SPATIAL ACCESSIBILITY OF HEALTH CARE IN INDIANA

Healthy populations and access to health care services are significant factors influencing economic development and prosperity. Since geographic access is an essential feature of an overall health system, it is important for health service researchers to develop accurate measures of physical access to health. In this paper we develop a series of gravity-based health care accessibility measures for all the counties in Indiana. The measures go beyond local availability of health care services within a county and account for travel impedance via distance-discounted health care services accessible throughout the state. When applied to Indiana counties, the results show sharp disparities in health care accessibility with extensive pockets of poor accessibility in rural and peripheral areas. The research concludes with a demonstration of how spatial accessibility measures can be beneficially used to evaluate of policies indicative of changes in the provision of health services.spatial accessibility, health care, geographic information systems (GIS),

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels

GIS-based analysis of spatial accessibility : an approach to determine public primary healthcare demand in metropolitan areas

It is important for health planners to provide health services as effectively and equitably as possible for the development of quality living environments. The provision of adequate healthcare services, particularly in metropolitan areas, is becoming more difficult because of three developments: slow economic growth; the rapid growth of metropolitan areas and their subsequent increases in population. It is thus a challenge to provide what is considered a fair or socially just distribution of healthcare services to a population with changing healthcare needs. The spatial distribution of people and their varying need for healthcare services is a long-standing interest in the field of service planning, and provides a classic issue well suited for Geographical Information Systems (GIS) to analyse. Access is an important aspect in healthcare service planning. GIS-based accessibility analysis is a logical method that can be applied to test the degree to which access is obtained. Such successful applications of GIS-based analysis have been useful in indicating the accessibility of an existing or potential service. This has provided a good basis for the planning of healthcare services. However, it has been increasingly realised that there is a growing need for a paradigm shift in the planning process. In South Africa, primary healthcare (PHC) is a dual system made up of private and public healthcare facilities. Private PHC is expensive and only affordable to people with medical insurance. These people, most currently belonging to the middle and high income brackets, are theoretically also healthier than the rest of the population. But a small proportion of the population in the low income bracket also has medical aid or insurance. Hence, it is quite difficult to make a clear distinction of the low, middle and high income uninsured population when measuring access to public primary healthcare services. In this study, three different scenarios to calculate the uninsured population were generated and tested using a GIS-based form of catchment area analysis. The results from the catchment area analysis were compared with actual public PHC demand in the form of headcounts and further analysis of the origins of the patients was undertaken using a patient register. Results indicate that there is no significant difference in the spatial extent of the catchment areas of the facilities across the three demand scenarios but that there are significant differences in demand visits per scenario. A patient register and facility headcounts, both based on actual visits to public PHC facilities, were compared to the results of the catchment area analysis. The comparison results show that almost 45% of the patients did not use their closest facility as a first point of contact. The total allocated demand visits in scenario 3 was strongly in line with the total number of headcounts of the area, and thus is considered the most suitable calculation of uninsured population for implementation in a GIS-based accessibility analysis

Towards the development of a resource allocation model for primary, continuing and community care in the health services - Volume 1

This report proposes a resource allocation model for the Irish health services based on the principle that each Irish resident should be provided with access to health services funded from general taxation and in proportion to their need for those services. At the moment, such a system cannot be deployed as some necessary financial information is not available. The information could be made available, and should be done as quickly as possible. If this information were made available, the model proposed here, while very crude, would serve as a good starting point for resource allocation and should be initiated as soon as possible. Any reasonable system of resource allocation would be an improvement on the system that is currently in place

A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions

Background: This paper analyses the relationship between public perceptions of access to general practitioners (GPs) surgeries and hospitals against health status, car ownership and geographic distance. In so doing it explores the different dimensions associated with facility access and accessibility. Methods: Data on difficulties experienced in accessing health services, respondent health status and car ownership were collected through an attitudes survey. Road distances to the nearest service were calculated for each respondent using a GIS. Difficulty was related to geographic distance, health status and car ownership using logistic generalized linear models. A Geographically Weighted Regression (GWR) was used to explore the spatial non-stationarity in the results. Results: Respondent long term illness, reported bad health and non-car ownership were found to be significant predictors of difficulty in accessing GPs and hospitals. Geographic distance was not a significant predictor of difficulty in accessing hospitals but was for GPs. GWR identified the spatial (local) variation in these global relationships indicating locations where the predictive strength of the independent variables was higher or lower than the global trend. The impacts of bad health and non-car ownership on the difficulties experienced in accessing health services varied spatially across the study area, whilst the impacts of geographic distance did not. Conclusions: Difficulty in accessing different health facilities was found to be significantly related to health status and car ownership, whilst the impact of geographic distance depends on the service in question. GWR showed how these relationships were varied across the study area. This study demonstrates that the notion of access is a multi-dimensional concept, whose composition varies with location, according to the facility being considered and the health and socio-economic status of the individual concerned

Measuring spatial accessibility to urban services for older adults: an application to healthcare facilities in Milan

This study proposes a Geographic Information Systems-based methodology to measure accessibility to urban services from the elderly perspective to support urban planning processes. Specifically, it seeks to understand and clarify how the urban environment can influence the quality of life for older adults, mostly through pedestrian and public transport networks, locations of essential urban services, and the organisation of their resources. In light of a significant demographic change, policymakers will have to promote age-friendly urban planning approaches to guarantee equal access to services and activities. We propose a methodology to measure accessibility to healthcare provision services that considers land-use and mobility features and older adults' behavioural traits. The method belongs to the family of 2SFCA—2 steps floating catchment area—which evaluate accessibility as the combination of both supply and demand of urban services. Therefore, we have introduced innovative elements to shape actual mobility opportunities for the elderly and their travel choices. The methodology was applied to Milan's city to measure accessibility to the Health Protection Agency (ATS) services, which is responsible for healthcare assistance to the elderly dwelling in the city. The outputs show that a significant share of older people (almost 40%) suffer from poor accessibility to primary health services and that they mostly live in the city periphery. Moreover, the application to a case study has shown that the methodology could identify the critical aspects needed to aid urban planning to achieve a high quality of life for elderly people

Identifying public transport gaps using time-dependent accessibility levels

One of the concerns that has aroused much scholarly attention in transport geography lately is the extent to which public transport provision enables the less privileged population segments, especially those without privately owned motorized vehicles, to participate in activities that are deemed normal within the society they live in. This study contributes to this line of inquiry by proposing a methodology for identifying public transit gaps, a mismatch between the socially driven demand for transit and the supply provided by transit agencies. The methodology draws on the latest accomplishments in the field of modeling time-continuous, schedule-based public transport accessibility. Accessibility levels to key destinations are calculated at regular time intervals, and synoptic metrics of these levels over various peak and off-peak time windows are computed for weekdays and weekends. As a result, a temporally reliable picture of accessibility by public transport is constructed. The obtained index of public transport provision is compared to a public transport needs index based on the spatial distribution of various socio-demographics, in order to highlight spatial mismatches between these two indices. The study area consists of Flanders, which is the northern, Dutch-speaking region of Belgium. The results indicate that mainly suburban areas are characterized by high public transport gaps. Due to the time-variability of public transport frequencies, these gaps differ over time

Adaptable Spatial Agent-Based Facility Location for Healthcare Coverage

Lack of access to healthcare is responsible for the world’s poverty, mortality and morbidity. Public healthcare facilities (HCFs) are expected to be located such that they can be reached within reasonable distances of the patients’ locations, while at the same time providing complete service coverage. However, complete service coverage is generally hampered by resource availability. Therefore, the Maximal Covering Location Problem (MCLP), seeks to locate HCFs such that as much population as possible is covered within a desired service distance. A consideration to the population not covered introduces a distance constraint that is greater than the desired service distance, beyond which no population should be. Existing approaches to the MCLP exogenously set the number of HCFs and the distance parameters, with further assumption of equal access to HCFs, infinite or equal capacity of HCFs and data availability. These models tackle the real-world system as static and do not address its intrinsic complexity that is characterised by unstable and diverse geographic, demographic and socio-economic factors that influence the spatial distribution of population and HCFs, resource management, the number of HCFs and proximity to HCFs. Static analysis incurs more expenditure in the analytical and decision-making process for every additional complexity and heterogeneity. This thesis is focused on addressing these limitations and simplifying the computationally intensive problems. A novel adaptable and flexible simulation-based meta-heuristic approach is employed to determine suitable locations for public HCFs by integrating Geographic Information Systems (GIS) with Agent-Based Models (ABM). Intelligent, adaptable and autonomous spatial and non-spatial agents are utilized to interact with each other and the geographic environment, while taking independent decisions governed by spatial rules, such as •containment, •adjacency, •proximity and •connectivity. Three concepts are introduced: assess the coverage of existing HCFs using travel-time along the road network and determine the different average values of the service distance; endogenously determine the number and suitable locations of HCFs by integrating capacity and locational suitability constraints for maximizing coverage within the prevailing service distance; endogenously determine the distance constraint as the maximum distance between the population not covered within the desired service distance and its closest facility. The models’ validations on existing algorithms produce comparable and better results. With confirmed transferability, the thesis is applied to Lagos State, Nigeria in a disaggregated analysis that reflects spatial heterogeneity, to provide improved service coverage for healthcare. The assessment of the existing health service coverage and spatial distribution reveals disparate accessibility and insufficiency of the HCFs whose locations do not factor in the spatial distribution of the population. Through the application of the simulation-based approach, a cost-effective complete health service coverage is achieved with new HCFs. The spatial pattern and autocorrelation analysis reveal the influence of population distribution and geographic phenomenon on HCF location. The relationship of selected HCFs with other spatial features indicates agents’ compliant with spatial association. This approach proves to be a better alternative in resource constrained systems. The adaptability and flexibility meet the global health coverage agenda, the desires of the decision maker and the population, in the support for public health service coverage. In addition, a general theory of the system for a better-informed decision and analytical knowledge is obtained

Evaluation of complex integrated care programmes: the approach in North West London

Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. Theory and discussion: This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. Conclusions: We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important