Developing composite indices of geographical access and need for nursing home care in Ireland using multiple criteria decision analysis

Abstract

Background: Spatial accessibility has consistently been shown to influence utilisation of care and health outcomes, compared against local population needs. We sought to identify how appropriately nursing homes (NHs) are distributed in Ireland, as its NH market lacks central planning. Methods: We used multiple criteria decision analysis (MCDA) approaches to develop composite indices of both access (incorporating measures of availability, choice, quality and affordability) and local NH need for over 65s (relating to the proportion living alone, with cognitive disabilities or with low self-rated health, estimated scores for activities of daily living and instrumental activities of daily living, the average number of disabilities per person and the average age of this group). Data for need were derived from census data. Results were mapped to better understand underlying geographical patterns. Results: By comparing local accessibility and need, underserved areas could be identified, which were clustered particularly in the country’s northwest. Suburbs, particularly around Dublin, were by this measure relatively overserved. Conclusions: We have developed multi-dimensional indices of both accessibility to, and need for, nursing home care. This was carried out by combining granular, open data sources and elicited expert/stakeholder opinion from practitioners. Mapping these data helped to highlight clear evidence of inequitable variation in nursing home distribution.

Geographic inequalities in non-acute healthcare supply: evidence from Ireland

“…In contrast, data collection on acute care and lifestyle survey data 52 , 53 has been more extensive. For some non-acute services such as GPs and LTRC, where data can be geocoded, more detailed analysis of spatial accessibility has been undertaken 24 , 25 , 27 , 41 . The need for timely access to information to support an integrated healthcare system has been underlined in international policy 3 .…”

“…The 2SFCA method and other related techniques have been applied to a wide range of countries and healthcare services: for example, variations in geographic accessibility of different aspects of primary care in Wales 20 , Texas, US 21 , Ontario, Canada 22 , and ambulatory and inpatient services in Germany 23 . Analysis of spatial accessibility in healthcare in Ireland has been focused on GPs and long-term residential care (LTRC) 24 – 27 but extending this type of analysis to other non-acute healthcare services is hindered by the absence of adequately geocoded data.…”