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Operations Research Methodologies to Improve the Quality, Accessibility and Equity of Primary Care.

机译：运筹学方法，以提高基层医疗的质量，可及性和公平性。

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摘要

A growing body of evidence reveals the importance of primary care to the overall health of populations, resulting in an increasing interest in efficient, effective, timely and equitable delivery of primary care services. This research focuses on two perspectives of delivering primary care. First, the work focuses on the quality of primary care delivery, represented by distribution of facilities that provide primary care on different quality levels and incur varying costs on the regulator. The proposed model optimizes the geographic distribution of facilities (locations and types) and provides tradeoffs between two objectives - the quality of provided care and the annual operating cost. The Pampalon deprivation index is incorporated directly as a proxy of varying needs, as it was correlated with complex health-care problems, more frequent visits and barriers to obtain care. Results are showcased on the area of Kingston, Ontario. Second, the distribution of general practitioners is addressed, measured in terms of general practitioners (GPs) per population. Many countries are experiencing inequitable distribution of GPs, such that does not match the distribution of the population. It usually results from the fact that health professionals are choosing practice locations according to their own preferences and considerations. To address this issue, human choice is incorporated into the modeling approach explicitly, using Huff's spatial interactions approach. The utilities of the professionals when choosing communities are modeled, affecting in turn the probabilities of location choice. The presented model explores the option of modifying policies so that the resulting distribution of general practitioners in the studied geographic area will be more equitable. As an example, educational policies are explored, devising the optimal locations of residency training of family physicians and their background combinations (at each training location) for Ontario. The developed methodologies showcased for the province of Ontario, Canada, however they are general enough to be used in any jurisdiction with similar characteristics.
机译：越来越多的证据表明，初级保健对人口整体健康的重要性，导致人们对有效，有效，及时和公平地提供初级保健服务的兴趣日益浓厚。这项研究集中于提供初级保健的两种观点。首先，工作重点在于提供初级保健的质量，以提供不同质量水平的初级保健的设施的分布为代表，并给监管机构带来不同的成本。所提出的模型优化了设施的地理分布（位置和类型），并在两个目标之间进行权衡，即提供的护理质量和年度运营成本。 Pampalon贫困指数直接作为各种需求的替代指标，因为它与复杂的医疗保健问题，更频繁的就诊和获得治疗的障碍相关。结果显示在安大略省金斯顿地区。其次，解决全科医生的分布问题，以每个人群的全科医生（GP）来衡量。许多国家的全科医生分布不均，与人口分布不符。这通常是由于以下事实造成的：卫生专业人员正在根据自己的喜好和考​​虑因素选择执业地点。为了解决这个问题，使用霍夫（Huff）的空间互动方法将人为选择明确地纳入了建模方法。选择社区时对专业人员的效用进行了建模，进而影响了位置选择的可能性。提出的模型探索了修改政策的选择，以使全科医生在研究的地理区域内的分布更加公平。例如，探索了教育政策，为安大略省的家庭医生定居培训的最佳地点及其背景组合（在每个培训地点）。在加拿大安大略省展示了已开发的方法，但是它们足够通用，可用于具有类似特征的任何辖区。

著录项

  • 作者

    Graber-Naidich, Anna.;

  • 作者单位

    University of Toronto (Canada).;

  • 授予单位 University of Toronto (Canada).;
  • 学科 Operations research.
  • 学位 Ph.D.
  • 年度 2015
  • 页码 99 p.
  • 总页数 99
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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