A novel technique to optimize facility locations of new nephrology services for remote areas

Abstract

Background and objectives: Travel distance to healthcare facilities affects healthcare access and utilization. Using the example of patients with kidney disease and nephrology services, we investigated the feasibility and utility of using geographic information system (GIS) techniques to identify the ideal location for new clinics to improve care for patients with kidney disease, on the basis of systematically minimizing travel time for remote dwellers.

Design, setting, participants, & measurements: Using a provincial laboratory database to identify patients with kidney disease and where they lived, we used GIS techniques of buffer and network analysis to determine ideal locations for up to four new nephrology clinics. Service-area polygons for different travel-time intervals were generated and used to determine the best locations for the four new facilities that would minimize the number of patients with kidney disease who were traveling >2 hours.

Results: We studied 31,452 adults with living in Alberta, Canada. Adding the four new facilities would increase the number of patients living <30 minutes from a clinic by 2.2% and reduce the number living >120 minutes away by 72.5%. Different two- and three-clinic scenarios reduced the number of people living >120 minutes away by as much as 65% or as little as 32%, emphasizing the importance of systematic evaluation.

Conclusions: GIS techniques are an attractive alternative to the current practice of arbitrarily locating new facilities on the basis of perceptions about patient demand. Optimal location of new clinical services to minimize travel time might facilitate better patient care.

Figure 1.

(A) The existing facilities and population density of patients with eGFR <45 ml/min per 1.73 m². Red shading denotes higher density; green shading denotes lower density. (B) The proposed nephrology facilities and the effect of the starting the search for a new nephrologist facility in the southeast corner of Alberta instead of the northwest corner as in the primary analysis.

Figure 2.

Diagram showing the process of eliminating postal codes. PC, postal code.

Figure 3.

The implications of adding new facilities (denoted with ^) for the percentage of patients in each travel-time category. The bar graph in the center is rank ordered (from lowest to highest) by the percentage of patients who must travel more than 120 minutes to the practice location of the closest nephrologist. The locations of the proposed facilities are numbered 1 through 4. The different combinations of proposed facilities 1 through 4 are shown in the small maps labeled A through O. Scenario A (four new facilities) has the lowest percentage of patients in the >120 minutes category; scenario N (only one new facility at location 3) has the highest percent of patients in the >120 minutes category.

Figure 4.

Patients by time category ordered by maximizing the proportion residing <30 minutes from the closest nephrologist.

Figure 5.

Total time and gas saved for 2699 remotely dwelling patients by scenario.