Spatial Accessibility
2023-7-19
Optimizing allocation of colorectal cancer screening hospitals in Shanghai: a geospatial analysis
This paper examines limitations in current methods for measuring spatial accessibility to healthcare and proposes a new approach to account for suboptimal configurations of facilities.
Abstract:
Screening programmes are important for early diagnosis and treatment of colorectal cancer (CRC) but they are not equally efficient in all locations. Depending on which hospital people belong to, they often are not willing to follow up even after a positive result, resulting in a lower-than-expected overall detection rate. Improved allocation of health resources would increase the program’s efficiency and assist hospital accessibility. A target population exceeding 70,000 people and 18 local hospitals were included in the investigation of an optimization plan based on a locationallocation model. We calculated the hospital service areas and the accessibility for people in communities to CRC-screening hospitals using the Huff Model and the Two-Step Floating Catchment Area (2SFCA) approach. We found that only 28.2% of the residents with initially a positive screening result had chosen followup with colonoscopy and significant geographical differences in spatial accessibility to healthcare services indeed exist. The lowest accessibility was found in the Southeast, including the Zhangjiang, Jichang and Laogang communities with the best accessibility mainly distributed near the city centre of Lujiazui; the latter also had relatively a high level of what is called “ineffective screening” as it represents wasteful resource allocation. It is recommended that Hudong Hospital should be chosen instead of Punan Hospital as the optimization, which can improve the service population of each hospital and the populations served per colonoscope. Based on our results, changes in hospital configuration in colorectal cancer screening programme are needed to achieve adequate population coverage and equitable facility accessibility. Planning of medical services should be based on the spatial distribution trends of the population served.
Summary:
- Study evaluated and optimized allocation of hospitals for colorectal cancer (CRC) screening program in Shanghai, China
- Used spatial analysis methods - Huff model, Two-Step Floating Catchment Area, and location-allocation optimization
- Found unequal distribution of hospitals and accessibility between urban and rural communities
- Low accessibility communities were in southeast region, high accessibility near city center
- Proposed changing one hospital in program and adding facilities in low access areas
- Showed optimization can improve population coverage and balance hospital loads
Study questions and answers:
| Study Questions | Answers |
|---|---|
| What was the main goal of this study? | To evaluate and optimize the allocation of hospitals for CRC screening in Shanghai |
| What spatial analysis methods were used? | Huff model, Two-Step Floating Catchment Area, location-allocation optimization |
| What disparity was found between urban and rural areas? | Unequal distribution of hospitals and accessibility |
| Where were low accessibility communities located? | In the southeast region |
| What changes were proposed to improve accessibility? | Change one hospital in program, add facilities in low access areas |
| How did optimization help the screening program? | Improved population coverage and balanced hospital loads |
DOI: 10.4081/gh.2023.1152