Using spatial analytics and social determinants of health to redefine critical access to medical transport services for rural populations

项目概要/摘要 大约五分之一的美国人生活在农村指定区域，占全国土地的97% mass.1美国农村地区广泛的地理分布为寻求健康的人带来了独特的挑战 服务，特别是当遇到时间敏感的紧急情况，如心脏病发作，中风或创伤。 需要及时医疗护理的农村病人往往通过直升机转移到城市学术机构， 医疗中心已被证明是一种挽救生命的干预措施，因此被认为是关键的医疗保健 2，3 -10然而，不为人知的是，农村在基础设施的使用、成本和结果中的作用， 医院间转移（IHT），增加获得和减少差异所需的重要信息， 结果。识别导致IHT患者预后不良的因素非常复杂， 缺乏全面的数据集，包括所有必要的数据来源，以解开复杂的 患者健康与IHT后结果之间的关系与患者位置和地点有关的差异- 健康的社会决定因素（SDOH）。当前包含SDOH数据，数据合并到其他数据集 以非特异性的方式包括，通常将所有患者分为广泛的类别， 农村与城市，通常在县一级，或更广泛地作为农村指定的整个 比较组。这种缺乏一致性的情况阻碍了我们理解IHT使用本质的能力， 在农村或服务不足的地区。因此，指南和协议仍然存在缺陷，因为它们是基于 对农村的概念定义不一致，数据点不可靠或不有效。因此为了 提供了一个更全面和准确的理解之间的复杂的真实关系， IHT的干预和SDOH在农村环境中的作用，数据管理和分析的新方法 是必要的。本提案的目的是建立一个综合数据管理平台，将联合收割机 健全的卫生系统电子健康记录数据、运输数据和健康数据的社会决定因素， 空间数据库，其中可以执行各种地理空间操作、查询和分析。一旦 我们将利用这个分析平台进行多方面的分析。在NIMHD研究的指导下 框架，我们将检查个人（例如，运输），社区（例如，医院，交通服务， 地理分布、人口普查），以及社会（例如，补偿政策）对农村获得IHT的影响。如果 如果成功，我们将能够确定和识别IHT服务关键访问有限的农村地区 区域-提供所需的证据，以支持改善获得护理和减少病人的经济损失。 此外，来自该创新平台的数据将为研究提供动态分析工具和数据资源 和目前不存在的公共用途。包括更新作为新数据集的动态功能是 发布，将提供一个强大的工具，以监测和评估随着时间的推移，在国际卫生保健实践的变化， 评估农村地区政策变化和报销做法的影响的可靠和有效的系统。

Project Summary/Abstract Approximately one in five Americans live in a rural-designated area, representing 97% of the country’s land mass.1 The broad geographic distribution of rural America presents unique challenges for those seeking health services, particularly when experiencing a time-sensitive emergency such as heart attack, stroke, or trauma. Rural patients requiring time-sensitive medical care are often transferred via helicopter to urban academic medical centers which has been shown to be a lifesaving intervention and thus considered critical healthcare infrastructure.2,3-10 However, what is unknown, is the role of rurality in the use, cost, and outcomes of interhospital transfer (IHT), vital information that is needed to increase access and decrease disparity in outcomes. Identifying factors that contribute to poor outcomes for IHT patients is significantly complicated due to a lack of comprehensive datasets that include all sources of data necessary to disentangle the complex relationships between patient health and post-IHT outcomes disparity in relation to patient location and place- based social determinants of health (SDOH). Current inclusion of SDOH data, data merged to other datasets by location, are included in a non-specific manner, often classifying all patients into broad categories such as rural versus urban and usually at the county level, or more broadly as rural designation for the entire comparative group. This lack of consistency hinders our ability to understand the nature of IHT use—especially in rural or underserved areas. As a result, guidelines and protocols remain flawed because they are based on inconsistent conceptual definitions of rurality and data points that are not reliable or valid. Therefore, in order to provide a more comprehensive and accurate understanding of the true relationship between the complicated intervention of IHT and the role of SDOH in rural settings, new approaches to data management and analysis are needed. The purpose of this proposal is to build an integrated data management platform that will combine robust health system electronic health record data, transport data and social determinants of health data into a spatial database where various geospatial manipulations, queries, and analysis can be performed. Once established, we will use the analytic platform to conduct several analyses. Guided by the NIMHD research framework, we will examine individual (e.g., transports), community (e.g., hospitals, transport services, geographic distribution, census), and societal (e.g., reimbursement policy) influences on rural access to IHT. If successful, we will be able to define and identify rural regions with limited IHT services—critical access regions—to provide needed evidence to support improving access to care and reducing patient financial harm. Further, data from this innovative platform will provide a dynamic analytic tool and data resource for research and public use that currently does not exist. The dynamic capability of including updates as new datasets are released, will provide a powerful tool to monitor and assess changes in IHT practice over time, providing a reliable and valid system to assess the effect of policy changes and reimbursement practices in rural settings.