دانلود رایگان مقاله روند توسعه مبنی بر الگوریتم فضایی برای مشخص کردن مناطق خدمات بیمارستانی

Abstract

Hospital service areas (HSAs) capture most of local patient-to-hospital travel flows, and have been accepted as the most basic unit for analyzing local hospital utilization and hospitalization patterns. If a given HSA includes multiple hospitals providing care for its residents, it is complicated to assign responsibility for small-area variation in hospital performance or healthcare costs to specific hospitals without established HSA managers. The goal of this study is to produce HSAs with the fewest number of hospitals within an HSA unit. Only a very limited number of studies are related to the HSA delineation. This study reviews the existing approaches to delineate a broader range of service areas besides HSAs. A spatial algorithm named Travel-to-Hospital Algorithm (TTHA) was developed and implemented using the individual hospital discharge records from the Florida State Inpatient Database for 2011. The final output, named the TTHA-derived HSAs, included 14 more eligible divisions in Florida than the HSAs produced by the traditional approach (92 vs. 78), with the degree of self-containment comparable between the two sets of HSAs. The TTHA provides insight into the patterns of hospital visits and holds great value for the delineation of other types of service and catchment areas.

6. Discussion

Despite abundant and detailed hospital admission and discharge data available, only a very limited number of studies are related to the HSA delineation. The goal of this study is to develop an efficient spatial algorithm to produce as many eligible selfcontained HSA units as possible within a given area. The TTHA meets this criterion by producing an apparently larger number of HSAs than traditional methods. The skeleton of the algorithm is primarily composed of iterative spatial computation and spatial neighbor searching, which have been well supported and facilitated by Geographic Information Systems (GIS) and could be easily automated. In addition, a select review of literature on the delineation of HSAs and other types of service areas is presented, which serves as an important step forward to enable the adaptation of more traditional classical methods to healthcare facility catchment area delineation. An eligible self-contained HSA unit was defined as an area with LI 0.5, which followed the same setting of LI in previous studies for an easy comparison. When the threshold of LI changes from 50% to a higher level, such as 70% or 80%, delineation was expected to change as well; however, although more research is warranted, on the basis of the nature of the algorithm and results from this study, it can be reasonably hypothesized that the TTHA would still outperform the traditional method regardless of threshold.