Patient outcomes and regional planning of coronary care services: A location-allocation approach

We explore the use of patient outcome criteria in planning the locations of critical care health services. Two attributes of the regional distribution of health services which influence health outcomes are: (1) the geographical accessibility of services and (2) the number of patients served by each facility (the patient volume). A model incorporating both factors is developed to determine the number, sizes, and locations of coronary care services in a region in order to maximize patient outcomes. We examine the implications and use of the model in an investigation of the location of coronary care units in rural upstate New York. The results indicate that a system consisting of fewer, well-located coronary care units would be superior for patient survival than the existing system of many dispersed units. Disparities in access to services between urban and rural areas are discussed.