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Abstract
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BACKGROUND: Trauma system expansion is a complex process often governed by financial and health care system imperatives. We sought to propose a new, informed approach to trauma system expansion through the use of geospatial mapping. We hypothesized that geospatial mapping set to specific parameters could effectively identify optimal placement of new trauma centers (TC) within an existing trauma system.
METHODS: We used Pennsylvania Trauma Systems Foundation (PTSF) registry data of adult (age ≥ 15) trauma for calendar years 2003-2015 (n=408,432), hospital demographics, road networks, and US Census data files. We included TCs and zip codes outside of Pennsylvania to account for edge effects with trauma cases aggregated to the zip code centroid of residence. Our model assumptions included existing PTSF level 1 and 2 TCs, a maximum travel time of 60 minutes to the TC, capacity based on mean statewide ratios of trauma cases per hospital bed size, ISS, candidate hospitals ≥ 200 licensed beds and ≥ 30 or ≥ 15 minutes from an existing TC in non-urban/urban areas respectively. We used the Network Analyst Location-Allocation function in ArcGIS Desktop to generate spatial models.
RESULTS: Of the 130 candidate sites, only 14 met the bed size and travel time criteria from an existing TC. Approximately 70% of zip codes and 91% of cases were within 60 minutes of an existing TC. Adding 1 to 6 new optimally paced TCs increased to a maximum of 82% of zip codes and 96% of cases within 60 minutes of an existing TC. Changes to model assumptions had an impact on which candidate sites were selected.
CONCLUSION: Intelligent trauma system design should include an objective process like geospatial to determine the optimum locations for new trauma centers within existing trauma networks. LEVEL OF EVIDENCE: Level III epidemiological study.
Language: en |