An enhanced approach for modeling spatial accessibility for in vitro fertilization services in the rural Midwestern United States

• 29% of census tracts in Iowa have moderate spatial access, and 17% of tracts have low spatial access.
• Approximately 19% of IVF patients traveled from locations that have moderate to low spatial accessibility.
• Accessibility may not improve the prospect of providing IVF care to tracts with a low match for sociodemographic variables.

Highly technological in vitro fertilization (IVF) treatment is available at relatively few medical centers in rural United States. This research derives a spatial accessibility surface for IVF centers in a rural Midwestern state through the application of computational methods that consider spatial and non-spatial parameters to discover potentially underserved areas in the state. These methods include a modified gravity model and techniques from spatial interaction modeling. The approach develops an enhanced accessibility index that incorporates three key sociodemographic variables describing patients seeking infertility healthcare in Iowa that have been identified based on a survey of IVF care practitioners in the state. Self-organizing map techniques are used to reveal cluster locations based on the degree of match between census sociodemographic data and the expert-identified variables. The spatial accessibility surface is combined with the sociodemographic clusters to define an enhanced measure of spatial accessibility. The results suggest that while the state's IVF centers are located in tracts characterized by high spatial accessibility, at least 19% of patients travel from census tracts classed as moderate to low accessibility. This result reveals some opportunities for service improvements for these locations. Interestingly, for tracts that are characterized as having a lower patient sociodemographic match, high spatial accessibility does not appear to be a factor that improves the likelihood of patient care, at least for the variables investigated as part of this research.