Development of a Geospatial Approach for the Quantitative Analysis of Trauma Center Access

Introduction Decisions around trauma center (TC) designation have become contentious in many areas. There is no consensus regarding the ideal number and location of TC, and no accepted metrics to assess the effect of changes in system structure. We aim to develop metrics of TC access, using publicly available data and analytic tools. We hypothesize that geospatial analysis can provide a reproducible approach to quantitatively asses potential changes in trauma system structure. Methods A region in New York State was chosen for evaluation. Geospatial data and analytic tools in ArcGIS Online were used. Transport time polygons were created around TC, and the population covered was estimated by summing the census tracts within these polygons. Transport time from each census tract to the nearest TC was calculated. The baseline model includes the single designated TC. Model 1 includes 1 additional TC, and Model 2 includes 2 additional TC, chosen to maximize coverage. The population covered, population-weighted distribution of transport times, and population covered by a specific TC were calculated for each model. Results The baseline model covered 1.12 x 106 people. The median transport time was 19.2 minutes. In Model 1 the population covered increased by 14.4%, while the population catchment, and thus the estimated trauma volume, of the existing TC decreased by 12%. Median transport time to the nearest TC increased to 20.4 minutes. Model 2 increased coverage by 18% above baseline, while the catchment, and thus the estimated trauma volume, of the existing TC decreased by 22%. Median transport time to the nearest TC decreased to 19.6 minutes. Conclusions Geospatial analysis can provide objective measures of population access to trauma care. The analysis can be performed using different numbers and locations of TC, allowing direct comparison of changes in coverage and impact on existing centers. This type of data is essential for guiding difficult decisions regarding trauma system design. Study Type Ecological Level of Evidence Not applicable Corresponding Author: Robert J. Winchell, MD, New York-Presbyterian Weill Cornell Medical Center, 525 E 68th St Payson 7-714, Box 116. New York, NY 10065. row9057@med.cornell.edu. (646) 962-8477 Presented at the 77th Annual Meeting of the American Association for the Surgery of Trauma, September 26, 2018, in San Diego, California Conflicts of Interest and Source of Funding There are no conflicts of interest to declare. This study received no funding support © 2018 Lippincott Williams & Wilkins, Inc.

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