a significant association between RUCA and travel distance, with longer travel distances for patients in non-urban locales. Proximity of cancer care sites to the patient’s home reduces distance traveled, minimizing the burden on the patients and their families. Interventions addressing transportation needs (such as improving infrastructure, increasing transportation options, subsidizing healthcare travel, etc.) can be augmented with efforts to strengthen access to community-based sites (expansion of telehealth, incentivizing providers serving non-urban areas, etc.) to reduce patient and caregiver burden.

Clinic
Site Category
% of patients traveling

<5 mi

<10mi

<15mi

<50mi

>50mi

A
Suburban Metro
53.8%
30.7%
5.2%
9.1%
0.9%

B
Suburban Small Town
24.1%
40.6%
21.9%
12.3%
0.4%

C
Suburban Metro
45.7%
34.3%
5.01%
13.8%
1.0%

D
Suburban Metro
60.1%
23.9%
6.8%
7.9%
1.2%

E
Urban Metro
80.3%
9.7%
3.5%
5.2%
1.0%

ALL SITES

54.7%

27.1%

7.2%

9.8%

0.9%

Clinic

Median travel distance in miles (% of patients) by patient RUCA within 50 miles of clinics

Urban

Metropolitan – High Commute

Micropolitan – Flow to Large Urban Cluster

Small Town – Flow to Small Urban Cluster

All Other

A
4.8 (98.2%)
27.5 (1.7%)
48.7
49.4

B
4.0 (42.3%)
8.6 (54.2%)
25.0
20.6 (3.2%)

C
5.9 (95.2%)
17.7 (4.5%)
36.7
27.7

D
4.8 (97.1%)
23.7 (2.8%)
48.4
40.1

E
2.7 (98.9%)
32.3 (1.0%)

4.5

ALL

4.8 (91.2%)

10.8 (8.3%)

36.7 (0.1%)

20.6 (0.4%)

4.5