Abstract
BackgroundIn an era of budget constraints for healthcare services, strategies for provision of services that improve quality whilst saving costs are highly valued. A proposed means to achieve this is consolidation of services into fewer specialist centres, but this may lead to reduced spatial accessibility. We describe a methodology which includes implementing a combinatorial optimisation algorithm to derive combinations of services which optimise spatial accessibility in the context of service rationalisation, and demonstrate its use through the exemplar of tuberculosis clinics in London.MethodsOur methodology involves (1) identifying the spatial distribution of the patient population using the service; (2) calculating patient travel times to each service location, and (3) using a combinatorial optimisation algorithm to identify subsets of locations that minimise overall travel time. We estimated travel times for tuberculosis patients notified in London between 2010 and 2013 to each of 29 clinics in the city. Travel time estimates were derived from the Transport for London Journey Planner service. We identified the subset of clinics that would provide the shortest overall travel time for each possible number of clinic subsets (1–28).ResultsBased on the 29 existing clinic locations, mean estimated travel time to clinics used by 12,061 tuberculosis patients in London was 33 min; and mean time to their nearest clinics was 28 min. Using optimum combinations of clinic locations, and assuming that patients attended their nearest clinics, a mean travel time of less than 45 min could be achieved with three clinics; of 34 min with ten clinics, and of less than 30 min with 18 clinics.ConclusionsWe have developed a methodological approach to optimise spatial accessibility which can be used to inform rationalisation of health services. In urban conurbations, this may enable service reorganisation which increases quality and efficiency without substantially affecting spatial accessibility. This approach could be used to inform planning of service reorganisations, but may not be generalisable to rural areas or smaller urban centres.
Highlights
In an era of budget constraints for healthcare services, strategies for provision of services that improve quality whilst saving costs are highly valued
We propose a methodology based on spatial accessibility for selecting optimum combinations of service locations in the context of service rationalisation in metropolitan areas
Data sources and travel time data We applied this method to clinic travel times for cases of tuberculosis who resided in London and were notified between 1 January 2010 and 31 December 2013
Summary
A proposed means to achieve this is consolidation of services into fewer specialist centres, but this may lead to reduced spatial accessibility. In an era of budget constraints for healthcare services, strategies for provision of services that improve quality whilst saving costs are highly valued. For specialist services, such as major trauma, stroke care and cardiac surgery, a proposed means to achieve this is consolidation of service provider locations into fewer centres [1,2,3].
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