Interactive maps of county-level postacute rehabilitation therapy utilization across the United States based on ten years of Original Medicare data: user-centered codesign

Interactive maps of county-level postacute rehabilitation therapy utilization across the United States based on ten years of Original Medicare data: user-centered codesign | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Interactive maps of county-level postacute rehabilitation therapy utilization across the United States based on ten years of Original Medicare data: user-centered codesign Tiago S Jesus, Mech Frazier, Pedro C Monteiro, Catia S Pinho, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9706307/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Postacute rehabilitation therapy supports effective transitions to community living following a major illness or injury leading to disabilities, however their availability and utilization vary by geography, including rural-urban residence. Interactive maps developed by Geographic Information Systems can help stakeholders understand these geographic differences, which could inform targeted policies, public health, and advocacy. Objective: User-centered codesign of the attributes of web-based, county-level interactive maps of postacute therapy utilization in the USA derived from 10 years of public-domain Original Medicare data. Methods: The ArcGIS Pro was used to develop interactive maps of therapy utilization gradients for home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities. Hot and cold spot analyses, reflecting statistically significant geographic clusters of high and low utilization versus the nationwide trends, were also mapped. Potential end-users ( n = 9), including disability, rural health, and rehabilitation advocates, codesigned and beta-tested the map attributes. Results: The final maps included the following end-user codesigned features : a) “zero” utilization rates visualized; b) observed utilization rates and their percentile ranks both displayed; c) using multiple years of data; d) state-level maps showing rural utilization rates; e) accessibility features and multimodal user instruction options; and f) additional layers of data (e.g., pinned provider locations), with geographical boundaries inputted (e.g., tiers of rural counties; and medically underserved counties). Conclusion: This paper illustrates the development of a user-centered web-based interactive map with attributes from a user-centered knowledge translation perspective, toward informing public health, policy, and advocacy activities. The free interactive maps are publicly accessible: https://ohiostate.maps.arcgis.com/apps/instant/media/index.html?appid=bbb6b65433c342e298185d31de6b9576. Health Policy Geographic Information Systems Geographic Information Systems Geographic Mapping User-Centered Design Rehabilitation Persons with Disabilities Medicare Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9706307","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639867108,"identity":"aa120097-f614-4fda-9927-b6cbdc3c2f57","order_by":0,"name":"Tiago S Jesus","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYDACZjDJBiIYH8AEJfDp4EHSwmxAnBYkNhtcJV4t9uzMj198YOCTk5+R/qziw5/D0fwNzAdv8+DRwsPMZmY5g4HN2OBGjtnNmW2Hc2ccYEu2xq+FwcyYh4EtcYNEDttt3obDuRsYeMyk8Wth/wbSUj8f6LBinj8gLfzfCGjhMX4M1JLAcCPBjJmHDWwLG34th3nKGGcYsBluOPPGWHJmW3rujMNsxpZz8Ghh7z+++cOHimPy8u3pDz98+GOd29/e/PDGGzxaGMDRYXAMic+MXzlYyQcGhhrCykbBKBgFo2DkAgCAbkOYt5xlfwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-1300-6308","institution":"School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University","correspondingAuthor":true,"prefix":"","firstName":"Tiago","middleName":"S","lastName":"Jesus","suffix":""},{"id":639867109,"identity":"22f7fe17-9c4b-4a14-be23-4019599a9052","order_by":1,"name":"Mech Frazier","email":"","orcid":"","institution":"Northwestern University Libraries, Northwestern University","correspondingAuthor":false,"prefix":"","firstName":"Mech","middleName":"","lastName":"Frazier","suffix":""},{"id":639867110,"identity":"45899aeb-99f2-4616-a0bf-cd7d418989d2","order_by":2,"name":"Pedro C Monteiro","email":"","orcid":"","institution":"School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University","correspondingAuthor":false,"prefix":"","firstName":"Pedro","middleName":"C","lastName":"Monteiro","suffix":""},{"id":639867111,"identity":"55cbe64f-18ca-44b6-a0b2-744f528e53c6","order_by":3,"name":"Catia S Pinho","email":"","orcid":"","institution":"Independent Consultant, Grove City, OH, USA.","correspondingAuthor":false,"prefix":"","firstName":"Catia","middleName":"S","lastName":"Pinho","suffix":""},{"id":639867112,"identity":"b8b5e3fb-dc57-405a-a437-35633f23d4b9","order_by":4,"name":"Grace Delaney","email":"","orcid":"","institution":"School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University","correspondingAuthor":false,"prefix":"","firstName":"Grace","middleName":"","lastName":"Delaney","suffix":""},{"id":639867113,"identity":"610cffc7-40f4-4276-aaaf-d9adc2c35b8c","order_by":5,"name":"Allen W. 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Interactive maps developed by Geographic Information Systems can help stakeholders understand these geographic differences, which could inform targeted policies, public health, and advocacy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e User-centered codesign of the attributes of web-based, county-level interactive maps of postacute therapy utilization in the USA derived from 10 years of public-domain Original Medicare data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The ArcGIS Pro was used to develop interactive maps of therapy utilization gradients for home health agencies, skilled nursing facilities, and inpatient rehabilitation facilities. \u003cem\u003eHot\u003c/em\u003e and \u003cem\u003ecold spot\u003c/em\u003e analyses, reflecting statistically significant geographic clusters of high and low utilization versus the nationwide trends, were also mapped. Potential end-users (\u003cem\u003en\u003c/em\u003e= 9), including disability, rural health, and rehabilitation advocates, codesigned and beta-tested the map attributes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The final maps included the following end-user codesigned features : a) “zero” utilization rates visualized; b) observed utilization rates and their percentile ranks both displayed; c) using multiple years of data; d) state-level maps showing rural utilization rates; e) accessibility features and multimodal user instruction options; and f) additional layers of data (e.g., pinned provider locations), with geographical boundaries inputted (e.g., tiers of rural counties; and medically underserved counties).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e This paper illustrates the development of a user-centered web-based interactive map with attributes from a user-centered knowledge translation perspective, toward informing public health, policy, and advocacy activities. 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