Background: Many cities with traffic congestion lack accessibility assessments accounting for traffic congestion and equity considerations but have disaggregated georeferenced municipal-level open data on health services, populations, and travel times big data. We convened a multistakeholder intersectoral collaborative group that developed a digital, web-based platform integrating open and big data to derive dynamic spatial-temporal accessibility measurements (DSTAM) for haemodialysis services. We worked with stakeholders and data scientists and considered people's places of residence, service locations, and travel time to the service with the shortest travel time. Additionally, we predicted the impacts of strategically introducing haemodialysis services where they optimise accessibility.
Methods: Cross-sectional analyses of DSTAM, accounting for traffic congestion, were conducted using a web-based platform. This platform integrated traffic analysis zones, public census and health services datasets, and Google Distance Matrix API travel-time data. Predictive and prescriptive analytics identified optimal locations for new haemodialysis services and estimated improvements. Primary outcomes included the percentage of residents within a 20-min car drive of a haemodialysis service during peak and free-flow traffic congestion. Secondary outcomes focused on optimal locations to maximise accessibility with new services and potential improvements. Findings were disaggregated by sociodemographic characteristics, providing an equity perspective. The study in Cali, Colombia, used geographic and disaggregated sociodemographic data from the adjusted 2018 Colombian census. Predicted travel times were obtained for two weeks in 2020.
Findings: There were substantial traffic variations. Congestion reduced accessibility, especially among marginalised groups. For 6-12 July, free-flow and peak-traffic accessibility rates were 95.2% and 45.0%, respectively. For 23-29 November, free-flow and peak traffic accessibility rates were 89.1% and 69.7%. The locations where new services would optimise accessibility had slight variation and would notably enhance accessibility and health equity.
Interpretation: Establishing haemodialysis services in targeted areas has significant potential benefits. By increasing accessibility, it would enhance urban health and equity.
Funding: No external or institutional funding was received.
Competing Interests: All authors and collaborators completed the ICMJE uniform disclosure form and declared no financial support from any organisation for the submitted work. IQuartil SAS provided technical support to develop the AMORE Platform and was subsidised for consulting services by LGC. For the AMORE Platform development, PZ and LFP received consulting fees and time from IQuartil SAS. DC is a partner at IQuartil SAS and a sibling to LGC. LGC contributed to this work in his personal capacity and time. CJ and EMH are LGC's thesis directors. EAM disclosed a fiduciary role with the Consul World Transplant Games Federation. Universidad del Valle supports LO's academic contribution. LGC and CJV contributed personal time to Driving for Equity, a proposal aligned with the AMORE Project and a finalist at WHO's 2023 LEAD Innovation Challenge. All other authors have nothing to declare.
(© 2024 The Authors.)