Differences in Access to Services in Rural Emergency Departments of Quebec and Ontario

Fleet, Richard; Pelletier, Christina; Marcoux, Jérémie; Maltais-Giguère, Julie; Archambault, Patrick; Audette, Louis David; Plant, Jeff; Bégin, François; Tounkara, Fatoumata Korika; Poitras, Julien

doi:10.1371/journal.pone.0123746

Cited by 26 publications

(41 citation statements)

References 26 publications

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“…[48][49][50] Existing Canadian and American studies evaluating inequality in health care based on geographic variation identified factors contributing to such variation including patient need, patient preferences, illness burden, insurance coverage and community wealth/poverty. [51][52][53][54][55] Further research is required into possible medical practice and health system barriers, such as referral wait times, misdiagnoses, geographic distance to clinic and urbanity that may result in longer times to diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Provincial Differences in the Diagnosis and Care of Amyotrophic Lateral Sclerosis

Hodgkinson

Lounsberry

Mirian

et al. 2018

Can. J. Neurol. Sci.

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Background: Amyotrophic lateral sclerosis (ALS) is a progressive motor neuron disease resulting in muscle weakness, dysarthria and dysphagia, and ultimately respiratory failure leading to death. Half of the ALS patients survive less than 3 years, and 80% of the patients survive less than 5 years. Riluzole is the only approved medication in Canada with randomized controlled clinical trial evidence to slow the progression of ALS, albeit only to a modest degree. The Canadian Neuromuscular Disease Registry (CNDR) collects data on over 140 different neuromuscular diseases including ALS across ten academic institutions and 28 clinics including ten multidisciplinary ALS clinics. Methods: In this study, CNDR registry data were analyzed to examine potential differences in ALS care among provinces in time to diagnosis, riluzole and feeding tube use. Results: Significant differences were found among provinces, in time to diagnosis from symptom onset, in the use of riluzole and in feeding tube use. Conclusions: Future investigations should be undertaken to identify factors contributing to such differences, and to propose potential interventions to address the provincial differences reported.

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Section: Discussionmentioning

confidence: 99%

Provincial Differences in the Diagnosis and Care of Amyotrophic Lateral Sclerosis

Hodgkinson

Lounsberry

Mirian

et al. 2018

Can. J. Neurol. Sci.

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“…Catchment areas can also delineate locations that are ostensibly served by a service facility. This type of information can help determine whether at-risk populations are getting access to health care [31], if patients with mental health issues can get adequate access to specialized doctors, or determine whether there is a differential stress on some services due to higher catchment flows in some others compared to others [32]. Upon inspection, the demand/supply ratios for the catchment areas provide insight into where resources need to be reallocated or where personnel need to be re-assign to better meet the demands of the population in the service area [33].…”

Section: Catchment Areasmentioning

confidence: 99%

Information fusion to estimate resilience of dense urban neighborhoods

Palladino

Bienenstock

West

et al. 2019

Signal Processing, Sensor/Information Fusion, and Target Recognition XXVIII

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Diverse sociocultural influences in rapidly growing dense urban areas may induce strain on civil services and reduce the resilience of those areas to exogenous and endogenous shocks. We present a novel approach with foundations in computer and social sciences, to estimate the resilience of dense urban areas at finer spatiotemporal scales compared to the state-ofthe-art. We fuse multi-modal data sources to estimate resilience indicators from social science theory and leverage a structured ontology for factor combinations to enhance explainability. Estimates of destabilizing areas can improve the decision-making capabilities of civil governments by identifying critical areas needing increased social services.Keywords: Dense urban areas, behavior modeling, social/cultural modeling, social capital, situation/threat assessment INTRODUCTIONTwo-thirds of the world's population is expected to live in urban areas by the year 2050. This rapid growth of dense neighborhoods with diverse sociocultural influences may strain civil services, e.g., law enforcement, health care, and waste management, reducing the resilience of these areas to exogenous and endogenous shocks. Aggregate statistics for large, sprawling, urban areas are likely to miss critical indicators.To address these issues, we developed a novel approach that advances the state-of-the-art by (i) ascertaining the stability and resilience of densely populated areas at much finer geospatial and temporal scales, and (ii) basing that estimate on a solid social science foundation. We fuse multi-modal data sources to estimate the prevalence of indicators from social theories (e.g., social capital). Aggregate statistics from structured city-level data (censuses, surveys) provide a baseline for the entire city, while social media and news reports provide features at shorter time scales, and smaller geographic areas (i.e., neighborhoods, city blocks) introducing deviations from the baseline. This social science foundation, combined with our structured ontology, leads to enhanced explainability of the stability assessment, increasing confidence in downstream decisions. Knowledge of destabilizing areas informs the decisionmaking process in civil governments by identifying neighborhoods in need of social services and civil control. Our computational framework estimates the capacity of a dense urban area to cope with stress and volatility, allowing governments, soldiers, humanitarian organizations, and private companies to better understand and manage local disturbances. THEORETICAL FRAME: SOCIAL SCIENCE FOUNDATIONThere is a need to bridge the gap between the computational and social sciences. Modern decision-makers require support from computational tools with near real-time feedback, however social science theories are still validated/quantified after lengthy surveys and structured interviews. We performed comprehensive research and built methods using open-source data and text analytics to allow data science to quantify social science theories at a rapid pace. As a first step...

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“…Cost-cutting by provincial governments in the early to mid-1990s in response to growing levels of public debt and economic slowdown led to the closure of a number of smaller hospitals in rural and remote areas. This was accompanied by the introduction of geographically based regional health authorities in most provinces and a Health Services Restructuring Commission in Ontario which in turn accelerated the tendency to concentrate hospital and emergency department resources in larger hospitals outside of sparsely populated rural and remote communities [13,14]. After these changes were introduced, 22.5% of Canadian live more than one hour driving distance by road from either a level I or level II trauma centre [13].…”

Section: Canadamentioning

confidence: 99%

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries

Rechel

Džakula

Durán³

et al. 2016

Health Policy

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Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services.

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Differences in Access to Services in Rural Emergency Departments of Quebec and Ontario

Cited by 26 publications

References 26 publications

Provincial Differences in the Diagnosis and Care of Amyotrophic Lateral Sclerosis

Provincial Differences in the Diagnosis and Care of Amyotrophic Lateral Sclerosis

Information fusion to estimate resilience of dense urban neighborhoods

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries

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