Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California.
Use of the spatial access ratio to measure geospatial access to emergency general surgery services in California.
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DOI：
10.1097/ta.0000000000003087
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发表时间：
2021-05-01
期刊：
影响因子：
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通讯作者：
Nirula R
中科院分区：
文献类型：
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作者：
McCrum ML;Wan N;Lizotte SL;Han J;Varghese T;Nirula R
急诊普通外科（EGS）包括一系列时间敏感和资源密集型的疾病，需要充分和及时的手术治疗。制定指标，以准确地量化空间获得护理是至关重要的这一领域。我们试图评估的空间访问率（SPAR），其中包括旅行时间，医院的能力和人口需求的能力，以衡量空间访问EGS护理和划定差距的能力。我们为加州具备EGS能力的医院构建了一个地理信息科学（GIS）平台，并绘制了人口位置、种族和社会经济特征。我们将SPAR与最短旅行时间模型在识别整体空间访问差异和弱势群体方面的能力进行了比较。减少的空间访问被定义为>60分钟的旅行时间，或最低的三个SPAR等级。确定了283家具备EGS能力的医院，其中142家（50%）拥有先进的资源。使用最短的旅行时间，只有166，950人（占总人口的0.4%）经历了前往任何具有EGS功能的医院的旅行时间延长（>60分钟），对于高级资源中心，这增加到105万（2.7%）。使用SPAR，11.5M（29.5%）减少了对任何EGS医院的空间访问，13.9M（35.7%）减少了对高级资源中心的空间访问。尽管旅行时间在60分钟的阈值内，但SPAR评估的农村居民获得整体和高级EGS服务的机会显着减少。虽然旅行时间和SPAR显示了类似的总体地理模式的空间访问EGS医院，SPAR确定了更大的人口比例有限的医疗服务。根据SPAR的评估，近三分之一的加州居民体验到EGS医院的空间访问减少。在评估外科服务的空间可及性时，将人口需求和医院能力以及旅行时间的措施结合起来可能是有用的。观察结果不适用
Emergency General Surgery (EGS) encompasses a spectrum of time-sensitive and resource-intensive conditions which require adequate and timely access to surgical care. Developing metrics to accurately quantify spatial access to care is critical for this field. We sought to evaluate the ability of the Spatial Access Ratio (SPAR) which incorporates travel-time, hospital capacity and population demand in its ability to measure spatial access to EGS care and delineate disparities. We constructed a Geographic Information Science (GIS) platform for EGS-capable hospitals in California and mapped population location, race and socioeconomic characteristics. We compared the SPAR to the shortest travel time model in its ability to identify disparities in spatial access overall, and for vulnerable populations. Reduced spatial access was defined as >60 minutes travel time, or lowest three classes of SPAR. 283 EGS-capable hospitals identified, of which 142 (50%) had advanced resources. Using shortest travel time, only 166,950 persons (0.4% of total population) experienced prolonged (>60 minutes) travel time to any EGS-capable hospital, which increased to 1.05M (2.7%) for advanced-resource centers. Using SPAR, 11.5M (29.5%) had reduced spatial access to any EGS hospital, and 13.9M (35.7%) for advanced-resource centers. Rural residents had significantly decreased access for both overall and advanced EGS services when assessed by SPAR despite travel times within the 60-minute threshold. While travel time and SPAR showed similar overall geographic patterns of spatial access to EGS hospitals, SPAR identified a greater a greater proportion of the population as having limited access to care. Nearly one-third of California residents experience reduced spatial access to EGS hospitals when assessed by SPAR. Metrics that incorporate measures of population demand and hospital capacity in addition to travel time may be useful when assessing spatial access to surgical services. Observational Not applicable