Is there a role for GIS in the 'new NHS'?

Spatiotemporal analysis of COVID-19 outbreaks in Wuhan, China

Few study has revealed spatial transmission characteristics of COVID-19 in Wuhan, China. We aimed to analyze the spatiotemporal spread of COVID-19 in Wuhan and its influence factors. Information of 32,682 COVID-19 cases reported through March 18 were extracted from the national infectious disease surveillance system. Geographic information system methods were applied to analysis transmission of COVID-19 and its influence factors in different periods. We found decrease in effective reproduction number (Rt) and COVID-19 related indicators through taking a series of effective public health measures including restricting traffic, centralized quarantine and strict stay-at home policy. The distribution of COVID-19 cases number in Wuhan showed obvious global aggregation and local aggregation. In addition, the analysis at streets-level suggested population density and the number of hospitals were associated with COVID-19 cases number. The epidemic situation showed obvious global and local spatial aggregations. High population density with larger number of hospitals may account for the aggregations. The epidemic in Wuhan was under control in a short time after strong quarantine measures and restrictions on movement of residents were implanted.

Evaluating the Inequality of Medical Service Accessibility Using Smart Card Data

The measurement of medical service accessibility is typically based on driving or Euclidean distance. However, in most non-emergency cases, public transport is the travel mode used by the public to access medical services. Yet, there has been little evaluation of the public transport system-based inequality of medical service accessibility. This work uses massive real smart card data (SCD) and an improved potential model to estimate the public transport-based medical service accessibility in Beijing, China. These real SCD data are used to calculate travel costs in terms of time and distance, and medical service accessibility is estimated using an improved potential model. The spatiotemporal variations and patterns of medical service accessibility are explored, and the results show that it is unevenly spatiotemporally distributed across the study area. For example, medical service accessibility in urban areas is higher than that in suburban areas, accessibility during peak periods is higher than that during off-peak periods, and accessibility on weekends is generally higher than that on weekdays. To explore the association of medical service accessibility with socio-economic factors, the relationship between accessibility and house price is investigated via a spatial econometric analysis. The results show that, at a global level, house price is positively correlated with medical service accessibility. In particular, the medical service accessibility of a higher-priced spatial housing unit is lower than that of its neighboring spatial units, owing to the positive spatial spillover effect of house price. This work sheds new light on the inequality of medical service accessibility from the perspective of public transport, which may benefit urban policymakers and planners.

Accessibility and site suitability for healthcare services using GIS-based hybrid decision-making approach: a study in Murshidabad, India

Healthcare accessibility and site suitability analysis is an elongated and complex task that requires evaluation of different decision factors. The main objective of the present study was to develop a hybrid decision-making approach with geographic information systems to integrate spatial and non-spatial data to form a weighted result. This study involved three-tier analyses for assessing accessibility and selecting suitable sites for healthcare facilities, and analysing shortest-path network. The first tier of analysis stressed the spatial distance, density and proximity from existing healthcare to find more deprived and inaccessible areas in term of healthcare facilities. The result revealed that spatial discrepancy exists in the study area in term of access to healthcare facilities and for achieving equal healthcare access, it is essential to propose new plans. Thus, require finding suitable sites for put forward new healthcare service, which was highlighted in the second tier of analysis based on land use land cover, distancing to road and rail, proximity to residential areas, and weighted overlay of accessibility as decision factors. Finally, in the third tier of analysis, the most suitable site among the proposed healthcare was identified using the technique for order of preference by similarity to ideal solution. The road network analysis was also performed in this study to determine the shortest and fastest route from these healthcare facilities to connect with district medical hospital. The present study found some suitable sites throughout the district on inaccessible zones where people are deprived from better healthcare facilities. This attempt will highly helpful for preparing a spatial decision support system which assists the health authorities regarding the healthcare services in inaccessible, underprivileged, and rural areas.

Evaluating Spatial Accessibility to General Hospitals with Navigation and Social Media Location Data: A Case Study in Nanjing

Spatial accessibility to general hospitals is an important indicator of the convenience and ability of residents to obtain medical services. Therefore, developing a model for measuring accessibility to general hospitals by multiple transportation modes is necessary. In this study, considering that the increase in travel time will reduce the attractiveness of general hospitals, we used the Two-Step Floating Catchment Area with the Gaussian attenuation function, in which the supply was presented by capacity of hospitals (i.e., number of beds), and the demand was presented by population in each grid derived with social media data mapping real-time locations of active users. The Gaussian Two-Step Floating Catchment Area (Ga2SFCA) simulates the attenuation tendency of the general hospital service capabilities over transit time. To obtain a highly precise understanding of accessibility to hospitals, transit time on Baidu Maps' navigation service was used as the impedance condition, and the study area was divided into 1 square kilometer grids as the basic unit of research. Taking Nanjing city as a case study, it is found that the accessibility distribution shape changes from a multi-centered circular pattern to a multi-peak distribution, as the time threshold increases. By comparing the accessibility among 11 districts varying from main urban area to suburbs, the accessibility to general hospitals in Nanjing is significantly regionally unbalanced in both travel modes. By calculating and mapping the Modal Accessibility Gap (MAG) of the two travel modes, different modes of transportation resulted in different general hospital accessibility distributions. Generally, private car is superior in access to general hospitals to public transit in most areas. In the central area, public traffic may not contribute to the access to medical services as much as we thought, rather it plays a role in areas far from hospitals along metro lines and bus routes.

Accessibility Evaluation of High Order Urban Hospitals for the Elderly: A Case Study of First-Level Hospitals in Xi’an, China

With reference to the hospitalizing trips made by the elderly, the impedance of these trips that require the use of public transportation, is introduced. An evaluation model that can accurately detect the accessibility of high order urban hospitals (HOUHs) for the elderly is established with the help of Geographic Information System (GIS) technology. Furthermore, the established model is employed to detect the accessibility of first-level hospitals in Xi’an City. Results showed that the traffic connection between hospitals and their service objects is an important factor for the feasibility and effectiveness of an accessibility evaluation. It is suggested that special evaluations of the accessibility of hospitals for the elderly are needed to achieve the human-oriented goal of urban traffic planning. The well-served spatial pattern of hospitalizing accessibility for the elderly in Xi’an City has been established in recent years because of the strategies for public transit metropolis. The accessibility constraints can be divided into three types: The imprisonment, the antagonism and the running-in, for which the corresponding countermeasures to settle the low accessibility of hospitals will be taken by the planning administration. Attention is paid to specific population groups during their hospitalizing trips in the accessibility research, which is beneficial for enabling the improvement of the current traditional method which is mainly based on travel facilities.

Scaling the Peaks Research Protocol: understanding the barriers and drivers to providing and using dementia-friendly community services in rural areas-a mixed methods study

INTRODUCTION

Scaling the Peaks is a cross-disciplinary research study that draws on medical ethnography, human geography and Geospatial Information Science (GIS) to address the issues surrounding the design and delivery of dementia-friendly services in rural communities. The research question seeks to understand the barriers and drivers to the development of relevant, robust, reliable and accessible services that make a difference among older rural families affected by dementia.

METHODS AND ANALYSIS

This mixed methods study recruits both families affected by dementia who reside within the Peak District National Park, Derbyshire, and their service providers. The study explores the expectations and experiences of rural dementia by adopting a three-part approach ¹ : longitudinal ethnographic enquiry with up to 32 families affected by dementia (aged 70 years plus) who identify themselves as rural residents ² ; ethnographic semistructured interviews and systematic observations of a range of statutory, third sector, private and local community initiatives that seek to support older people living with dementia ³ ; and geospatial visual mapping of the qualitative and quantitative data. The ethnographic data will be used to explore the ideas of belonging in a community, perceptions of place and identity to determine the factors that influence everyday decisions about living well with dementia and, for the providers, working in a rural community. The geospatial component of the study seeks to incorporate quantitative and qualitative data, such as types, locations and allocation of services to produce an interactive web-based map for local communities to determine the future design and delivery of services when considering dementia-friendly services.

ETHICS AND DISSEMINATION

The study is approved by the Leeds and Humberside Health Research Authority 16/YH/0163. The study is also approved by other participating organisations as required by their own governance procedures. The study includes people with dementia and as such adheres to the ethical considerations when including people with dementia. A publicly available interactive visual map of the findings will be produced in relation to current services related to location and, by default, identify gaps in provision. Formal reports and dissemination activities will be undertaken in collaboration with the study advisory group members.

STUDY PROGRESS

The recruitment began in September 2016. The data analysis commenced June 2017, using 59 provider interviews and 27 family participants. Data collection will be completed June 2018.

NOTE ON TERMINOLOGY

Please note that the term 'families affected by dementia' is the preferred term of usage by the family members of the Scaling the Peaks Study Advisory Group. The group wish to emphasise that they consider this term to be more representative of their lives than the term living with dementia.

TRIAL REGISTRATION NUMBER

NIHR IRAS 188103; Pre-results.

Quantifying the Error Associated with Alternative GIS-based Techniques to Measure Access to Health Care Services

The aim of this study was to quantify the error associated with different accessibility methods commonly used by public health researchers. Network distances were calculated from each household to the nearest GP our study area in the UK. Household level network distances were assigned as the gold standard and compared to alternate widely used accessibility methods. Four spatial aggregation units, two centroid types and two distance calculation methods represent commonly used accessibility calculation methods. Spearman's rank coefficients were calculated to show the extent which distance measurements were correlated with the gold standard. We assessed the proportion of households that were incorrectly assigned to GP for each method. The distance method, level of spatial aggregation and centroid type were compared between urban and rural regions. Urban distances were less varied from the gold standard, with smaller errors, compared to rural regions. For urban regions, Euclidean distances are significantly related to network distances. Network distances assigned a larger proportion of households to the correct GP compared to Euclidean distances, for both urban and rural morphologies. Our results, stratified by urban and rural populations, explain why contradicting results have been reported in the literature. The results we present are intended to be used aide-memoire by public health researchers using geographical aggregated data in accessibility research.

Using geographical information systems and cartograms as a health service quality improvement tool

INTRODUCTION

Disease prevalence can be spatially analysed to provide support for service implementation and health care planning, these analyses often display geographic variation. A key challenge is to communicate these results to decision makers, with variable levels of Geographic Information Systems (GIS) knowledge, in a way that represents the data and allows for comprehension. The present research describes the combination of established GIS methods and software tools to produce a novel technique of visualising disease admissions and to help prevent misinterpretation of data and less optimal decision making. The aim of this paper is to provide a tool that supports the ability of decision makers and service teams within health care settings to develop services more efficiently and better cater to the population; this tool has the advantage of information on the position of populations, the size of populations and the severity of disease.

METHODS

A standard choropleth of the study region, London, is used to visualise total emergency admission values for Chronic Obstructive Pulmonary Disease and bronchiectasis using ESRI's ArcGIS software. Population estimates of the Lower Super Output Areas (LSOAs) are then used with the ScapeToad cartogram software tool, with the aim of visualising geography at uniform population density. An interpolation surface, in this case ArcGIS' spline tool, allows the creation of a smooth surface over the LSOA centroids for admission values on both standard and cartogram geographies. The final product of this research is the novel Cartogram Interpolation Surface (CartIS).

RESULTS

The method provides a series of outputs culminating in the CartIS, applying an interpolation surface to a uniform population density. The cartogram effectively equalises the population density to remove visual bias from areas with a smaller population, while maintaining contiguous borders. CartIS decreases the number of extreme positive values not present in the underlying data as can be found in interpolation surfaces.

DISCUSSION

This methodology provides a technique for combining simple GIS tools to create a novel output, CartIS, in a health service context with the key aim of improving visualisation communication techniques which highlight variation in small scale geographies across large regions. CartIS more faithfully represents the data than interpolation, and visually highlights areas of extreme value more than cartograms, when either is used in isolation.

Spatial Analysis of Factors Associated with Household Subscription to the National Health Insurance Scheme in Rural Ghana

The use of health insurance schemes in financing healthcare delivery and to minimize the poverty gap is gaining considerable recognition among the least developed and resource challenged countries around the world. With the implementation of the socialized health insurance scheme, Ghana has taken the lead in Sub-Saharan Africa and now working out further strategies to gain universal coverage among her citizenry. The primary goal of this study is to explore the spatial relationship between the residential homes and demographic features of the people in the Barekese subdistrict in Ghana on the probability to enroll the entire household unit in the National Health Insurance Scheme (NHIS). Household level data were gathered from 20 communities on the enrollment status into the NHIS alongside demographic and socioeconomic indicators and the spatial location of every household that participated in the study. Kulldorff’s purely spatial scan statistic was used to detect geographic clusters of areas with participatory households that have either higher or lower enrollment patterns in the insurance program. Logistic regression models on selected demographic and socioeconomic indicators were built to predict the effect on the odds of enrolling an entire household membership in the NHIS.

Three clusters significantly stood out to have either high or low enrollment patterns in the health insurance program taking into accounts the number of households in those sub-zones of the study region. Households in the Cluster 1 insurance group have very high travel expenses compared to their counterparts in the other idenfied clusters. Travel cost and time to the NHIS registration center to enroll in the program were both significant predictors to participation in the program when controlling for cluster effect. Residents in the High socioeconomic group have about 1.66 [95% CI: 1.27-2.17] times the odds to enroll complete households in the insurance program compared to their counterparts in the Low socioeconomic group.

The study demonstrated the use of spatial analytical tools to identify clusters of household enrollment pattern in the NHIS among residents in rural Ghana. In the face of limited resources, policy makers can therefore use the findings as guideline to strategically channel interventions to areas of most need. Furthermore, these analyses can be repeated annually to assess progress on improving insurance coverage.

Geographical information systems and health: current state and future directions

This paper provides an introduction to Geographical Information Systems (GIS) and how they can be used. It reviews the current state of GIS use in health care before identifying the barriers to more pervasive use of GIS in health. Finally, it makes recommendations for the direction of health GIS research over the next decade and concludes with a call to action to health informatics researchers to stop ignoring a tool and methodology that has such immense potential for improving the health of our communities.

Rethinking health planning: a framework for organising information to underpin collaborative health planning

The field of collaborative health planning faces significant challenges created by the narrow focus of the available information, the absence of a framework to organise that information and the lack of systems to make information accessible and guide decision-making. These challenges have been magnified by the rise of the 'healthy communities movement', resulting in more frequent calls for localised, collaborative and evidence-driven health related decision-making. This paper discusses the role of decision support systems as a mechanism to facilitate collaborative health decision-making. The paper presents a potential information management framework to underpin a health decision support system and describes the participatory process that is currently being used to create an online tool for health planners using geographic information systems. The need for a comprehensive information management framework to guide the process of planning for healthy communities has been emphasised. The paper also underlines the critical importance of the proposed framework not only in forcing planners to engage with the entire range of health determinants, but also in providing sufficient flexibility to allow exploration of the local setting-based determinants of health.

"To me it's just another tool to help understand the evidence": public health decision-makers' perceptions of the value of geographical information systems (GIS)

While geographical information systems (GIS) have applications in a range of diverse fields, they remain underused by decision-makers in health settings. Through analysis of data captured in semi-structured interviews, the paper explores four thematic areas (the ontological, power, functionality and collaboration discourses) to understand how GIS are perceived and valued by public health decision-makers. The findings suggest that although GIS are viewed as useful tools to inform decision-making, they are in no way a panacea for practice. Participants' concerns that GIS outputs can potentially be misinterpreted or used erroneously might partly explain resistance to their use. GIS are, therefore, likely to be most effective in decision-making when applied in a multi-disciplinary context to facilitate sharing of data, knowledge and expertise across the public health landscape.

Human biomonitoring and the INSPIRE directive: spatial data as link for environment and health research

Recently, there has been a rapid gain of interest in the availability, applicability, and integration of different types of spatial data for environment and health issues. The INSPIRE Directive (Directive 2007/2/EC) aims at providing better and easily accessible spatial information in Europe for the formulation and implementation of community policy on the environment by triggering the creation of a European spatial information infrastructure that delivers integrated spatial information services to potential users. Human biomonitoring (HBM) significantly contributes to the already existing data on environment and health because of its specific nature of providing information on the internal dose of chemicals rather than their mere presence in different environmental compartments. However, due to the intrinsic nature of HBM data, a number of issues need to be dealt with if HBM data are to be used to its full capacity in a geographic information systems (GIS) environment and within the INSPIRE directive. The current article highlights some of these issues, and discusses a number of options to improve the geographical relevance of HBM data for their optimal use within the INSPIRE Directive framework. The main aim of this publication is to illustrate that HBM has a significant contribution to make to the INSPIRE Directive, although some kind of data aggregation will be necessary to protect individual privacy. If HBM data wants to have a significant contribution to spatial information used to assist policymaking and on the surveillance or tracking of the direct or indirect impact of such policies, the HBM data need to be compatible with other data collected within the other themes of the INSPIRE Directive.

Geomatics in injury prevention: the science, the potential and the limitations

BACKGROUND

Geomatics describes the activities involved in acquiring and managing geographical data and producing geographical information for scientific, administrative and technical endeavors. As an emerging science, geomatics has a great potential to support public health. Geomatics provides a conceptual foundation for the development of geographic information systems (GIS), computerized tools that manage and display geographical data for analytical applications. As descriptive epidemiology typically involves the examination of person, place and time in the occurrence of disease or injury, geomatics and GIS can play an important role in understanding and preventing injury.

AIM

This article provides a background to geomatics for those in the injury prevention field who are unfamiliar with spatial analysis. We hope to stimulate researchers and practitioners to begin to use geomatics to assist in the prevention of injury.

METHODS

The authors illustrate the potential benefits and limitations of geomatics in injury prevention in a non-technical way through the use of maps and analysis.

RESULTS

By analysing the location of patients treated for fall injuries in Central Toronto using GIS, some demographic and land use variables, such as household income, age, and the location of homeless shelters, were identified as explanatory factors for the spatial distribution.

CONCLUSION

By supporting novel approaches to injury prevention, geomatics has a great potential for efforts to combat the burden of injury. Despite some limitations, those with an interest in injury prevention could benefit from this science.

Analyzing Location-Based Accessibility to Dental Services: An Ohio Case Study

Oral health is important to overall health. Therefore, dental services should be available and accessible in order for patients to receive care.

OBJECTIVE

This study aims to identify regional inequities in dental provider location and suggest an innovative methodology that could be useful in establishing new dental facilities that are geographically accessible.

METHODS

Using a census of dentist locations for the state of Ohio in 1998, geographical accessibility to dental care was analyzed. A geographic information systems (GIS)-based model to evaluate the regional distribution of dentists was developed. In this article, it is applied to estimate the number of new dental facilities needed based on the geographical proximity or distance to nearest dentist or dental facility. Results are interactively displayed and mapped with GIS for visualization.

RESULTS

Four hundred thirteen of 1,008 zip codes in Ohio did not have dentists. Using a service standard of S = 5 (all zip codes without dentists must be within 5 miles of a zip code with a dentist), 307 zip codes were not served by dentists. With a standard of S = 10, only 45 zip codes in Ohio were not served by dentists, with only 24 additional offices needed to be located to allow accessibility to a dentist within 10 miles.

CONCLUSIONS

Using GIS and geographical techniques to reveal and solve the potential locational inequities in accessibility to dental care, this work links oral health policy with geographical techniques.

Geographical access to imaging facilities for stroke patients in Scotland

This study examines the geographical access to imaging facilities for suspected stroke patients in Scotland. A survey of Scottish clinical directors of radiology was initially undertaken to determine the current and future provision of brain imaging for the diagnosis of stroke. We analysed geographical and digital population data with geographical information systems software to determine access to brain imaging services for stroke patients during 'normal' working hours and 'out-of-hours'. The findings suggest that, in general, most departments are able to deliver scanning for stroke as set within current guidelines, at least in normal working hours. However, radiological departments are generally operating at full capacity, and there is restricted availability of scanning services for stroke in certain regions during weekend periods. It is vital that policy makers consider these findings when reviewing the guidelines for recommending scanning for stroke.

Access to rural health services: research as community action and policy critique

Although access to rural health services has been an enduring focus for a variety of scholars, little has been recorded about the intersection between health service policy, provision and access experiences. This paper identifies how community action can highlight the gaps between policy rhetoric and access experiences. Taking the case of rural New Zealand, we document how a community organisation Rural Women New Zealand (RWNZ) completed a national survey as a form of community action. This study records rural households' experiences and challenges when accessing both primary and secondary health services. A range of access problems is identified. The study also illustrates how community-based activism concerning health care need not be local or single-service focussed, but can involve a multi-service critique at the national scale. Such work highlights not only the experience but also the complexity and politics of health service access.

Using software agents to preserve individual health data confidentiality in micro-scale geographical analyses

Confidentiality constraints often preclude the release of disaggregate data about individuals, which limits the types and accuracy of the results of geographical health analyses that could be done. Access to individually geocoded (disaggregate) data often involves lengthy and cumbersome procedures through review boards and committees for approval (and sometimes is not possible). Moreover, current data confidentiality-preserving solutions compatible with fine-level spatial analyses either lack flexibility or yield less than optimal results (because of confidentiality-preserving changes they introduce to disaggregate data), or both. In this paper, we present a simulation case study to illustrate how some analyses cannot be (or will suffer if) done on aggregate data. We then quickly review some existing data confidentiality-preserving techniques, and move on to explore a solution based on software agents with the potential of providing flexible, controlled (software-only) access to unmodified confidential disaggregate data and returning only results that do not expose any person-identifiable details. The solution is thus appropriate for micro-scale geographical analyses where no person-identifiable details are required in the final results (i.e., only aggregate results are needed). Our proposed software agent technique also enables post-coordinated analyses to be designed and carried out on the confidential database(s), as needed, compared to a more conventional solution based on the Web Services model that would only support a rigid, pre-coordinated (pre-determined) and rather limited set of analyses. The paper also provides an exploratory discussion of mobility, security, and trust issues associated with software agents, as well as possible directions/solutions to address these issues, including the use of virtual organizations. Successful partnerships between stakeholder organizations, proper collaboration agreements, clear policies, and unambiguous interpretations of laws and regulations are also much needed to support and ensure the success of any technological solution.

Research protocol: EB-GIS4HEALTH UK - foundation evidence base and ontology-based framework of modular, reusable models for UK/NHS health and healthcare GIS applications

EB-GIS4HEALTH UK aims at building a UK-oriented foundation evidence base and modular conceptual models for GIS applications and programmes in health and healthcare to improve the currently poor GIS state of affairs within the NHS; help the NHS understand and harness the importance of spatial information in the health sector in order to better respond to national health plans, priorities, and requirements; and also foster the much-needed NHS-academia GIS collaboration. The project will focus on diabetes and dental care, which together account for about 11% of the annual NHS budget, and are thus important topics where GIS can help optimising resource utilisation and outcomes. Virtual e-focus groups will ensure all UK/NHS health GIS stakeholders are represented. The models will be built using Protégé ontology editor based on the best evidence pooled in the project's evidence base (from critical literature reviews and e-focus groups). We will disseminate our evidence base, GIS models, and documentation through the project's Web server. The models will be human-readable in different ways to inform NHS GIS implementers, and it will be possible to also use them to generate the necessary template databases (and even to develop "intelligent" health GIS solutions using software agents) for running the modelled applications. Our products and experience in this project will be transferable to address other national health topics based on the same principles. Our ultimate goal is to provide the NHS with practical, vendor-neutral, modular workflow models, and ready-to-use, evidence-based frameworks for developing successful GIS business plans and implementing GIS to address various health issues. NHS organisations adopting such frameworks will achieve a common understanding of spatial data and processes, which will enable them to efficiently and effectively share, compare, and integrate their data silos and results for more informed planning and better outcomes.

Understanding the spatial clustering of severe acute respiratory syndrome (SARS) in Hong Kong

We applied cartographic and geostatistical methods in analyzing the patterns of disease spread during the 2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong using geographic information system (GIS) technology. We analyzed an integrated database that contained clinical and personal details on all 1,755 patients confirmed to have SARS from 15 February to 22 June 2003. Elementary mapping of disease occurrences in space and time simultaneously revealed the geographic extent of spread throughout the territory. Statistical surfaces created by the kernel method confirmed that SARS cases were highly clustered and identified distinct disease "hot spots." Contextual analysis of mean and standard deviation of different density classes indicated that the period from day 1 (18 February) through day 16 (6 March) was the prodrome of the epidemic, whereas days 86 (15 May) to 106 (4 June) marked the declining phase of the outbreak. Origin-and-destination plots showed the directional bias and radius of spread of superspreading events. Integration of GIS technology into routine field epidemiologic surveillance can offer a real-time quantitative method for identifying and tracking the geospatial spread of infectious diseases, as our experience with SARS has demonstrated.

Creating spatially defined databases for equitable health service planning in low-income countries: the example of Kenya

Equity is an important criterion in evaluating health system performance. Developing a framework for equitable and effective resource allocation for health depends upon knowledge of service providers and their location in relation to the population they should serve. The last available map of health service providers in Kenya was developed in 1959. We have built a health service provider database from a variety of traditional government and opportunistic non-government sources and positioned spatially these facilities using global positioning systems, hand-drawn maps, topographical maps and other sources. Of 6674 identified service providers, 3355 (50%) were private sector, employer-provided or specialist facilities and only 39% were registered in the Kenyan Ministry of Health database during 2001. Of 3319 public service facilities supported by the Ministry of Health, missions, not-for-profit organizations and local authorities, 84% were registered on a Ministry of Health database and we were able to acquire co-ordinates for 92% of these. The ratio of public health services to population changed from 1:26,000 in 1959 to 1:9300 in 1999-2002. There were 82% of the population within 5 km of a public health facility and resident in 20% of the country. Our efforts to recreate a comprehensive, spatially defined list of health service providers has identified a number of weaknesses in existing national health management information systems, which with an increased commitment and minimal costs can be redressed. This will enable geographic information systems to exploit more fully facility-based morbidity data, population distribution and health access models to target resources and monitor the ability of health sector reforms to achieve equity in service provision.

Users’ perspectives on epidemiological, GIS and point pattern approaches to analysing environment and health data

Despite examples showing the usefulness of geographical information systems (GIS) and spatial point pattern analysis in health research, there remain barriers to their widespread use within health service settings. This paper explores potential users' views on the relative usefulness of such approaches for analysing spatially referenced environmental health data. Our findings indicate that researchers and practitioners do not always prefer the approach with which they are most familiar. In addition, there is a need for higher levels of understanding of, and confidence in, GIS and point pattern analysis techniques amongst health service professionals. The greatest need is for multi-disciplinary research which uses the most appropriate approach for each investigation, rather than that with which researchers are most familiar.

Determining location and size of medical departments in a hospital network: a multiobjective decision support approach

Decisions on the location and size of medical departments in a given hospital network are prime examples of priority setting in health care, which is an issue of growing political importance. As such decisions are regularly characterized by multiple and often conflicting objectives in real-life, this paper integrates the fields of hospital planning and multiobjective decision support. The proposed two-phase solution procedure for our corresponding mathematical programming model does not require a priori preference information. Instead, it seeks efficient solutions by means of multiobjective tabu search in the first phase, while applying clustering in the second phase to allow the decision makers to interactively explore the solution space until the "best" configuration is determined. The real-world applicability of our approach is illustrated through a numerical example based on hospital data from Germany.

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.

Towards evidence-based, GIS-driven national spatial health information infrastructure and surveillance services in the United Kingdom

The term "Geographic Information Systems" (GIS) has been added to MeSH in 2003, a step reflecting the importance and growing use of GIS in health and healthcare research and practices. GIS have much more to offer than the obvious digital cartography (map) functions. From a community health perspective, GIS could potentially act as powerful evidence-based practice tools for early problem detection and solving. When properly used, GIS can: inform and educate (professionals and the public); empower decision-making at all levels; help in planning and tweaking clinically and cost-effective actions, in predicting outcomes before making any financial commitments and ascribing priorities in a climate of finite resources; change practices; and continually monitor and analyse changes, as well as sentinel events. Yet despite all these potentials for GIS, they remain under-utilised in the UK National Health Service (NHS). This paper has the following objectives: (1) to illustrate with practical, real-world scenarios and examples from the literature the different GIS methods and uses to improve community health and healthcare practices, e.g., for improving hospital bed availability, in community health and bioterrorism surveillance services, and in the latest SARS outbreak; (2) to discuss challenges and problems currently hindering the wide-scale adoption of GIS across the NHS; and (3) to identify the most important requirements and ingredients for addressing these challenges, and realising GIS potential within the NHS, guided by related initiatives worldwide. The ultimate goal is to illuminate the road towards implementing a comprehensive national, multi-agency spatio-temporal health information infrastructure functioning proactively in real time. The concepts and principles presented in this paper can be also applied in other countries, and on regional (e.g., European Union) and global levels.

Data quality and the spatial analysis of disease rates: congenital malformations in New York State

Spatial analyses of disease rates are increasing as the hardware and software used in disease surveillance and cluster investigations become more accessible and easier to use. The results of these analyses should be interpreted with caution since inconsistencies in health outcome reporting and population estimates may lead to erroneous conclusions. In this report we provide an example, using data on congenital malformations in New York State, to show how under-reporting of malformations by some New York City hospitals can lead to apparent clusters of malformations in other areas of the state where reporting is more complete. We illustrate how spatial analysis techniques can be used to locate under-reporting problems and determine the extent to which the problem exists.

The use of geographical information systems in examining variations in sociodemographic profiles of dental practice catchments: a case study of a Swansea practice

AIM

The aim of this paper is to use a case study approach to illustrate the potential for using geographical information systems (GIS) to examine the provision of dental services in the UK. A major benefit of using GIS to examine sociodemographic profiles of patients on a dental register is to inform policy makers.

METHOD

We illustrate the advantages of such an approach by using a postcoded list of registered patients for a dental practice in Swansea. To be of value in this context, the maintenance of up-to-date and fully postcoded information by practitioners is vital. We draw attention to the advantages (and current limitations) of using deprivation indices in conjunction with such lists.

RESULT

GIS has significant potential in analysing patterns of registration, and utilisation, of such services but, to date, there has been a relative dearth of studies that have developed such systems.

CONCLUSION

We conclude by drawing attention to wider benefits of such software tools in the dental profession and outline a research agenda to take these issues further.