Optimal allocation of physicians improves accessibility and workload disparities in stroke care

Kazuki Ohashi; Toshiya Osanai; Kyohei Bando; Kensuke Fujiwara; Takumi Tanikawa; Yuji Tani; Soichiro Takamiya; Hirotaka Sato; Yasuhiro Morii; Tomoki Ishikawa; Katsuhiko Ogasawara

doi:10.1186/s12939-023-02036-9

Optimal allocation of physicians improves accessibility and workload disparities in stroke care

Int J Equity Health. 2023 Nov 7;22(1):233. doi: 10.1186/s12939-023-02036-9.

Authors

Kazuki Ohashi¹, Toshiya Osanai², Kyohei Bando³, Kensuke Fujiwara^{1

4}, Takumi Tanikawa^{1

5}, Yuji Tani^{1

6}, Soichiro Takamiya^{2

7}, Hirotaka Sato⁸, Yasuhiro Morii^{1

9}, Tomoki Ishikawa^{1

10}, Katsuhiko Ogasawara¹¹

Affiliations

¹ Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan.
² Department of Neurosurgery, Faculty of Medicine, Graduate School of Medicine, Hokkaido University, N15-W7, Kita-ku, Sapporo, 060-8638, Japan.
³ Graduate School of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan.
⁴ Graduate School of Commerce, Otaru University of Commerce, 3-5-21, 047-8501, Otaru, Midori, Japan.
⁵ Faculty of Health Sciences, Hokkaido University of Science, 7-15-4-1, Maeda, Teine-ku, Sapporo, 006- 8585, Japan.
⁶ Department of Medical Informatics and Hospital Management, Asahikawa Medical University, E2-1-1-1, 078-8510, Asahikawa, Midorigaoka, Japan.
⁷ Department of Neurosurgery, Otaru General Hospital, 1-1-1, Wakamatsu, Otaru, 047-8550, Japan.
⁸ Department of Neurosurgery, Asahikawa Medical University, E2-1-1-1, Midorigaoka, Asahikawa, 078- 8510, Japan.
⁹ Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6, Minami, Wako, Japan.
¹⁰ Institute for Health Economics and Policy, 1-21-19, Toranomon, Minato-ku, 105-0001, Japan.
¹¹ Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-ku, Sapporo, 060-0812, Japan. oga@hs.hokudai.ac.jp.

Abstract

Background: Inequalities in access to stroke care and the workload of physicians have been a challenge in recent times. This may be resolved by allocating physicians suitable for the expected demand. Therefore, this study analyzes whether reallocation using an optimization model reduces disparities in spatial access to healthcare and excessive workload.

Methods: This study targeted neuroendovascular specialists and primary stroke centers in Japan and employed an optimization model for reallocating neuroendovascular specialists to reduce the disparity in spatial accessibility to stroke treatment and workload for neuroendovascular specialists in Japan. A two-step floating catchment area method and an inverted two-step floating catchment area method were used to estimate the spatial accessibility and workload of neuroendovascular specialists as a potential crowdedness index. Quadratic programming has been proposed for the reallocation of neuroendovascular specialists.

Results: The reallocation of neuroendovascular specialists reduced the disparity in spatial accessibility and the potential crowdedness index. The standard deviation (SD) of the demand-weighted spatial accessibility index improved from 125.625 to 97.625. Simultaneously, the weighted median spatial accessibility index increased from 2.811 to 3.929. Additionally, the SD of the potential crowdedness index for estimating workload disparity decreased from 10,040.36 to 5934.275 after optimization. The sensitivity analysis also showed a similar trend of reducing disparities.

Conclusions: The reallocation of neuroendovascular specialists reduced regional disparities in spatial accessibility to healthcare, potential crowdedness index, and disparities between facilities. Our findings contribute to planning health policies to realize equity throughout the healthcare system.

Keywords: Mechanical thrombectomy; Potential crowdedness index; Primary Stroke center; Quadratic programming; Spatial accessibility; Two-step floating catchment area method.

MeSH terms

Health Facilities
Health Services Accessibility
Humans
Physicians*
Stroke* / therapy
Workload