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A multicriteria decision analysis framework to measure equitable healthcare access during COVID-19.

ABSTRACT: The ongoing novel coronavirus (COVID-19) pandemic has highlighted the need for individuals to have easy access to healthcare facilities for treatment as well as vaccinations. The surge in COVID-19 hospitalizations during 2020 also underscored the fact that accessibility to nearby hospitals for testing, treatment and vaccination sites is crucial for patients with fever or respiratory symptoms. Although necessary, quantifying healthcare access is challenging as it depends on a complex interaction between underlying socioeconomic and physical factors. In this case study, we deployed a Multi Criteria Decision Analysis (MCDA) approach to uncover the barriers and their effect on healthcare access. Using a least cost path (LCP) analysis we quantified the costs associated with healthcare access from each census block group in the Los Angeles metropolitan area (LA Metro) to the nearest hospital. Social vulnerability reported by the Centers for Disease Control and Prevention (CDC), the daily number of COVID-19 cases from the Los Angeles open data portal and built environment characteristics (slope of the street, car ownership, population density distribution, walkability, traffic collision density, and speed limit) were used to quantify overall accessibility index for the entire study area. Our results showed that the census block groups with a social vulnerability index above 0.75 (high vulnerability) had low accessibility owing to the higher cost of access to nearby hospitals. These areas were also coincident with the hotspots for COVID-19 cases and deaths which highlighted the inequitable exposure of socially disadvantaged populations to COVID-19 infections and how the pandemic impacts were exacerbated by the synergistic effect of socioeconomic status and built environment characteristics of the locations where the disadvantaged populations resided. The framework proposed herein could be adapted to geo-target testing/vaccination sites and improve accessibility to healthcare facilities in general and more specifically among the socially vulnerable populations residing in urban areas to reduce their overall health risks during future pandemic outbreaks.

SUBMITTER: Roy A

PROVIDER: S-EPMC8743600 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Since light fidelity (LiFi) and wireless fidelity (WiFi) do not interfere with one another, a LiFi/WiFi hybrid network may provide superior performance to existing wireless options. With many users and constant changes, a network can easily become overloaded, leading to slowdowns and fluctuations in data transfer speeds. Access point assignment (APA) is required with the increase of users, which can negatively impact the system performance and quality-of-service (QoS) due to mobility and line-of-sight (LOS) blockage. Many variables could influence the APA process; these variables are considered as criteria, such as the network capacity, the degree of blockage, the speed of the connected user, etc. Unlike conditional APA methods, recent studies have considered treating these variables as "evaluation criteria". Considering these criteria can offer better and more accurate results, eventually enhancing the APA process and QoS. However, the variety of these criteria, the conflict amongst them, their weights (importance), and priority have not been addressed so far. Moreover, treating the criteria equally might result in inaccurate outcomes. Therefore, to solve this issue, it is essential to investigate the impact of each criterion on the APA process. In this work, a multicriteria decision-making (MCDM) problem is formulated to determine a network-level selection for each user over a period of time The decision problem is modeled as a hierarchy that fragments a problem into a hierarchy of simple and small subproblems, and the selection of the AP network among various alternatives is a considered as an MCDM problem. Based on the previous works, we are not aware of any previous research attempts using MCDM methods in the LiFi research area for network selection. Therefore, this work proposes an access point assignment framework using an MCDM approach for users in a hybrid LiFi/WiFi network. The experiment was conducted based on four phases: Five criteria were identified and evaluated with eleven APs (alternatives). The outcome of this phase was used to build the decision matrix and an MCDM was developed and built based on user mobility and blockages with various scenarios using all the criteria; The analytic hierarchy process (AHP) was employed to identify the criterion of the subjective weights of each criterion and to determine the degree of importance supported by experts' judgement. Determining the weights in the AHP process considered various investigations, including the consistency ratio (CR) and the AHP consensus indicator, which is calculated using the rank-based maximum likelihood method (RGMM) and Shannon entropy techniques. The VIekriteri-Jumsko KOmpromisno Rangiranje (VIKOR) method is adopted in the selection of the optimal AP for the proper selection of whether a LiFi or WiFi AP must serve the users. The integrated AHP-VIKOR was effective for solving the APA and was the best solution based on using weighted criteria simultaneously. Moreover, the ranking outcomes of the developed integrated AHP-VIKOR approach were evaluated using sensitivity analysis. The result of this work takes the APA for hybrid LiFi networks to a new perspective.

Project description:ObjectiveMulticriteria decision analysis (MCDA) is a useful tool in complex decision-making situations, and has been used in medical fields to evaluate treatment options and drug selection. This study aims to provide valuable insights into MCDA in healthcare through examining the research focus of existing studies, major fields, major applications, most productive authors and countries, and most common journals in the domain.MethodsA bibliometric analysis was conducted on the publication related to MCDA in healthcare from the Web of Science Core Collection (WoSCC) database on 14 July 2021. Three bibliometric software (VOSviewer, R-bibliometrix, and CiteSpace) were used to conduct the analysis including years, countries, institutes, authors, journals, co-citation references, and keywords.ResultsA total of 410 publications were identified with an average yearly growth rate of 32% (1999-2021), from 196 academic journals with 23,637 co-citation references by 871 institutions from 70 countries/regions. The United States was the most productive country (n = 80). Universiti Pendidikan Sultan Idris (n = 16), Université de Montréal (n = 13), and Syreon Research Institute (n = 12) were the top productive institutions. A A Zaidan, Mireille Goetghebeur and Zoltan Kalo were the biggest nodes in every cluster of authors' networks. The top journals in terms of the number of articles (n = 17) and citations (n = 1,673) were Value in Health and Journal of Medical Systems, respectively. The extant literature has focused on four aspects, including the analytic hierarchy process (AHP), decision-making, health technology assessment, and healthcare waste management. COVID-19 and fuzzy TOPSIS received careful attention from MCDA applications recently. MCDA in big data, telemedicine, TOPSIS, and fuzzy AHP is well-developed and an important theme, which may be the trend in future research.ConclusionThis study uncovers a holistic picture of the performance of MCDA-related literature published in healthcare. MCDA has a broad application on different topics and would be helpful for practitioners, researchers, and decision-makers working in healthcare to advance the wheel of medical complex decision-making. It can be argued that the door is still open for improving the role of MCDA in healthcare, whether in its methodology (e.g., fuzzy TOPSIS) or application (e.g., telemedicine).

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A multicriteria decision analysis framework to measure equitable healthcare access during COVID-19.

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