A Geospatial Analysis of Freestanding and Hospital Emergency Department Accessibility via Public Transit

New Approach to Selecting Civil Defense Centers in Al-Riyadh City (KSA) Based on Multi-Criteria Decision Analysis and GIS

Maintaining and enhancing the quality of civil defense services are of importance to citizens’ life in any city. During the past few decades, the expansion of settlements in Al-Riyadh City has led to a shortage in the distribution of the civil defense centers (CDCs) there. The main aim of this study is to implement the Weighted Sum Method (WSM) and Analytic Hierarchy Process (AHP) to evaluate the distribution of the CDCs in Al-Riyadh City. Eight criteria (i.e., distance from the existing civil defense center, accident density, population density, distance from the road, distance from commercial centers, distance from educational services, distance from industrial areas, and distance from residential areas) were used. The areas under the curve (AUC) of the Prediction Rate Curve (PRC) show that almost all of the AHP models are better than the WSM model. We suggest establishing five CDCs in Al-Riyadh City in areas that are lacking CDCs and characterized by a high population density and consequently a high rate of accidents. We recommend highly long-term planning for establishing new CDCs in cities where there is rapid areal expansion (e.g., Al-Riyadh City).

Distance From Freestanding Emergency Departments to Nearby Emergency Care

STUDY OBJECTIVE

The number of freestanding emergency departments (EDs) has increased rapidly in the United States, and there is concern that such entities are located near existing EDs rather than in areas lacking emergency care. In 2018, the Medicare Payment Advisory Commission recommended a reduction in Medicare reimbursement rates to freestanding EDs located within 6 miles of the nearest hospital-based ED. We aim to assess the potential effect of this proposal.

METHODS

Using the 2016 National Emergency Department Inventory-USA database, we identified the locations and visit volumes of all US freestanding EDs. Using QGIS, we mapped the distances from all freestanding EDs to both the nearest hospital-based ED and to the nearest ED (either hospital-based or freestanding ED).

RESULTS

We collected location information for all 5,375 EDs open in 2016. Of these EDs, 609 (11%) were freestanding. Few freestanding EDs (1.4%) were located in rural areas and only 11% were located in areas with a median household income of less than $43,000. Overall, 460 freestanding EDs (76%) were within 6 miles of the nearest hospital-based ED, and these had 5.3 million total patient visits, whereas those greater than 6 miles away had 2.6 million visits.

CONCLUSION

We found that most freestanding EDs (76%) are within 6 miles of the nearest hospital-based ED, and most visits (67%) to freestanding EDs are to those within that proximity, indicating that many freestanding EDs would be affected by this Medicare Payment Advisory Commission proposal, if implemented.