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We develop a methodology for modeling post-earthquake hospital needs and accessibility, coupling a probabilistic regional casualty risk model with a novel agent-based human behavior model. We use it to study hospital transportation in two socio-economically distinct districts of Lima, Peru, after a hypothetical moment magnitude 8.0 event. Our work provides insights into the infrastructure and socio-economic vulnerability factors that determine timely healthcare access, across various hypothetical behavioral and policy contexts/scenarios. In the baseline scenario that assumes households respond to the emergency independently (i.e. transport only their own members to hospital) but there is coordination among hospitals (i.e. ambulance sharing), car ownership is key for rapid healthcare access. Twenty-four percent of non-life-threatening casualties in the district with 57% car ownership will arrive at hospital in the first 45 min; only 6% of such patients in the more economically deprived district (18% car ownership) will reach hospital in that time. If car-owning neighbors help transporting patients without cars, over 96% of non-life-threatening casualties will reach hospital in the first 45 min in both districts, significantly reducing intra-regional disparities in healthcare access. Arrival times would nearly halve compared to the baseline scenario if the number of available ambulances doubled. If hospitals do not share ambulances, arrival times of non-life-threatening and threatening casualties show a notable reduction in one district (by 56% and 42%, respectively) but a significant increase in the other, more economically deprived district (by 109% and 97%, respectively), compared to the baseline case. The arrival times presented in this study are specific to the studied context, and the appropriate assumptions made. We benchmark the performance of the methodology using patient arrival times from the 2023 Turkey-Syria earthquake, yielding an acceptable outcome (i.e. similar temporal trends in the proportion of hospital arrivals). The findings can be leveraged for planning effective post-earthquake emergency response strategies.
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Optimal Two-Tier Outpatient Care Network Redesign With a Real-World Case Study of Shanghai
Healthcare capacity shortage contributes to poor access in many countries. Moreover, rapid urbanization often occurring in these countries has exacerbated the imbalance between healthcare capacity and need. One way to address the above challenge is expanding the total capacity and redistributing the capacity spatially. In this research, we studied the problem of locating new hospitals in a two-tier outpatient care system comprising multiple central and district hospitals, and upgrading existing district hospitals to central hospitals. We formulated the problem with a discrete location optimization model. To parameterize the optimization model, we used a multinomial logit model to characterize individual patients’ diverse hospital choice and to quantify the patient arrival rates at each hospital accordingly. To solve the hard nonlinear combinatorial optimization problem, we developed a queueing network model to approximate the impact of hospital locations on patient flows. We then proposed a multi-fidelity optimization approach, which involves both the aforementioned queuing network model as a surrogate and a self-developed stochastic simulation as the high-fidelity model. With a real-world case study of Shanghai, we demonstrated the changes in the care network and examined the impacts on the network design by population center emergence, governmental budget change and considering patients with different age groups or income levels. Note to Practitioners —Our work focuses on improving system-wide care access in a two-tier care network. We believe that our work can lead to effective development of a location analytics tool for city-wide healthcare system planners. We also think the importance of this study is further strengthened by the case studies based on real-world hospital choice experimental data from Shanghai, China, a region suffering from the imbalance between healthcare capacity and need. Our case studies are expected to make recommendations on care facility expansion and dispersion to better align with the spatial distribution of residential communities and patient hospital choice behavior.
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- Award ID(s):
- 1761022
- PAR ID:
- 10377873
- Date Published:
- Journal Name:
- IEEE Transactions on Automation Science and Engineering
- ISSN:
- 1545-5955
- Page Range / eLocation ID:
- 1 to 19
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1109/TASE.2022.3198484
