Location selection of field hospitals amid COVID-19 considering effectiveness and fairness: A case study of Florida.

The world has experienced an unprecedented global health crisis since 2020, the COVID-19 pandemic, which inflicted massive burdens on countries' healthcare systems. During the peaks of the pandemic, the shortages of intensive care unit (ICU) beds illustrated a critical vulnerability in the fight. Many individuals suffering the effects of COVID-19 had difficulty accessing ICU beds due to insufficient capacity. Unfortunately, it has been observed that many hospitals do not have enough ICU beds, and the ones with ICU capacity might not be accessible to all population strata. To remedy this going forward, field hospitals could be established to provide additional capacity in helping emergency health situations such as pandemics; however, location selection is a crucial decision ultimately for this purpose. As such, we consider finding new field hospital locations to serve the demand within certain travel-time thresholds, while accounting for the presence of vulnerable populations. A multi-objective mathematical model is proposed in this paper that maximizes the minimum accessibility and minimizes the travel time by integrating the Enhanced 2-Step Floating Catchment Area (E2SFCA) method and travel-time-constrained capacitated p-median model. This is performed to decide on the locations of field hospitals, while a sensitivity analysis addresses hospital capacity, demand level, and the number of field hospital locations. Four counties in Florida are selected to implement the proposed approach. Findings can be used to identify the ideal location(s) of capacity expansions concerning the fair distribution of field hospitals in terms of accessibility with a specific focus on vulnerable strata of the population.

Understanding the spatial heterogeneity of COVID-19 vaccination uptake in England.

BACKGROUND: Mass vaccination has been a key strategy in effectively containing global COVID-19 pandemic that posed unprecedented social and economic challenges to many countries. However, vaccination rates vary across space and socio-economic factors, and are likely to depend on the accessibility to vaccination services, which is under-researched in literature. This study aims to empirically identify the spatially heterogeneous relationship between COVID-19 vaccination rates and socio-economic factors in England. METHODS: We investigated the percentage of over-18 fully vaccinated people at the small-area level across England up to 18 November 2021. We used multiscale geographically weighted regression (MGWR) to model the spatially heterogeneous relationship between vaccination rates and socio-economic determinants, including ethnic, age, economic, and accessibility factors. RESULTS: This study indicates that the selected MGWR model can explain 83.2% of the total variance of vaccination rates. The variables exhibiting a positive association with vaccination rates in most areas include proportion of population over 40, car ownership, average household income, and spatial accessibility to vaccination. In contrast, population under 40, less deprived population, and black or mixed ethnicity are negatively associated with the vaccination rates. CONCLUSIONS: Our findings indicate the importance of improving the spatial accessibility to vaccinations in developing regions and among specific population groups in order to promote COVID-19 vaccination.

Analyzing the Role of Service Congestion in Accessibility Modeling

An important variable in measuring potential access is the competitive nature of the service being provided. Health services such as physician visits or hospital beds are often viewed as rival goods where one's consumption of a service will diminish another's ability to consume the same service. Congestion at facilities is as important as the overall level of supply at facilities. For rival goods, accessibility and congestion are linked as reciprocal concepts. The relationship between accessibility and congestion is even more important in the current era of the COVID-19 pandemic because critical care services, such as the need for intensive care unit beds, illustrate the need to focus on a balanced level of congestion among hospitals to prevent care failure at the local level. This research investigates the role of service congestion in various existing and proposed models and measures using data from the state of Illinois. Because evenness of service congestion and lower travel times are conflicting goals, evenness of congestion as measured by Gini coefficients is weighed against the cost of travel to determine a compromise solution. Results suggest that the rational agent access model and the congested supply accessibility model provide such compromises when used in conjunction with the transportation problem.

Analyzing the Role of Service Congestion in Accessibility Modeling

An important variable in measuring potential access is the competitive nature of the service being provided. Health services such as physician visits or hospital beds are often viewed as rival goods where one's consumption of a service will diminish another's ability to consume the same service. Congestion at facilities is as important as the overall level of supply at facilities. For rival goods, accessibility and congestion are linked as reciprocal concepts. The relationship between accessibility and congestion is even more important in the current era of the COVID-19 pandemic because critical care services, such as the need for intensive care unit beds, illustrate the need to focus on a balanced level of congestion among hospitals to prevent care failure at the local level. This research investigates the role of service congestion in various existing and proposed models and measures using data from the state of Illinois. Because evenness of service congestion and lower travel times are conflicting goals, evenness of congestion as measured by Gini coefficients is weighed against the cost of travel to determine a compromise solution. Results suggest that the rational agent access model and the congested supply accessibility model provide such compromises when used in conjunction with the transportation problem. © 2022 by American Association of Geographers.

Daily changes in spatial accessibility to ICU beds and their relationship with the case-fatality ratio of COVID-19 in the state of Texas, USA.

During the COVID-19 pandemic, many patients could not receive timely healthcare services due to limited availability and access to healthcare resources and services. Previous studies found that access to intensive care unit (ICU) beds saves lives, but they overlooked the temporal dynamics in the availability of healthcare resources and COVID-19 cases. To fill this gap, our study investigated daily changes in ICU bed accessibility with an enhanced two-step floating catchment area (E2SFCA) method in the state of Texas. Along with the increased temporal granularity of measurements, we uncovered two phenomena: 1) aggravated spatial inequality of access during the pandemic, and 2) the retrospective relationship between insufficient ICU bed accessibility and the high case-fatality ratio of COVID-19 in rural areas. Our findings suggest that those locations should be supplemented with additional healthcare resources to save lives in future pandemic scenarios.

Spatial Accessibility and Equity Evaluation of Medical Facilities Based on Improved 2SFCA: A Case Study in Xi'an, China.

Accurate evaluation of the accessibility of medical facilities is a prerequisite for the reasonable allocation of medical resources in a city. The accessibility of medical facilities depends not only on the distance to the supply and demand points, but also on the time spent in the process, and the supply capacity of the supply points. Taking Xi'an City of Shaanxi Province as an example, this paper comprehensively considers the facility supply capacity and introduces the selection probability function based on the two-step floating catchment area (2SFCA) method. In addition, in order to approximate the residents' acceptance of different types of hospitals for long-distance medical treatment in real situations, different levels of search radius were set for the different levels of hospitals, and ArcGIS was used to measure the accessibility and evaluate the spatial layout of medical facilities in the main urban area of Xi'an. The results show that there is a significant difference in the accessibility of medical facilities in the main urban area of Xi'an, and the accessibility tends to decrease gradually from the central city to the periphery. The inequity in the allocation of medical facilities in the main urban area of Xi'an is more obvious, with about 81.64% of people having access to 54.88% of medical resources. The accessibility evaluation model established by the improved 2SFCA method can obtain more accurate and objective evaluation results. This study can provide a reference basis for urban medical facilities' planning and rational spatial layout.

Examining the interplay between racial segregation patterns and access to hospital care

Access to hospitals and especially intensive care units is an important issue given the current COVID-19 pandemic. This study examined the interplay between the pattern of spatial separation of racial groups and the access by those groups to hospital services as measured by the number of beds. Differences between racial groups in the Chicago Area were investigated using two models that calculated supply and cost accessibility to hospital care using Huff-style probabilities. An additional two models focused on minimizing the unevenness in congestion for ICU beds at hospitals. Results suggest that with respect to hospital beds, there was not much difference between racial groups in terms of supply accessibility, but there were greater differences in the travel cost for accessing those services. This is due to the association between the centrality dimension of residential segregation and the central location of hospitals in the Chicago Area. Results also suggest that the goal of even congestion levels results in higher travel costs with the region. © The Author(s) 2022.

Use of an E2SFCA method to assess healthcare resources in Jordan during COVID-19 pandemic

Healthcare spatial accessibility requires a better understanding and evaluation, especially during pan-demic outbreaks like the recent COVID-19 pandemic. The main goal of this study is to measure and assess community-level spatial accessibility in Amman city to various COVID-19 related healthcare resources that could provide any urgent medical care for suspected or confirmed COVID-19 cases. To address this aim, the Enhanced 2-step floating catchment area (E2SFCA) method combined with several geospatial techniques were performed. The main E2SFCA results show the differences in the capacities and spatial accessibility of health facilities within Amman city, as well as how the variations are captured at different regions. The resulted spatial accessibility scores were presented in interactive Geo-spatial maps, ana-lyzed, and compared for several health resources in public, private, and educational hospitals. The current research findings stated that although there are enough healthcare facilities to service almost the entire city, inappropriate health facility distribution, rather than a lack of resources, has resulted in coverage gaps in some areas. The center zones had been fully serviced, or perhaps over-served, by a large number of facilities. The other zones, on the contrary, were partially served or were even underserved by a certain number of resources.(c) 2022 National Authority of Remote Sensing & Space Science. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Modeling of emergency support capacity and optimization of delivery service system for urban living materials under uncertain situations: a case study of Xi'an City during COVID-19 epidemic.

The severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has brought a heavy burden and severe challenges to the global economy and society, forcing different countries and regions to take various preventive and control measures ranging from normal operations to partial or complete lockdowns. Taking Xi'an city as an example, based on multisource POI data for the government's vegetable storage delivery points, logistics terminal outlets, designated medical institutions, communities, etc., this paper uses the Gaussian two-step floating catchment area method (2SFCA) and other spatial analysis methods to analyze the spatial pattern of emergency support points (ESPs) and express logistics terminals in different situations. It then discusses construction and optimization strategies for urban emergency support and delivery service systems. The conclusions are as follows. (1) The ESPs are supported by large-scale chain supermarkets and fresh supermarkets, which are positively related to the population distribution.The spatial distribution of express logistics terminals is imbalanced, dense in the middle while sparse at the edges. 90% of express terminals are located within a 500 m distance of communities, however, some terminals are shared, which restrict their ability to provide emergency support to surrounding residents. (2) In general, accessibility increases as the number of ESPs increases; under normal traffic, as the distance threshold increases, the available ESPs increase but accessibility slightly decreases; with a traffic lockdown, the travel distance of residents is limited, and as ESPs increase, accessibility and the number of POIs covered significantly increase. (3) The spatial accessibility of the ESPs has a "dumbbell-shaped" distribution, with highest accessibility in the north and south, higher around the second ring road, slightly lower in the center, and lowest near the third ring road at east and west. (4) With the goal of "opening up the logistics artery and unblocking the distribution microcirculation", based on "ESPs + couriers + express logistics terminals + residents", this paper proposes to build and optimize the urban emergency support and delivery service system to improve the comprehensive ability of the city to cope with uncertain risks.

Use of an E2SFCA method to assess healthcare resources in Jordan during COVID-19 pandemic

Healthcare spatial accessibility requires a better understanding and evaluation, especially during pandemic outbreaks like the recent COVID-19 pandemic. The main goal of this study is to measure and assess community-level spatial accessibility in Amman city to various COVID-19 related healthcare resources that could provide any urgent medical care for suspected or confirmed COVID-19 cases. To address this aim, the Enhanced 2-step floating catchment area (E2SFCA) method combined with several geospatial techniques were performed. The main E2SFCA results show the differences in the capacities and spatial accessibility of health facilities within Amman city, as well as how the variations are captured at different regions. The resulted spatial accessibility scores were presented in interactive Geo-spatial maps, analyzed, and compared for several health resources in public, private, and educational hospitals. The current research findings stated that although there are enough healthcare facilities to service almost the entire city, inappropriate health facility distribution, rather than a lack of resources, has resulted in coverage gaps in some areas. The center zones had been fully serviced, or perhaps over-served, by a large number of facilities. The other zones, on the contrary, were partially served or were even underserved by a certain number of resources.

Examining the impact of COVID-19 vaccination rates on differential access to critical care.

The measurement of potential access to health care has focused primarily on what might be called "place-based" access or the differential access among geographic locations rather than between different populations. The vaccination program to inoculate the population against the effects of the COVID-19 virus has created two different at-risk populations. This research examines the impact of COVID-19 vaccination rates on access to critical care for persons fully-vaccinated versus those not fully-vaccinated. In this situation, additional tools are necessary to understand: 1) if there is a significant difference in accessibility between different populations, 2) the magnitude of this difference and how it is distributed across accessibility levels, and 3) how the differences between groups are distributed across the state. A study of access to intensive care unit (ICU) beds by these two populations for the state of Illinois found that although there was a statistically significant difference in access, the magnitude of differences was small. A more important difference was being located in the Chicago Area of the state. The not-fully vaccinated in the Chicago Area had higher than expected spatial access due to the lower need for ICU beds by a higher percentage of fully vaccinated people.

Patient delay in a coronavirus disease 2019 (COVID-19) outbreak in Tianjin, China from January to February 2020.

BACKGROUND: Patient delay of COVID-19 patients occurs frequently, which poses a challenge to the overall epidemic situation. In this study, we aimed to evaluate the extent of patient delay, explore its factors, and investigate the effects of patient interval on epidemic situation. METHODS: A retrospective cohort study was conducted with 136 COVID-19 patients in Tianjin, China. Factors associated with patient delay were explored using logistic regression models. The relationship was investigated by spearman correlation analysis and mean absolute error between patient interval of lagging days and epidemic situation. RESULTS: The factors associated with patient delay of COVID-19 patients were mainly the imported cases, the first presentation to a tertiary hospital, close contacts and spatial accessibility to fever clinic. The longer the patient intervals of lagging days, the greater the number of new-onset and confirmed cases in 3-4 and 5-7 days after the first day symptoms, respectively. CONCLUSION: Identification and quarantine of close contacts, promoting the spatial accessibility to fever clinics and creating public awareness are crucial to shortening patient delays to flat the curve for COVID-19.

Measuring COVID-19 vaccination coverage: an enhanced age-adjusted two-step floating catchment area model.

BACKGROUND: There are only limited studies on access to COVID-19 vaccines and identifying the most appropriate health centres for performing vaccination in metropolitan areas. This study aimed to measure potential spatial access to COVID-19 vaccination centres in Mashhad, the second-most populous city in Iran. METHODS: The 2021 age structure of the urban census tracts was integrated into the enhanced two-step floating catchment area model to improve accuracy. The model was developed based on three different access scenarios: only public hospitals, only public healthcare centres and both (either hospitals or healthcare centres) as potential vaccination facilities. The weighted decision-matrix and analytic hierarchy process, based on four criteria (i.e. service area, accessibility index, capacity of vaccination centres and distance to main roads), were used to choose potential vaccination centres looking for the highest suitability for residents. Global Moran's index (GMI) was used to measure the spatial autocorrelation of the accessibility index in different scenarios and the proposed model. RESULTS: There were 26 public hospitals and 271 public healthcare centres in the study area. Although the exclusive use of public healthcare centres for vaccination can provide the highest accessibility in the eastern and north-eastern parts of the study area, our findings indicate that including both public hospitals and public healthcare centres provide high accessibility to vaccination in central urban part. Therefore, a combination of public hospitals and public healthcare centres is recommended for efficient vaccination coverage. The value of GMI for the proposed model (accessibility to selected vaccination centres) was calculated as 0.53 (Z = 162.42, P < 0.01). Both GMI and Z-score values decreased in the proposed model, suggesting an enhancement in accessibility to COVID-19 vaccination services. CONCLUSIONS: The periphery and poor areas of the city had the least access to COVID-19 vaccination centres. Measuring spatial access to COVID-19 vaccination centres can provide valuable insights for urban public health decision-makers. Our model, coupled with geographical information systems, provides more efficient vaccination coverage by identifying the most suitable healthcare centres, which is of special importance when only few centres are available.

Spatial Accessibility Assessment of Prehospital EMS with a Focus on the Elderly Population: A Case Study in Ningbo, China.

The spatial accessibility of prehospital EMS is particularly important for the elderly population's physiological functions. Due to the recent expansion of aging populations all over the globe, elderly people's spatial accessibility to prehospital EMS presents a serious challenge. An efficient strategy to address this issue involves using geographic information systems (GIS)-based tools to evaluate the spatial accessibility in conjunction with the spatial distribution of aging people, available road networks, and prehospital EMS facilities. This study employed gravity model and empirical Bayesian Kriging (EBK) interpolation analysis to evaluate the elderly's spatial access to prehospital EMS in Ningbo, China. In our study, we aimed to solve the following specific research questions: In the study area, "what are the characteristics of the prehospital EMS demand of the elderly?" "Do the elderly have equal and convenient spatial access to prehospital EMS?" and "How can we satisfy the prehospital EMS demand of an aging population, improve their spatial access to prehospital EMS, and then ensure their quality of life?" The results showed that 37.44% of patients admitted to prehospital EMS in 2020 were 65 years and older. The rate of utilization of ambulance services by the elderly was 27.39 per 1000 elderly residents. Ambulance use by the elderly was the highest in the winter months and the lowest in the spring months (25.90% vs. 22.38%). As for the disease spectrum, the main disease was found to be trauma and intoxication (23.70%). The mean accessibility score was only 1.43 and nearly 70% of demand points had scored lower than 1. The elderly's spatial accessibility to prehospital EMS had a central-outward gradient decreasing trend from the central region to the southeast and southwest of the study area. Our proposed methodology and its spatial equilibrium results could be taken as a benchmark of prehospital care capacity and help inform authorities' efforts to develop efficient, aging-focused spatial accessibility plans.

Identifying areas of potential critical healthcare shortages: A case study of spatial accessibility to ICU beds during the COVID-19 pandemic in Florida.

Healthcare resource availability is potentially associated with COVID-19 mortality, and the potentially uneven geographical distribution of resources is a looming concern in the global pandemic. Given that access to healthcare resources is important to overall population health, assessing COVID-19 patients' access to healthcare resources is needed. This paper aims to examine the temporal variations in the spatial accessibility of the U.S. COVID-19 patients to medical facilities, identify areas that are likely to be overwhelmed by the COVID-19 pandemic, and explore associations of low access areas with their socioeconomic and demographic characteristics. We use a three-step floating catchment area method, spatial statistics, and logistic regression to achieve the goals. Findings of this research in the State of Florida revealed that North Florida, rural areas, and zip codes with more Latino or Hispanic populations are more likely to have lower access than other regions during the COVID-19 pandemic. Our approach can help policymakers identify potentially possible low access areas and establish appropriate policy intervention paying attention to those areas during a pandemic.

Spatial Inequity in Access to Intensive Care Unit Beds at Regional Level in Italy.

The high demand of hospitalization in the intensive care units (ICUs) during the first wave of the COVID-19 outbreak brought out the critical issues of the limited capacity of the regional systems to deal with high patient inflows in a short period of time. In this view, a rapid and efficient reallocation of resources is one of the main challenges to be addressed by regional systems to prevent overload and saturation. Aim of this study is to assess the spatial accessibility of ICU beds in the 20 Italian regions to capture the equity distribution of critical care services across the country. This analysis may contribute to gain a deeper understanding of the allocation of health resources. It can provide input for policy makers in view of a possible reorganization of the national system in terms of both its preparedness for emergency period and routine capability.

Spatial accessibility assessment of COVID-19 patients to healthcare facilities: A case study of Florida.

During the COVID-19 pandemic, healthcare facilities worldwide have been overwhelmed by the amount of coronavirus patients needed to be served. Similarly, the U.S. also experienced a shortage of healthcare resources, which led to a reduction in the efficiency of the whole healthcare system. In order to evaluate this from a transportation perspective, it is critical to understand the extent to which healthcare facilities with intensive care unit (ICU) beds are available in both urban and rural areas. As such, this study aims to assess the spatial accessibility of COVID-19 patients to healthcare facilities in the State of Florida. For this purpose, two methods were used: the two-step floating catchment area (2SFCA) and the enhanced two-step floating catchment area (E2SFCA). These methods were applied to identify the high and low access areas in the entire state. Furthermore, a metric, namely the Accessibility Ratio Difference (ARD), was developed to evaluate the spatial access difference between the models. Results revealed that many areas in the northwest and southern Florida have lower access compared to other locations. The residents in central Florida (e.g., Tampa and Orlando cities) had the highest level of accessibility given their higher access ratios. We also observed that the 2SFCA method overestimates the accessibility in the areas with a lower number of ICU beds due to the "equal access" assumption of the population within the catchment area. The findings of this study can provide valuable insights and information for state officials and decision makers in the field of public health.

Rapidly measuring spatial accessibility of COVID-19 healthcare resources: a case study of Illinois, USA.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.

Unequable spatial accessibility to hospitals in developing megacities: New evidence from Beijing.

The increasing inequality in spatial accessibility to hospitals in developing countries has been attracting attention from researchers and politicians. The situation seems to be worse in growing megacities where more than 10 million people live and rapid urban sprawl has caused serious problems with the supply of health and public transport services. The recent global COVID-19 pandemic calls for particular attention to be afforded to the matter of equal access to basic medical facilities and services for people across different neighborhoods. Although some studies have already been undertaken into the subject of health-focused inequality in the cities of developing countries, the spatial inequity in hospital accessibility has rarely been discussed to date. In this paper, I aim to provide new evidence by considering Beijing as a case study. With the results of my analysis, I show that low-income neighborhoods have experienced lower levels of accessibility not only to high-tier hospitals (secondary and tertiary hospitals) but also to primary healthcare services (primary hospital and neighborhood clinics). The rate at which high-income neighborhoods access secondary and tertiary hospitals is approximately 4 times and 1.5 times as high as that of low-income neighborhoods. Low-income face nearly twice the travel time of those from high-income neighborhoods to reach the nearest primary hospital or neighborhood clinics. Suburban neighborhoods have less access to medical services than neighborhoods that are located in the central urban areas. It seems that the rapid urban sprawl has been worsening spatial inequality in the context of access to medical services in the growing megacity of Beijing. Equal access to healthcare services should be prioritized in future policy discussions, especially in relation to the urban growth management of megacities in developing countries in order to ensure that fair and inclusive urbanization processes are undertaken. Equal access to healthcare services would also be widely beneficial in the context of managing the COVID-19 pandemic.