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

项目摘要/摘要 大约五分之一的美国人生活在农村指定的地区，占全国土地的97% 美国农村的广泛地理分布给那些寻求健康的人带来了独特的挑战 服务，特别是在经历时间敏感的紧急情况时，如心脏病发作、中风或创伤。 需要时间敏感医疗护理的农村患者通常通过直升机被转移到城市的学术机构 医疗中心已被证明是一种拯救生命的干预措施，因此被认为是关键的医疗保健 基础设施。2，3-10然而，未知的是农村在使用、成本和结果中的作用 医院间转移(IHT)，这是增加访问和减少差距所需的重要信息 结果。确定导致IHT患者预后不良的因素是非常复杂的 缺乏全面的数据集，包括解开复杂结构所需的所有数据源 患者健康与IHT术后结局的关系--患者位置和地点的差异 基于健康的社会决定因素(SDOH)。当前包含SDOH数据、合并到其他数据集的数据 根据位置，以非特定的方式包括在内，通常将所有患者归类为广泛的类别，如 农村相对于城市，通常在县级，或者更广泛地说，作为整个农村的名称 比较组。这种一致性的缺乏阻碍了我们理解IHT使用的性质的能力--尤其是 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 对乡村和不可靠或不有效的数据点的概念定义不一致。因此，为了 更全面、更准确地理解复杂事物之间的真实关系 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 都是需要的。该提案的目的是构建一个综合数据管理平台，该平台将结合 强大的健康系统电子健康记录数据、传输数据和健康数据的社会决定因素 可执行各种地理空间操作、查询和分析的空间数据库。一次 建立后，我们将利用分析平台进行几次分析。由NIMHD研究指导 框架，我们将检查个人(例如，交通工具)、社区(例如，医院、交通服务、 (例如，地理分布、人口普查)和社会(例如，补偿政策)对农村地区获得国际托儿服务的影响。如果 成功后，我们将能够定义和确定IHT服务有限的农村地区-关键接入 区域--提供必要的证据，以支持改善获得护理的机会和减少患者的经济损失。 此外，来自这一创新平台的数据将为研究提供动态分析工具和数据资源 以及目前还不存在的公共用途。将更新作为新数据集包含的动态功能 发布后，将提供一个强大的工具来监控和评估IHT实践随时间的变化，提供 可靠和有效的制度，以评估农村地区政策变化和补偿做法的影响。

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.