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Spatial accessibility in suboptimally configured health care systems: A modified two-step floating catchment area (M2SFCA) metric

机译：配置欠佳的医疗保健系统中的空间可访问性：修改后的两步浮动集水区（M2SFCA）指标

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摘要

The floating catchment area (FCA) family of metrics employ principles from gravity-based models to incorporate supply, demand, and distance in their characterization of the spatial accessibility of health care resources. Unlike traditional gravity models, the FCA metrics provide an output in highly interpretable container-like units (e.g., physicians per person). This work explores two significant issues related to FCA metrics. First, the Three Step Floating Catchment Area is critically examined. Next, the research shows that all FCA metrics contain an underlying assumption that supply locations are optimally configured to meet the needs of the population within the system. Because truly optimal configurations are highly unlikely in real-world health care systems, a modified two-step floating catchment area (M2SFCA) metric is offered to address this issue. The M2SFCA is built upon previous FCA metrics, but allows for spatial accessibility to be discounted as a result of the suboptimal configuration of health care facilities within the system. The utility of the new metric is demonstrated through simulated data examples and a case study exploring acute care hospitals in Michigan.
机译：浮动集水区（FCA）度量标准采用基于重力的模型中的原理，在表征医疗保健资源的空间可及性时将供应，需求和距离结合在一起。与传统的引力模型不同，FCA指标以高度可解释的容器状单位（例如，每人医师）提供输出。这项工作探讨了与FCA指标有关的两个重要问题。首先，严格检查三步浮动集水区。接下来，研究表明，所有FCA指标都包含一个基本假设，即供应位置已被最佳配置以满足系统内人口的需求。由于在现实世界的医疗保健系统中极不可能实现真正的最佳配置，因此提供了一种经过修改的两步浮动集水区（M2SFCA）度量标准来解决此问题。 M2SFCA建立在以前的FCA度量标准之上，但由于系统内医疗设施的配置欠佳，因此可降低空间可访问性。通过模拟数据示例和探索密歇根州急诊医院的案例研究，证明了新指标的实用性。

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