By Dr. Ali Lakhani and Professor Elizabeth Kendall
Incidences of neuro-trauma (a form of brain or spinal cord injury) in Australia have a considerable impact on health and social service systems. For example, the Australian Institute of Health and Welfare, Australia’s Health 2016 report clarified that during 2013-2014, there were approximately 37,000 hospitalisations due to stroke, and 28,000 incidences of stroke related entry into rehabilitation. As many of those engaging with rehabilitation will spend a considerable time engaging with diverse health and social services in medical and community settings, it is important that health services in community and medical environments have the capacity to meet the demand. Inevitably, capacity issues amongst health and social care providers can either necessitate or prevent the movement of people with traumatic injury across medical and community environments, and these capacity issues can have favourable or unfavourable consequences on the health and wellbeing of people who have experienced neuro-trauma and their family and/or carers.
The spatial nature of traumatic injury
Experiencing a traumatic injury can be regarded as the initiation of a spatial journey resulting in the consistent movement between health and community settings. For people who have experienced neuro-trauma in an urban centre, their rehabilitation journey may involve an initial entry into a general emergency department, or trauma -specific emergency department. After, dependent on severity of injury and availability of services, they may be transferred to an intensive care unit or an acute trauma care unit, followed by a rehabilitation unit or a neuro-trauma specific rehabilitation unit. Their rehabilitation journey continues upon re-entry into the community, where wrap-around health and social services can support rehabilitation upon return to home.
For people in a rural and/or remote settings within Australia, the rehabilitation journey can be described as a ‘black hole’. People with traumatic injury in rural and/or remote settings may or may not have access to the same level of hospital and community supports required to promote favourable health and rehabilitation outcomes. For example, as highlighted in Position issue 99, people within rural and remote locations within Queensland, experience statistically significantly higher travel times to disability services than those in inner regional or major cities in Queensland. The lack of proximately available services has the potential to negatively impact rehabilitation outcomes and subsequent community engagement outcomes of people who have experienced a traumatic injury.
The importance of geography
At times, health service capacity gaps necessitate the spatial journey experienced by people with traumatic injury. In their 2017 article published in Disability and Rehabilitation Abrahamson and colleagues detail the process of movement between medical and community health services that people who have experienced a traumatic brain injury face. They highlight how the limited availability of hospital beds or clinician staff within hospital units can inhibit the receipt of care, create confusion amongst inpatients and family members, and potentially adversely impact health outcomes. Furthermore, they confirm that these issues are also faced upon re-entry into the community, as health and social services in the community may not be proximately available or have the adequate resources to support the health needs of clients requiring support. Clearly, given the spatial nature of disability, it is important that the decisions of health and social service systems are informed by spatial data and spatial methods.
The Epidoros-V2 data matrix
Researchers from The Hopkins Centre, Menzies Health Institute Queensland, Griffith University and ESRI Australia are developing Epidoros – V2, a spatial platform to engage GIS and non-GIS users, who are clinicians, end users with disability, social service organisations, and researchers. This platform will enable end users to engage with spatial data, raise queries, and support health and social service decision making. As a part of this work, researchers from The Hopkins Centre have developed a data matrix underpinning the platform. The data matrix clarifies spatial data necessary to assess the responsiveness and quality of health services across the continuum of health and social systems engaged with post-injury: emergency and critical care, acute treatment, rehabilitation, and community service systems. The infographic included as Figure 1 above provides an illustration of the Epidoros-V2 matrix, and examples of the types of data aligned with each cell are provided within ovals.
Queensland car accidents and emergency department capacity
The power of Epidoros-V2 is best exemplified by spatial queries that will be addressed via the platform and underpinning data. One essential spatial query surrounds ascertaining the capacity of emergency departments to address the needs of people who have experienced a traumatic injury due to a car accident. Maps 1 and 2 clarify the extent of car accident hotspots across the Greater Brisbane Area, and the capacity of hospitals with emergency units to support those who may have experienced an accident. Hospital locations were sourced from Health Direct’s, National Health Service Directory, the extent of hospitals with a rehabilitation unit and the number of beds within the rehabilitation unit were identified from the Australian Institute of Health and Welfare ‘My Hospitals’ website. Data surrounding the number of car accidents resulting in a fatality, medical treatment, and/or hospitalisation over a 10 year period were sourced from the Queensland Government data portal. All analysis were conducted using ESRI ArcMap 10.4.1.
Map 1 illustrates where car accident hotspots exist across Greater Brisbane’s SA4s. To produce this map, nine optimised hotspot analyses were conducted clarifying areas where significantly high numbers of car accidents were occurring across Greater Brisbane’s nine SA4s. Within the map frame, SA4s for East, West, North, South, and Inner City Brisbane are enlarged to enhance visibility due to smaller polygons produced within these areas during hotspot analyses.
Map 2 clarifies the capacity of Queensland Hospital and Health Service (QHHS) emergency departments to address the health needs of those who have experienced a car accident. A service area analysis using ESRI’s administered road network service was conducted to clarify the service area covered over a 5, 10, and 15 minute drive of each hospital with an emergency department. Combined, Map 1 and 2 support the notion that inner regional and outer regional hospitals may have limited capacity to address the health needs of those who experience a car accident across an extended geographical area. Furthermore, dedicating greater resources towards emergency and critical care within such regions may be warranted.
The potential to reduce harm
It is important that spatial data is made available to those who engage with health and rehabilitation services, and those who plan and coordinate the delivery of such services. Epidoros-V2 will inform decision making by making spatial data available and providing a portal for GIS and non-GIS users to engage with this data. Consequently, the platform has the potential to promote favourable health and wellbeing outcomes for people who have experienced a traumatic injury. It is necessary that end users with lived experience are involved in this development process. To this aim, towards the end of the year, Researchers from The Hopkins Centre and ESRI Australia will be piloting an initial iteration of the platform among people who have experienced a traumatic injury, clinicians, and policy makers.
Dr Ali Lakhani is a Research Fellow with The Hopkins Centre, Menzies Health Institute Queensland at Griffith University. He is leading a program of research which investigates the geospatial determinants of health for people with traumatic injury.
Professor Elizabeth Kendall is the Executive Director of The Hopkins Centre, Menzies Health Institute Queensland at Griffith University. She has run a collaborative research program for the last 25 years with several significant partners including Queensland Health, the Motor Accident Insurance Commission, Synapse, Spinal Life Australia and Health Consumers Queensland.