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.

项目概要/摘要 大约五分之一的美国人居住在农村指定地区，占全国土地的 97% Mass.1 美国农村地区广泛的地理分布给那些寻求健康的人带来了独特的挑战 服务，特别是在遇到心脏病、中风或创伤等时间敏感的紧急情况时。 需要时间紧迫的医疗护理的农村患者通常会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，未知的是农村在基础设施的使用、成本和结果中所扮演的角色。 院间转运 (IHT)，这是增加可及性并减少医疗差异所需的重要信息 由于 IHT 患者预后不良，确定导致其预后不良的因素非常复杂。 缺乏全面的数据集，其中包括解开复杂问题所需的所有数据源 患者健康与 IHT 后结果之间的关系 患者所在位置和场所的差异 基于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。 按位置，以非特定方式包括，通常将所有患者分为广泛的类别，例如 相对于农村，通常是在县一级，或者更广泛地说，是对整个地区的农村指定。 这种一致性的缺乏阻碍了我们理解 IHT 使用性质的能力，尤其是。 因此，在农村或服务欠缺的地区，指导方针和协议仍然存在缺陷，因为它们的基础是。 因此，农村性的概念定义不一致，数据点不可靠或无效。 提供更全面、更准确的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 本提案的目的是建立一个综合数据管理平台，将这些数据结合起来。 健全的卫生系统将电子健康记录数据、传输数据和健康数据的社会决定因素转化为 可以执行各种地理空间操作、查询和分析的空间数据库。 建立后，我们将使用该分析平台在 NIMHD 研究的指导下进行多项分析。 框架中，我们将审查个人（例如交通）、社区（例如医院、交通服务、 地理分布、人口普查）和社会（例如报销政策）对农村获得 IHT 的影响。 如果成功的话，我们将能够定义和识别 IHT 服务有限的农村地区——关键接入 地区——提供必要的证据来支持改善获得护理的机会并减少患者的经济损失。 此外，来自这个创新平台的数据将为研究提供动态分析工具和数据资源 和当前不存在的公共使用将更新包含为新数据集的动态功能。 发布，将提供一个强大的工具来监测和评估 IHT 实践随时间的变化，提供 评估农村环境中政策变化和报销做法的影响的可靠且有效的系统。