Optimising spatial accessibility to inform rationalisation of specialist health services

Abstract

BackgroundIn an era of budget constraints for healthcare services, strategies for provision of services that improve quality whilst saving costs are highly valued. A proposed means to achieve this is consolidation of services into fewer specialist centres, but this may lead to reduced spatial accessibility. We describe a methodology which includes implementing a combinatorial optimisation algorithm to derive combinations of services which optimise spatial accessibility in the context of service rationalisation, and demonstrate its use through the exemplar of tuberculosis clinics in London.MethodsOur methodology involves (1) identifying the spatial distribution of the patient population using the service; (2) calculating patient travel times to each service location, and (3) using a combinatorial optimisation algorithm to identify subsets of locations that minimise overall travel time. We estimated travel times for tuberculosis patients notified in London between 2010 and 2013 to each of 29 clinics in the city. Travel time estimates were derived from the Transport for London Journey Planner service. We identified the subset of clinics that would provide the shortest overall travel time for each possible number of clinic subsets (1–28).ResultsBased on the 29 existing clinic locations, mean estimated travel time to clinics used by 12,061 tuberculosis patients in London was 33 min; and mean time to their nearest clinics was 28 min. Using optimum combinations of clinic locations, and assuming that patients attended their nearest clinics, a mean travel time of less than 45 min could be achieved with three clinics; of 34 min with ten clinics, and of less than 30 min with 18 clinics.ConclusionsWe have developed a methodological approach to optimise spatial accessibility which can be used to inform rationalisation of health services. In urban conurbations, this may enable service reorganisation which increases quality and efficiency without substantially affecting spatial accessibility. This approach could be used to inform planning of service reorganisations, but may not be generalisable to rural areas or smaller urban centres.

Impact of traffic variability on geographic accessibility to 24/7 emergency healthcare for the urban poor: A GIS study in Dhaka, Bangladesh

“…Findings also shed light on the importance of considering traffic variability in measurements of geographic coverage and accessibility, particularly in urban settings. Recognizing this reality, a recent paper has modeled the importance of taking travel time into account in efforts to optimize service utilization in urban areas [85]. In this analysis, we also consider the impact of traffic variability on access to emergency care in Dhaka City.…”

Quanto custa uma consulta médica especializada para as famílias de pacientes pediátricos no Sistema Único de Saúde?

“…Em outras palavras, pacientes apresentando casos de resolução cirúrgica direta e relativamente simples também eram referidos para o HFSE desde domicílios distantes, sugerindo que a oferta de cirurgia e anestesia pediátrica é restrita e distribuída geograficamente de forma desproporcional no Estado do Rio de Janeiro. A concentração de experts tem vantagens (economia de custos, qualidade, aprimoramento metodológico e de resultados), mas também pode implicar problemas, se incorre em dificuldade séria de acesso aos usuários e se a distribuição desses serviços limitados em número é extremamente desigual do ponto de vista geográfico 17 .…”

“…Atribuímos essa particularidade às condições de tráfego e transporte público no Rio de Janeiro. Esse problema dificultaria tentativas de planejamento de distribuição geográfica dos atendimentos usando uma correlação entre distância domicílio-hospital e tempo de transporte, como foi proposto por Smith et al 17 .…”

Measuring spatiotemporal accessibility for pediatric clinical services with multimodal transport modes: an exploratory analysis in Nanjing, China

“…The methodological framework of STA-PCS can offer implications for policymakers and planners regarding the dynamic accessibility of healthcare services. Typical application directions include optimizing the spatial relocation of hospitals to reduce urban traffic congestion (Yuxia Wang, Tong, Li, & Liu, 2019), optimizing healthcare services location-allocation problems (Smith, Fry, Anderson, Maguire, & Hayward, 2017;W. Zhang, Cao, Liu, & Huang, 2016), reducing the spatial inequity of multilevel healthcare services (Wei Hu, Li, & Su, 2019), and improving the spatial equity of multilevel healthcare in the metropolis (S. Zhang et al, 2019), which will facilitate movement to optimize the allocation and equity of medical facilities.…”