Development of Cancer Care Shortage Areas Using Geospatial Analysis and Spatial Network Optimization Techniques - PROJECT SUMMARY The ability to identify cancer care shortage areas (CCSAs) is crucial to inform actionable policies that improve health outcomes (e.g., live longer) and reduce health disparities (e.g., better served versus underserved communities). With the increasing demands from 18.1 million cancer survivors1 and fewer healthcare providers (e.g., 200 or more rural hospital closures2 and shortages of 86,000 physicians3) in the U.S., contemporary knowledge is lacking regarding which areas and populations are most affected by cancer care shortages. Historically, health care shortage areas are identified using the U.S. Department of Health and Human Services (DHHS) designation of health professional shortage areas (HPSAs) and medically underserved areas or populations (MUAs/Ps) to prioritize resources to high-need communities.4,5 Both influential systems are built on rational service areas (RSAs) and apply population-to-provider ratio and poverty as two common indicators to identify areas lacking access to primary, dental, and mental health care services.4,5 However, the definition of RSAs is largely descriptive and lacks a uniform approach, and identifying RSAs as shortage areas relies on the local knowledge of health care officials.5,6 Although the DHHS uses census units (e.g., counties) to define RSAs5, they are often criticized for not accurately representing health care markets (e.g., patient border crossing)6,7 or specific cancer care markets which differ from general health care markets found in our prior work.7 These issues lead to inaccurate measurement of the population-to-provider ratio which overlooks the interaction between populations and providers.8 Healthy People 20309 demonstrated a need to consider additional nonspatial (or social) factors beyond poverty which include demographic, socioeconomic, and cancer risk behavioral factors that contribute to the observed disparities in access to care.10-13 Given the limitations of existing methods to measure and address cancer disparities and the emergence of advanced geospatial, network science, and machine learning methods, the goal of this project is to develop CCSAs and disseminate data and tools to help researchers, professionals, policymakers better identify areas and populations with the greatest need of cancer care in the U.S. The new approach will overcome the weaknesses of prior methods by capturing cancer care utilization patterns of underserved communities and improving the accuracy of measuring access to cancer care to more comprehensively reflect their needs. Through this study, our team will produce methods for defining CCSAs that are novel, specific to cancer care, and more comprehensively incorporate spatial and nonspatial indicators of access. Further, we will develop an interactive, web-based tool to disseminate CCSAs which can be used by policymakers, healthcare administrators, and scientists within cancer research and control communities to promote care expansions, allocate resources, and enhance community engagement and outreach efforts in shortage areas. The methods developed could also be applied to improve the designation of general health care shortages.
