[Show abstract][Hide abstract] ABSTRACT: There is mounting pressure on healthcare planners to manage and contain costs. In rural regions, there is a particular need to rationalize health service allocation to ensure the best possible coverage for a dispersed population. Rural health administrators need to be able to quantify the population affected by their allocation decisions and, therefore, need the capacity to incorporate spatial analyses into their decision-making process. Spatial decision support systems (SDSS) can provide this capability. In this article, we combine geographical information systems (GIS) with a web-based graphical user interface (webGUI) in a SDSS tool that enables rural decision-makers charged with service allocation, to estimate population catchments around specific health services in rural and remote areas. Using this tool, health-care planners can model multiple scenarios to determine the optimal location for health services, as well as the number of people served in each instance.
Health Informatics Journal 12/2011; 17(4):277-93. DOI:10.1177/1460458211409806 · 0.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Trauma is a leading cause of morbidity, potential years of life lost and health care expenditure in Canada and around the world. Trauma systems have been established across North America to provide comprehensive injury care and to lead injury control efforts. We sought to describe the current status of trauma systems in Canada and Canadians' access to acute, multidisciplinary trauma care.
A national survey was used to identify the locations and capabilities of adult trauma centers across Canada and to identify the catchment populations they serve. Geographic information science methods were used to map the locations of Level I and Level II trauma centers and to define 1-hour road travel times around each trauma center. Data from the 2006 Canadian Census were used to estimate populations within and outside 1-hour access to definitive trauma care.
In Canada, 32 Level I and Level II trauma centers provide definitive trauma care and coordinate the efforts of their surrounding trauma systems. Most Canadians (77.5%) reside within 1-hour road travel catchments of Level I or Level II centers. However, marked geographic disparities in access persist. Of the 22.5% of Canadians who live more than an hour away from a Level I or Level II trauma centers, all are in rural and remote regions.
Access to high quality acute trauma care is well established across parts of Canada but a clear urban/rural divide persists. Regional efforts to improve short- and long-term outcomes after severe trauma should focus on the optimization of access to pre-hospital care and acute trauma care in rural communities using locally relevant strategies or novel care delivery options.
The Journal of trauma 12/2010; 69(6):1350-61; discussion 1361. DOI:10.1097/TA.0b013e3181e751f7 · 2.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Ensuring equity of access to primary health care (PHC) across Canada is a continuing challenge, especially in rural and remote regions. Despite considerable attention recently by the World Health Organization, Health Canada and other health policy bodies, there has been no nation-wide study of potential (versus realized) spatial access to PHC. This knowledge gap is partly attributable to the difficulty of conducting the analysis required to accurately measure and represent spatial access to PHC. The traditional epidemiological method uses a simple ratio of PHC physicians to the denominator population to measure geographical access. We argue, however, that this measure fails to capture relative access. For instance, a person who lives 90 minutes from the nearest PHC physician is unlikely to be as well cared for as the individual who lives more proximate and potentially has a range of choice with respect to PHC providers. In this article, we discuss spatial analytical techniques to measure potential spatial access. We consider the relative merits of kernel density estimation and a gravity model. Ultimately, a modified version of the gravity model is developed for this article and used to calculate potential spatial access to PHC physicians in the Canadian province of Nova Scotia. This model incorporates a distance decay function that better represents relative spatial access to PHC. The results of the modified gravity model demonstrate greater nuance with respect to potential access scores. While variability in access to PHC physicians across the test province of Nova Scotia is evident, the gravity model better accounts for real access by assuming that people can travel across artificial census boundaries. We argue that this is an important innovation in measuring potential spatial access to PHC physicians in Canada. It contributes more broadly to assessing the success of policy mandates to enhance the equitability of PHC provisioning in Canadian provinces.
L’évaluation du potentiel d’accessibilité spatiale aux services de santé primaires à l’aide d’un modèle gravitationnel modifié
L’organisation de la prestation des services de santé primaires (SSP) partout au Canada sur une base équitable demeure un enjeu de taille, notamment dans les régions rurales et éloignées. Malgré l’importance accordée par l’Organisation mondiale de la santé, Santé Canada et d’autres instances chargées des politiques de santé, aucune étude n’a encore été menée à l’échelle nationale sur l’accessibilité spatiale potentielle (plutôt que réelle) aux SSP. Les défis et obstacles de la recherche visant àévaluer et à représenter avec exactitude l’accessibilité spatiale aux SSP pourraient expliquer en partie ce déficit de connaissances. En épidémiologie, l’approche traditionnelle utilisée pour évaluer l’accessibilité géographique repose sur un rapport simpliste entre le nombre de médecins prodiguant des SSP et la population totale. Nous défendons l’idée que les résultats qui en sont issus ne rendent pas compte de l’accès relatif. Par exemple, le niveau de soins qu’une personne qui vit à 90 minutes d’un médecin en SSP peut s’attendre de recevoir est inférieur à celui d’une autre qui jouit d’une proximité et d’un plus vaste choix de SSP. Cet article porte sur les techniques d’analyse spatiale utilisées pour évaluer le potentiel d’accessibilité spatiale. Il est question d’examiner à la fois le bien-fondé relatif des méthodes d’estimation par noyau de densité ainsi que celui d’un modèle gravitationnel. Une modification a finalement été apportée au modèle gravitationnel utilisé pour le calcul du potentiel de l’accessibilité spatiale aux médecins prodiguant des SSP dans la province canadienne de la Nouvelle-Écosse. Ce modèle, qui utilise une fonction décroissante de la distance, permet de relativiser le niveau d’accessibilité spatiale aux SSP. Les résultats de l’application de ce modèle nuancent mieux le potentiel d’accessibilité. Il ressort de cette étude un portrait nuancé de l’accessibilité aux médecins en SSP en Nouvelle-Écosse. Partant du principe que les gens traversent les frontières arbitraires des unités de recensement, le modèle gravitationnel constitue un meilleur outil d’évaluation de l’accessibilité. Il constitue également un apport novateur dans l’évaluation du potentiel d’accessibilité aux médecins en SSP au Canada et fournit, de manière générale, une base sur laquelle évaluer si les politiques ont eu une incidence positive sur le caractère équitable de la prestation des SSP dans les provinces canadiennes.
Canadian Geographer / Le Géographe canadien 02/2010; 54(1):29 - 45. DOI:10.1111/j.1541-0064.2009.00301.x · 0.56 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Rural environments have consistently been characterized by high injury mortality rates. Although injury prevention efforts might be directed to reduce the frequency or severity of injury in rural environments, it is plausible that interventions directed to improve injury care in the rural settings might also play a significant role in reducing mortality. To test this hypothesis, we set out to examine the relationship between rurality and the setting in which patient death was most likely to occur.
This is a population-based retrospective cohort study evaluating all trauma deaths occurring in the province of Ontario, Canada, over the interval 2002 to 2003. Patient cohorts were defined by their potential to access trauma center care using two different approaches, rurality and timely access to trauma center care.
There were 3,486 deaths over the study interval, yielding an overall injury mortality rate of 14.6 per 100,000 person-years. Overall, more than half of deaths occurred before reaching an emergency department (ED). Prehospital deaths were twice as likely in the most rural locations and in those with limited access to timely trauma center care. However, among patients surviving long enough to reach hospital, there was a threefold increase in the risk of ED death among those injured in a region with limited access to trauma center care.
We demonstrate that a significant proportion of deaths occur in rural EDs. This study provides new insights into rural trauma deaths and suggests the potential value of targeted interventions at the policy and provider level to improve the delivery of preliminary trauma care in rural environments.
The Journal of trauma 12/2009; 69(3):633-9. DOI:10.1097/TA.0b013e3181b8ef81 · 2.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The creation of successful health policy and location of resources increasingly relies on evidence-based decision-making. The development of intuitive, accessible tools to analyse, display and disseminate spatial data potentially provides the basis for sound policy and resource allocation decisions. As health services are rationalized, the development of tools such graphical user interfaces (GUIs) is especially valuable at they assist decision makers in allocating resources such that the maximum number of people are served. GIS can used to develop GUIs that enable spatial decision making.
We have created a Web-based GUI (wGUI) to assist health policy makers and administrators in the Canadian province of British Columbia make well-informed decisions about the location and allocation of time-sensitive service capacities in rural regions of the province. This tool integrates datasets for existing hospitals and services, regional populations and road networks to allow users to ascertain the percentage of population in any given service catchment who are served by a specific health service, or baskets of linked services. The wGUI allows policy makers to map trauma and obstetric services against rural populations within pre-specified travel distances, illustrating service capacity by region.
The wGUI can be used by health policy makers and administrators with little or no formal GIS training to visualize multiple health resource allocation scenarios. The GUI is poised to become a critical decision-making tool especially as evidence is increasingly required for distribution of health services.
International Journal of Health Geographics 10/2008; 7(1):49. DOI:10.1186/1476-072X-7-49 · 2.62 Impact Factor