Academic journal article The Geographical Review

Delineating Hierarchical Hospital Service Areas in Florida

Academic journal article The Geographical Review

Delineating Hierarchical Hospital Service Areas in Florida

Article excerpt

ABSTRACT. Hospital service area (HSA) and hospital referral region (HRR), known as a hierarchical HSA system, have been used as analysis units in a growing body of large-scale studies of healthcare spending, utilization, and outcome in the United States. However, the popular Dartmouth HSAs and HRRs were produced more than two decades ago and are unable to represent contemporary healthcare markets. This research uses a revised Huff Model to delineate two levels of hospital service areas in Florida, resulting in sixty-four HSAs nested in twenty-one HRRs. Three elements distinguish our method from existing work. First, a best-fitting distance-decay function derived from the actual travel pattern of hospitalization is embedded in the Huff Model to strengthen the model's theoretical foundation in individual spatial behavior. Secondly, the hierarchal central place structure is supported by the differing travel-friction coefficients for general versus specialized patients; general patients experience a steeper gradient and thus a shorter average travel range that supports delineating more HSAs of smaller area size, and specialized patients exhibit a flatter gradient and thus a longer average travel range that leads to fewer HRRs of large-sized areas. Finally, the delineation method automated in geographic information systems (GIS) can be easily replicated in other regions to define large-scale and consistent hierarchical HSA systems. Keywords: distance-decay function, Huff Model, hospital service areas (HSAs), hospital referral regions (HRRs), central place theory, State Inpatient Database (SID), Florida.

Local hospitalization has been called upon by many countries because it reduces travel and medical cost of patients, balances supply and demand of healthcare services, maintains local hospital revenue, and improves patient-doctor relationships at large (Willbush 1974; Basu and Cooper 2000; Basu and Friedman 2007). However, some general hospitals are not equipped with sufficient infrastructure and expertise for specialized or tertiary care, such as cardiac surgery, and those patients need to be referred to tertiary hospitals. Tertiary hospitals normally deliver a higher level of specialty care to relatively less concentrated demand, and thus are fewer than general hospitals, and each covers a larger geographical area. There are more general hospitals that draw patients from local areas for routine care and fewer tertiary hospitals that reach patients farther away for highly technical or specialized services. They form a hierarchical hospital service area (HSA) system.

The Dartmouth hospital service areas (HSAs) are defined as areas within which most of local hospitalization occurs. The HSAs with most of their patients going to the same hospital for specialized services such as cardiovascular surgical procedures and neurosurgery are further aggregated into a Dartmouth hospital referral region (HRR). The Dartmouth HSA-HRR system, representing the healthcare market during 1992-1993, has been considered the most authoritative new-generation analysis unit specifically designed for hospital- or hospitalization-related studies in the United States (Center for Evaluative Clinical Sciences 1999). However, the Dartmouth HSAs are outdated and unrepresentative of overall patients (Jia and others 2015), and a similar claim applies to its derivative HRRs. The hierarchical HSA system needs to be updated for better representing contemporary healthcare markets.

Unlike the Dartmouth HSAs that relied on the Medicare patients' data, this research uses the State Inpatient Database (SID) that included all inpatient discharge records in 2011. More importantly, our method, based on a revised Huff Model, differs from existing work in at least three aspects:

1) A best-fitting distance-decay function is derived from the actual travel pattern of hospitalization, and is embedded in the revised Huff Model. The traditional Huff Model simply assumes a gravity kernel (for example, power function) for the distance-decay effect, whose parameter value is often set arbitrarily. …

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