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

利用空间分析和健康的社会决定因素重新定义农村人口获得医疗运输服务的关键途径

• 批准号: 10643235
• 负责人: Andrew Paul Reimer
• 金额: $ 24.15万
• 依托单位: CASE WESTERN RESERVE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-23 至 2024-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10643235
• 关键词: Academic Medical Centers; Address; Ambulances; American; Area; Cardiac Catheterization Procedures; Caring; Categories; Censuses; Classification; Clinic; Clinical; Communities; Complex; Country; County; Data; Data Analyses; Data Management Resources; Data Set; Database Management Systems; Databases; Decision Making; Dimensions; Electronic Health Record; Emergency Situation; Geographic Distribution; Geographic Information Systems; Geography; Guidelines; Health; Health Services; Health Services Accessibility; Health system; Healthcare; Healthcare Systems; Helicopter; Hospitals; Improve Access; Individual; Infrastructure; Insurance; Intervention; Investigation; Life; Location; Medical; Monitor; Myocardial Infarction; National Institute on Minority Health and Health Disparities; Nature; Operative Surgical Procedures; Outcome; Patient Transfer; Patients; Policies; Population Density; Poverty; Primary Care; Production; Protocols documentation; Provider; Research; Resources; Role; Rural; Rural Population; Services; Source; Stroke; Structure; System; Thrombectomy; Time; Transportation; Trauma; United States Agency for Healthcare Research and Quality; Update; Work; access disparities; analytical tool; billing data; clinical decision support; comorbidity; comparative; cost; critical access hospital; data exploration; data integration; data management; data repository; data resource; database design; digital; disparity reduction; experience; health care availability; health care service; health data; health disparity; innovation; medical specialties; mortality; novel; novel strategies; outcome disparities; rural America; rural area; rural dwellers; rural patients; rural setting; rurality; social health determinants; social inclusion; tool; underserved area; usability

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.

项目摘要/摘要 大约五分之一的美国人生活在一个粗糙的地区，占该国97％的土地 MASS.1美国农村地区的广泛地理分布给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，例如心脏病发作，中风或创伤。 需要时间敏感医疗服务的农村患者经常通过直升机转移到城市学术 已被证明是救生干预措施的医疗中心，因此被认为是关键的医疗保健 基础架构。2,3-10然而，未知的是农村在使用，成本和结果中的作用 院间转移（IHT），增加访问和减少差异所需的重要信息 结果。识别导致IHT患者结果不佳的因素显着复杂 由于缺乏包括所有数据源的全面数据集 患者健康与IHT后结局之间的关系与患者位置和地点有关 基于健康的社会决定者（SDOH）。当前包含SDOH数据，数据合并到其他数据集 按位置以非特异性方式包括在内，通常将所有患者分为广泛类别，例如 农村与城市，通常在县一级，或更广泛地为整个农村设计 比较组。缺乏一致性阻碍了我们理解IHT使用本质的能力，尤其是 在粗糙或服务不足的地区。结果，指南和协议仍然存在缺陷，因为它们是基于 不可靠或有效的粗糙度和数据点的概念定义不一致。因此，为了 对复杂的真实关系提供更全面，更准确的理解 IHT的干预以及SDOH在粗糙环境中的作用，数据管理的新方法和分析方法 需要。该提案的目的是建立一个集成的数据管理平台，该平台将结合起来 强大的卫生系统电子健康记录数据，运输数据和卫生数据的社会决定者 可以执行各种地理空间操作，查询和分析的空间数据库。一次 成立后，我们将使用分析平台进行多种分析。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，运输服务， 地理分布，人口普查）和社会（例如，报销政策）会影响对IHT的粗略访问。如果 成功，我们将能够定义和确定IHT服务有限的农村地区 - 临界访问 地区 - 提供所需的证据，以支持改善获得护理的机会并减少患者的财务损害。 此外，该创新平台的数据将为研究提供动态的分析工具和数据资源 目前不存在的公众使用。随着新数据集为止，包括更新的动态功能 发布，将提供一个强大的工具来监视和评估随着时间的推移IHT练习的变化，提供了 可靠且有效的系统，以评估在粗糙设置中的政策变化和报销实践的影响。