In the continuum of care model, a health system guides and tracks patients over time - from birth to death - through a comprehensive array of services across all levels of care. It is a shift from the traditional hospital-centered model, and instead embraces a mindset that coordinating primary care, wellness & health education, and rehabilitation are as important as acute care.
This example reflects an analysis that was conducted to support ambulatory planning. Executive leadership had developed questions surrounding PCP need:
- What factors influence PCP access?
- Where are the greatest needs for a PCP in Hawaii?
An assumption made was that reporting to have a personal doctor on the CDC Behavioral Risk Factor Surveillance System (BRFSS) was a proxy for having PCP access.
Frequency for Health Care Access: Had one or more personal doctor or health care provider
persdoc2 prevalence prevalence_low prevalence_upp N N_se <chr> <dbl> <dbl> <dbl> <dbl> <dbl> 1 1 0.626 0.610 0.641 705524. 11265. 2 2 0.221 0.209 0.234 249712. 7549. 3 3 0.153 0.141 0.165 172309. 7356.
The constraints for the microsimulation model was developed using estimates from the US Census American Community Survey. The BRFSS survey was callibrated to the census estimates at the tract-level using the GREGWT model. The synthetic population resulting from the microsimulation was then used to extrapolate PCP need.
Barriers to a PCP
Significant factors that contributed to not having a personal doctor were age -young adults were less likely to have a personal doctor- and insurance coverage. Females and those with incomes of $75K or greater were more likely to report having a personal doctor.
The choropleth map below represents the proportion having a personal doctor. Areas lower than state average (~84%) were identified as being an area of need. On Oahu, urban Honolulu reported higher estimates than rural areas except where public housing was located such as 62.02 (Kuhio Park Terrace) and 54 (Mayor Wright Homes).
The analysis helped to stimulate further discussion on PCP need and access on both Oahu and Hawaii island. For example, the results of this analysis gave both the estimated population in a tract area. Given this estimate and a “typical” panel, we could estimate the total number of PCPs needed to meet the need. This would help with ambulatory planning to ensure staffing is set properly and then eventually guide build-out of facilities, etc.