11/25/2011 LAYOUT GIS Applications in Health Systems Research • • • • Introduction to GIS Defining GIS Health and GIS Research areas in Health with Examples Dr. P.V.D.S. Dharmagunawardene MD Medical Administration Part II Trainee GIS – What is it? • Geographic/Geospatial Information – information about places on the earth’s surface – knowledge about “what is where when” Geographic/geospatial: synonymous • GIS--what’s in the S? – Systems: the technology – Science: the concepts & theory – Studies: the societal context Defining GIS • The common ground between information processing and the many fields using spatial analysis techniques. (Tomlinson, 1972) • A powerful set of tools for collecting, storing, retrieving, transforming, and displaying spatial data from the real world. (Burroughs, 1986) • A computerized database management system for the capture, storage, retrieval, analysis and display of spatial (locationally defined) data. (NCGIA, 1987) • A decision support system involving the integration of spatially referenced data in a problem solving environment. (Cowen, 1988) Geographic Information Technologies • Global Positioning Systems (GPS) GPS and RS are – a system of earth-orbiting satellites which can sources of input provide precise (100 meter to sub-cm.) location data for on the earth’s surface (in latitude/longitude a GIS coordinates or equiv.) • Remote Sensing (RS) – use of satellites or aircraft to capture information about the earth’s surface • Geographic Information Systems (GIS) – Software systems with capability for input, storage, manipulation/analysis and output/display of geographic (spatial) information . A GIS provides for storing and manipulating GPS and RS data. Comprehensive Definition for GIS A system of integrated computer-based tools for end-to-end processing (capture, storage, retrieval, analysis, display) of data using location on the earth’s surface for interrelation in support of operations management, decision making and scientific inquiries. • set of integrated tools for spatial analysis • encompasses end-to-end processing of data – capture, storage, retrieval, analysis/modification, display • uses explicit location on earth’s surface to relate data • aimed at decision support, as well as on-going operations and scientific inquiry 1 11/25/2011 Examples of Applied GIS • Urban Planning, Management & Policy – – – – – – – – • • – – – Monitoring environmental risk Modeling stormwater runoff Management of watersheds, floodplains, wetlands, forests, aquifers Environmental Impact Analysis Hazardous or toxic facility siting Groundwater modeling and contamination tracking Political Science – – – Redistricting Analysis of election results Predictive modeling Civil Engineering/Utility – – – • • Attendance Area Maintenance Enrollment Projections School Bus Routing Real Estate – – – • Demographic Analysis Market Penetration/ Share Analysis Site Selection Education Administration – – – • Locating underground facilities Designing alignment for freeways, transit Coordination of infrastructure maintenance Business – – – Environmental Sciences – – – • Zoning, subdivision planning Land acquisition Economic development Code enforcement Housing renovation programs Emergency response Crime analysis Tax assessment GIS & HEALTH – HISTORY Neighborhood land prices Traffic Impact Analysis Determination of Highest and Best Use Health Care – Epidemiology – Service Inventory and Analysis – Needs Analysis SPOT MAPS 1854 – London Cholera Epidemic Dr. John Snow Map GIS & HEALTH – RESEARCH AREAS 1. Description of spatial patterns of morbidity and mortality, factors associated with these patterns, disease diffusion and disease aeitilogy 2. The spatial distribution, location diffusion and regionalization of health care resources, access to utilization of resources and factors related to resource distribution and use 3. Spatial aspects of the interactions between disease and health care delivery 1. Description of Spatial Patterns of Morbidity and Mortality, Factors Associated with these Patterns, Disease Diffusion and Disease Aeitilogy EPIDEMIOLOGY EPIDEMIOLOGY OF HAEMODIALYSING END STAGE RENAL FAILURE (ESRF) PATIENTS IN NORTH CENTRAL PROVINCE (NCP) OF SRI LANKA Dr. P.V.D.S. Dharmagunawardene Medical Superintendent – Base Hospital – Dambadeniya Mrs. H.M.J.R. Herath Senior Lecturer – Department of Geography – University of Sri Jayewardenepura Dr. M.A.L.R. Perera Senior Consultant in Health System Management – Finance Commission 2 11/25/2011 Geographical Distribution of ESRF patients in NCP by Divisional Secretariat (DS) Divisions Prevalence and Geographical Distribution of ESRF patients in NCP and Relationship with Fluoride Levels in Soil and Fluoride Soil Map of Sri Lanka Average Fluoride Levels (Parts Per Million) 13 4 3.5 3 2.5 2 1.5 1 0.5 0 0 50 Prevalence of y = 0.0104x + 1.6579 ESRF in NCP R² = 0.2907 and Relationship with Fluoride 100 150 200 Levels in Soil Average Fluoride Levels (Parts Per Million) Prevalence of ESRF – U (Patients Per Million) Substantial relationship between soil Fluoride levels and prevalence of ESRF – U 3.5 3 2.5 2 1.5 1 0.5 0 y = 0.0047x + 1.8715 R² = 0.0705 Minimal relationship with the 0 50 100 150 prevalence of ESRF 15 –K Prevalence of ESRF – K (Patients per Million) LOCATION OF NEW LABORATORIES IN NORTH WESTERN PROVINCE (NWP) OF SRI LANKA 14 2. The Spatial Distribution, Location Diffusion and Regionalization of Health Care Resources, Access to Utilization of Resources and Factors Related to Resource Distribution and Use SERVICE INVENTORY / ANALYSIS Location of Health Care Institutions in Dr. R.M.S.K Rathnayake Provincial Director of Health Services – NWP North Western Province Dr. P.V.D.S. Dharmagunawardene Medical Superintendent – Base Hospital – Dambadeniya 3 11/25/2011 10 Km Service Location of Areas of Base and Probable Health District Hospitals Care Institutions in North Western for Provision of Province, Where Laboratory Existing Facilities in North Laboratories Western Province Analysis of Location Efficiency 3. Spatial Aspects of the Interactions between Disease and Health Care Delivery NEED ANALYSIS / LOCATION ALLOCATION • Location efficiency is defined as the ratio of actual performance (the average distance to the closest existing health services site) to optimal performance (the average distance to the closest optimal health service site selected by the Location Allocation Model) Location Allocation Model Graphical Representation of Concepts • A location-allocation model is a method for finding optimal sites for facility locations. (Optimal Performance) CRITERIA – Head Injury Patient should reach A Health Care Institution with 24 Hour CT Scan Facilities within 6 Hours of the Injury Travel Time should be 3 Hours • The method involves simultaneously selecting a set of locations for facilities and assigning spatially distributed sets of demands to these facilities to optimize some specified measurable criterion. • 3 Basic Elements – Demand – Spatial distribution of identified location criteria – Service Centre – Spatial Data on existing health infrastructure – Network – Connection between demand and service centres DEMAND SERVICE CENTRE 240 Km = 6 hours NETWORK ACTUAL LOCATION OF THE HEALTH CARE INSTITUTION OPTIMAL LOCATION OF THE HEALTH CARE INSTITUTION LOCATION EFFICIENCY = 50% 120 Km = 3 hours BUFFER 4 11/25/2011 EXAMPLE HEALTH SERVICE DEMAND HEALTH SERVICE LOCATIONS RESULTS – LOCATION EFFICIENCY LOCATION EFFICIENCY OF PHC IN 1981 = 0.89 LOCATION EFFICIENCY OF PHC IN 1991 = 0.85 LOCATION EEFICIENCY OF PHC IN 1996 = 0.83 RESULTS – LOCATION ALLOCATION MODEL 5