Accessibility of Computed Tomography (CT) : Survey to identify underserved populations in rural Alberta
Notice bibliographique
Résumé
Introduction: Computed tomography (CT) access is associated with an earlier diagnosis and initiation of treatment. As part of the clinical pathway, inadequate CT accessibility can contribute towards rural health inequities. A dedicated study on the accessibility of CT in rural Alberta, and perceived impact on patients has not been conducted previously. Methods: Physicians who practice emergency medicine out of one or more rural facilities in Alberta were invited to participate in a mixed methods survey on the accessibility of CT. A process map was created to provide an overview on CT access from rural emergency departments (EDs). Results: Thirteen physicians responded to the survey. Four respondents practice at a facility with onsite CT but limited hours of operation, and nine respondents practice at facilities without onsite CT. Respondents rated the value of CT as equal or higher than their accessibility satisfaction scores. Patients are often held in the emergency department (ED) waiting for CT to resume service, or are transferred to a referral facility for their scan. Distance and Emergency Medical Services (EMS) shortages are common sources of delays, which are perceived to contribute towards poorer patient outcomes. Discussion: CT infrastructure is limited in rural Alberta. Accessibility is further limited by hours of operation, and scan restrictions. High perceived value and low satisfaction indicate the demand for CT exceeds service levels in rural areas. Limited hours of operation for CT obstructs patient flow at all facilities within the catchment area. Poor CT accessibility is a barrier to stroke triage, thus, patients from select rural communities experience greater difficulty accessing treatment within the optimal therapeutic window. Frequent use of EMS for offsite CT transfers has a siphoning impact on limited resources, which have already become more constrained due to Covid-19. Extending CT service hours could preserve EMS crews for emergency patient care, and reduce patient holds in the ED; freeing resources to improve patient flow, and reduce ED wait times. Limitations: Responses are limited to opportunistic data, and subject to recall bias. Due to a low response rate, conclusions cannot be drawn regarding which communities experience the greatest inequities in health access compared to others. Recommendations: Further investigation on the feasibility of extending service hours for existing CT scanners is recommended. Facilities without onsite CT can focus on the frequency of imaging related EMS transfers, and access to acute stroke resources to determine if the addition of an onsite scanner can be justified.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».