*The Question

The use of Geographic Information Systems and linked, large, disparate datasets to evaluate the Australian

population’s access to Intensive Care and the impact of access upon patient

outcomes.

*Victor Nicholls, MacroGIS, Brisbane, Qld

*A/Prof Arthas Flabouris, Royal Adelaide Hospital, Uni of Adelaide, SA

*The Story

*Why Australian New Zealand Intensive Care Society

(ANZICS) and MacroGIS?

*More about the Big Data issues and how they were

overcome rather than the project itself

*Hopefully provide some insights into the application

of GIS to the Big Data Questions

*What is GIS and how it can be used

*The Task

*ANZICS collects patient specific data which is used to measure ICU activity and benchmark ICU performance

*Prior studies have shown inter-hospital transfer and remoteness to be associated with a higher mortality

*Use GIS to link geocoded data from various sources so as to explore the relationship of patient accessibility, remoteness, and distance to admitting ICU, upon outcome and changes over time

*The Data

*One of the largest Intensive Care patient databases in the world

Simple in structure but complex in context of business relationships

Compliance from contributors was a factor

*Australian Postcodes ARIA+ ratings

Populations

*The Demographics

78,486

46,813

8,863

5,144

4,397

15,107

54,036

5,863

218 709 patients, from 76 public hospital ICUs, over 6 years • 84% of known public ICUs • all patients with known

residential postcodes 49,674 (22.7 %) patients where transferred from another hospital prior to ICU admission

19,494 (8.9%) patients were transferred from another hospital, directly to an ICU.

*Patients and their admitting ICUs

Postcodes

of trauma

admissions

Postcodes of other

hospital admissions

Location of ICUs,

population and

infrastructure

*Problems and Solutions

*Having the right skills available

Difficult to find combined skills in GIS and healthcare

More difficult the more defined the health division

Can be a learn as you go process

*Understanding the data specifically from an ICU

Understanding the data in the context of the business

What is required spatial query or visualisation or both

So much data, what specific information is required

*Selecting appropriate External data sets. Given constraints of

Budget

What meets the needs

*Problems and Solutions

*Building a methodology to move forward

Cannot scope like a normal project

*Having flexibility in the business to absorb

changes as they happened

Can result in changes to business rules

*Budgetary constraints

*Time constraints on individuals

*Conclusions

GIS can be utilised to

* Link geocoded data from a wide variety of large, clinical and non clinical datasets

–Of the Australian population, 84.8% live within 0-50 km of any ICU

–However this varied amongst the States/Territories (49.3% - 100%)

* Qualitatively and quantitatively explore, and reveal, relationships that would not otherwise be obvious from typical tabulated and graphical formats

–Remoteness associated with lower Level ICU, patient distance to admitting ICU

–Neither distance, nor remoteness, were significant contributors to mortality, but were associated with an increase in ICU and hospital LOS

*Conclusions

GIS can be utilised to

* Illustrate temporal relationships

* Proportion of ICU admissions that are inter-hospital transfers has

not increased over time but distance travelled by patients, and

remoteness has

* Potential to aid in future planning of ICU services and

monitor the accessibility of population to such services,

and their outcomes.

*Where to from Here

*Move from a proof of concept to a fully installed

application

*Widen the scope

*Incorporate more data

*Improve data collection

*Refine functionality

*Utilise new technology

Questions

For more information contact

Victor Nicholls

victor.n@macrogis.com.au

www.macrogis.com.au

+ 61 7 3885 4429