Integration of GIS Data in Health Care Utilization

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Theodor Rainer Kopp
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1 Integration of GIS Data in Health Care Utilization G. Romstorfer1, S. Parragh1, G. Schneckenreither1,2, M. Landsiedl2, P. Einzinger2, M. Scheuringer3 Vienna University of Technology 2 dwh simulation services 3 Main Association of Austrian Social Security Institutions 1

2 Presentation Overview Modeling and Simulation of Health Care Systems Why do we need geographic Data? Data Requirements Process of Modeling Example Model Integration of geographic Data Results Live Demo

3 Simulating a Health Care System population medical providers provided health services? reimbursement system

4 Simulating a Health Care System provider search evolve medical problem choose provider recover or change provider service quality habit cost distance treat/heal/transfer patient recording and billing

Distance Dependence of Utilization Example: Radii where 20, 40, 60, 80 or 99 percent of the patients of heart rehabilitation centers come from Graphic from

5 Distance Dependence of Utilization Example: Radii where 20, 40, 60, 80 or 99 percent of the patients of heart rehabilitation centers come from Graphic from Urach et al. Distance Dependence on the Willingness of Patients to Participate in Ambulatory Heart Rehabilitation Programs, 13th Biennal SMDM European Meeting, 2010.

6 Simulating a Health Care System population medical providers provided health services? reimbursement system geographic information

7 Data provider search demographic data and forecasts socio-economic data spatial proximity register and billing of provided services budget, reallocations, reimbursement data infrastructure expert knowledge, clinical studies geographic information and data

8 Process of Modelling data acquisition preprocessing implementation dynamic simulation

9 Process of Modelling OSM Social Insurance Statistics Austria data acquisition preprocessing implementation

10 Process of Modeling OSM Statistics Austria geographic location of postcodes statistics on provided services Social Insurance statistics on health data acquisition preprocessing political structuring routing information population distribution implementation infrastructure

11 Process of Modelling privacy, legal usage simplification, aggregation granularity, level of detail data acquisition defective data sets, completeness extrapolation preprocessing alignment large database implementation

12 Inpatient Health Care Utilization Example Model: Inpatient Health Care Utilization Implementation as an Agent-based Model in AnyLogic Two classes of agents: Patient, Hospital Model assumptions: only 2 types of diseases considered 2 corresponding treatments possible differing reimbursement

13 Inpatient Health Care Utilization Treatment: cures Disease 1 Treatment A helps cures Treatment B Disease 2

14 Agent Patient State of Health: Healthy Disease 1 Disease 2 Life Quality Agent Patient Health Care Utilization maximize recommendations of other patients Satisfaction: Choice of Hospital distance

Disease rates Treat: TreatmentA TreatmentB weighting

15 Agent Hospital Diagnose probability of disease type Decide on Treatment Reimbursement Adjust criterion Disease rates Treat: TreatmentA TreatmentB weighting Agent Hospital Performance: Income Utilization Quality of Treatment maximize

16 Model Structure maximize action influence Satisfaction choose Utilization Life quality Patients Hospitals treat Health Income

17 From a patient's point of view Distance Recommendations 1 3 Free capacity 2

18 Choosing a Hospital Determine a probability for each hospital:

19 Network 1 3 P1 P3 2 P2

20 Network 1 3 2

21 Incorporating Geographic Information OpenStreetMap Project modifiable, free and open-source cartography platform great quality, decreasing amount of missing or wrong data compatible to local (e.g. Austrian) community identification numbering (Official Municipality Key, ) rich ecosystem geometric database queries (PostGIS) tools for extracting a local dump address look-up routing software tools for visualization and post-processing

22 Incorporating Geographic Information Data from Statistics Austria: Population raster data Number of persons in a raster cell Permanent habitable area Area where people actually live Lakes and mountains are an example of non permanent habitable area

23 Used GIS-Data Raster data of population density Permanent habitable area Location of medical providers (e.g. hospitals) OpenStreetMap

24 Incorporating Geographic Information Raster data OSM1 Anylogic Simulation Environment ShapeGTMapPane Hospitals PHA2 Common CRS3 PostGis DB OpenStreetMap Permanent habitable area 3 Coordinate Reference System 1 2

25 Results Simulation was done with and without GIS-Data. Using GIS-Data it is possible to identify regions with low health care supply. Hospitals and connections to patients: Without GIS With GIS

26 Results Patients colored by distance to chosen hospital and marked regions with low health care supply. Hospitals in blue.

27 Results Objective function per hospital (utilization, income, treatment success) Avg. Utilisation of all hospitals

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