Geography Department, Simon Fraser University, Robert C. Brown Hall, 8888 University Road, Burnaby, BC, V5A 1S6, Canada.
University of Auckland, 23 Symonds Street, Auckland, 1142, New Zealand.
BMC Health Serv Res. 2020 Mar 4;20(1):168. doi: 10.1186/s12913-020-5024-y.
In Canada, access to palliative care is a growing concern, particularly in rural communities. These communities have constrained health care services and accessing local palliative care can be challenging. The Site Suitability Model (SSM) was developed to identify rural "candidate" communities with need for palliative care services and existing health service capacity that could be enhanced to support a secondary palliative care hub. The purpose of this study was to test the feasibility of implementing the SSM in Ontario by generating a ranked summary of rural "candidate" communities as potential secondary palliative care hubs.
Using Census data combined with community-level data, the SSM was applied to assess the suitability of 12 communities as rural secondary palliative care hubs. Scores from 0 to 1 were generated for four equally-weighted components: (1) population as the total population living within a 1-h drive of a candidate community; (2) isolation as travel time from that community to the nearest community with palliative care services; (3) vulnerability as community need based on a palliative care index score; and (4) community readiness as five dimensions of fit between a candidate community and a secondary palliative care hub. Component scores were summed for the SSM score and adjusted to range from 0 to 1.
Population scores for the 12 communities ranged widely (0.19-1.00), as did isolation scores (0.16-0.94). Vulnerability scores ranged more narrowly (0.27-0.35), while community readiness scores ranged from 0.4-1.0. These component scores revealed information about each community's particular strengths and weaknesses. Final SSM scores ranged from a low of 0.33 to a high of 0.76.
The SSM was readily implemented in Ontario. Final scores generated a ranked list based on the relative suitability of candidate communities to become secondary palliative care hubs. This list provides information for policy makers to make allocation decisions regarding rural palliative services. The calculation of each community's scores also generates information for local policy makers about how best to provide these services within their communities. The multi-factorial structure of the model enables decision makers to adapt the relative weights of its components.
在加拿大，获得姑息治疗的机会是一个日益受到关注的问题，特别是在农村社区。这些社区的医疗服务受到限制，获得当地姑息治疗可能具有挑战性。地点适宜性模型（SSM）是为了确定需要姑息治疗服务的农村“候选”社区和现有卫生服务能力而开发的，这些能力可以增强以支持二级姑息治疗中心。本研究的目的是通过生成农村“候选”社区作为潜在二级姑息治疗中心的排名摘要，测试在安大略省实施 SSM 的可行性。
使用人口普查数据结合社区层面的数据，应用 SSM 评估 12 个社区作为农村二级姑息治疗中心的适宜性。为四个同等加权的组成部分生成 0 到 1 的分数：（1）人口：居住在候选社区 1 小时车程范围内的总人口；（2）隔离：从该社区到最近提供姑息治疗服务的社区的旅行时间；（3）脆弱性：基于姑息治疗指数得分的社区需求；以及（4）社区准备情况：候选社区和二级姑息治疗中心之间的五个适合度维度。对 SSM 得分进行了求和，并进行了调整，范围从 0 到 1。
12 个社区的人口得分差异很大（0.19-1.00），隔离得分也相差很大（0.16-0.94）。脆弱性得分范围较窄（0.27-0.35），而社区准备情况得分范围从 0.4 到 1.0。这些组成部分的得分揭示了每个社区的具体优势和劣势的信息。最终的 SSM 得分从 0.33 到 0.76 不等。
SSM 很容易在安大略省实施。最终得分根据候选社区成为二级姑息治疗中心的相对适宜性生成了一个排名列表。该列表为决策者提供了有关农村姑息治疗服务分配决策的信息。计算每个社区的得分还为当地决策者提供了有关如何在其社区内提供这些服务的信息。该模型的多因素结构使决策者能够调整其组成部分的相对权重。
