AMORE Project: Integrated knowledge translation and geospatial analysis to improve travel times to health services (accessibility) and health equity in Cali, Colombia: a proof of concept using mixed-methods research

Cuervo, Luis Gabriel; Cuervo, Daniel; Hatcher-Roberts, Janet; Martínez-Herrera, Eliana; Pinilla, Luis Fernando; Piquero, Felipe; Ospina, Maria; Molina, Ciro Jaramillo

doi:10.31237/osf.io/4atqc

Cited by 6 publications

(10 citation statements)

References 58 publications

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“…Future studies will assess the use and appropriation of data, and the advocacy of stakeholders, including those in the AMORE Project Collaborative Group (table 2). 10 49…”

Section: Discussionmentioning

confidence: 99%

Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel time big data from a Google API

et al. 2022

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ObjectivesTo test a new approach to characterise accessibility to tertiary care emergency health services in urban Cali and assess the links between accessibility and sociodemographic factors relevant to health equity.DesignThe impact of traffic congestion on accessibility to tertiary care emergency departments was studied with an equity perspective, using a web-based digital platform that integrated publicly available digital data, including sociodemographic characteristics of the population and places of residence with travel times.Setting and participantsCali, Colombia (population 2.258 million in 2020) using geographic and sociodemographic data. The study used predicted travel times downloaded for a week in July 2020 and a week in November 2020.Primary and secondary outcomesThe share of the population within a 15 min journey by car from the place of residence to the tertiary care emergency department with the shortest journey (ie, 15 min accessibility rate (15mAR)) at peak-traffic congestion hours. Sociodemographic characteristics were disaggregated for equity analyses. A time-series bivariate analysis explored accessibility rates versus housing stratification.ResultsTraffic congestion sharply reduces accessibility to tertiary emergency care (eg, 15mAR was 36.8% during peak-traffic hours vs 84.4% during free-flow hours for the week of 6–12 July 2020). Traffic congestion sharply reduces accessibility to tertiary emergency care. The greatest impact fell on specific ethnic groups, people with less educational attainment and those living in low-income households or on the periphery of Cali (15mAR: 8.1% peak traffic vs 51% free-flow traffic). These populations face longer average travel times to health services than the average population.ConclusionsThese findings suggest that health services and land use planning should prioritise travel times over travel distance and integrate them into urban planning. Existing technology and data can reveal inequities by integrating sociodemographic data with accurate travel times to health services estimates, providing the basis for valuable indicators.

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“…Future studies will assess the use and appropriation of data, and the advocacy of stakeholders, including those in the AMORE Project Collaborative Group (table 2). 10 49…”

Section: Discussionmentioning

confidence: 99%

Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel time big data from a Google API

et al. 2022

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“…These new data sources merit future testing by concerned stakeholders. 1 This study used the digital AMORE Platform to show the effects of traffic congestion on equitable access to tertiary care emergency departments. The data shows which populations take longer to reach a facility within a time threshold under different traffic congestion levels.(1) "AMORE" from the anagram of the earlier name of the project "Análisis espacial con Macrodatos para Orientar los Resultados en pro de la Equidad en salud" [Spatial analysis with bigdata to guide health equity outcomes].The broader proof-of-concept assesses the value of new data obtained by integrating secondary data from publicly available sources.…”

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confidence: 99%

“…This cross-sectional study builds on a proof-of-concept, the AMORE Project (1) and provides a baseline assessment of accessibility to urgent tertiary care at peak and free flow traffic times in Cali. 1 It makes the case for assessing travel time over distance, and accounting for traffic congestion.…”

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Cross-sectional equity analysis of accessibility by automobile to tertiary care emergency services in Cali, Colombia in 2020

Cuervo

Martínez-Herrera

Osorio³

et al. 2022

Preprint

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This study provides data on equity in accessibility to tertiary care emergency services in Cali, accounting for traffic congestion, in two separate weeks in 2020. This cross-sectional study builds on a proof-of-concept, the AMORE Project and provides a baseline assessment of accessibility to urgent tertiary care at peak and free-flow traffic times in Cali. It makes the case for assessing travel time over distance and accounting for traffic congestion. This study indicates that people in vulnerable situations have to travel longer and therefore invest more of their personal direct and indirect resources to access tertiary care emergency departments than the average population. This study emphasizes the added value of integrating new data sources that can inform health services and urban planning. These new data sources merit future testing by concerned stakeholders. This study used the digital AMORE Platform to show the effects of traffic congestion on equitable access to tertiary care emergency departments. The data shows which populations take longer to reach a facility within a time threshold under different traffic congestion levels. The broader proof-of-concept assesses the value of new data obtained by integrating secondary data from publicly available sources. These sources combine geospatial analysis with census microdata, health services location data, and bigdata for travel times. The analysis covered the city of Cali, which has 2.258 million residents and is the third-largest city in Colombia. The analysis shows the projected accessibility assessments for two weeks during the COVID-19 pandemic, 6 to 12 July 2020, and 23 to 29 November 2020. Restrictions on car travel had been lifted before the July assessment, but stay-at-home orders were in place during the November assessment, which showed substantially less traffic. This assessment found that traffic congestion sharply reduces accessibility to tertiary emergency care. Reduced access has the greatest impact on people with less education, those living in low-income households or on the periphery of Cali, and specific ethnic groups (e.g., nomadic people like the Rrom, and Afro-descendants). This assessment also identifies the concentration of tertiary care emergency departments in areas of lower population density, leaving large swaths of the population with poor accessibility. Dashboards were used to report data using simple univariate and bivariate analyses. In July 2020, the estimated overall accessibility at peak traffic hours was 37% and in November 2020 it increased to 57% due to reduced traffic congestion. These results illustrate the value of the proposed tools in monitoring and adjusting to changing conditions.

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Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020

Cuervo,

Villamizar,

Cuervo

et al. 2024

Int J Equity Health

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In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1–2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion.Methodology: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6–12 July 2020 and 23–29 November 2020. The interactive digital platform is openly available.Primary and secondary outcomes: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1–2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion.Results: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali’s urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6–12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1–2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.

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AMORE Project: Integrated knowledge translation and geospatial analysis to improve travel times to health services (accessibility) and health equity in Cali, Colombia: a proof of concept using mixed-methods research

Cited by 6 publications

References 58 publications

Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel time big data from a Google API

Dynamic accessibility by car to tertiary care emergency services in Cali, Colombia, in 2020: cross-sectional equity analyses using travel time big data from a Google API

Cross-sectional equity analysis of accessibility by automobile to tertiary care emergency services in Cali, Colombia in 2020

Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020

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