Using spatial analytics to redefine critical access to medical transport services for rural populations - 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 medical 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). Identifying factors that contribute to poor outcomes for IHT patients is significantly complicated due to a lack of comprehensive datasets that include data necessary to disentangle the complex relationships between patient health and post-IHT outcomes. Currently, patients are often classified 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 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, to provide a more comprehensive and accurate understanding of the relationship between the complicated intervention of IHT 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 spatial data into a 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), and geographic (e.g., hospitals, transport services, geographic distribution, census) 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. 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.
