Operations Research Methodologies to Improve the Quality, Accessibilty and Equity of Primary Care
Bibliographic record
Abstract
A growing body of evidence reveals the importance of primary care to the overall health of populations, resulting in an increasing interest in efficient, effective, timely and equitable delivery of primary care services. This research focuses on two perspectives of delivering primary care. First, the work focuses on the quality of primary care delivery, represented by distribution of facilities that provide primary care on different quality levels and incur varying costs on the regulator. The proposed model optimizes the geographic distribution of facilities (locations and types) and provides tradeoffs between two objectives - the quality of provided care and the annual operating cost. The Pampalon deprivation index is incorporated directly as a proxy of varying needs, as it was correlated with complex health-care problems, more frequent visits and barriers to obtain care. Results are showcased on the area of Kingston, Ontario. Second, the distribution of general practitioners is addressed, measured in terms of general practitioners (GPs) per population. Many countries are experiencing inequitable distribution of GPs, such that does not match the distribution of the population. It usually results from the fact that health professionals are choosing practice locations according to their own preferences and considerations. To address this issue, human choice is incorporated into the modeling approach explicitly, using Huff’s spatial interactions approach. The utilities of the professionals when choosing communities are modeled, affecting in turn the probabilities of location choice. The presented model explores the option of modifying policies so that the resulting distribution of general practitioners in the studied geographic area will be more equitable. As an example, educational policies are explored, devising the optimal locations of residency training of family physicians and their background combinations (at each training location) for Ontario. The developed methodologies showcased for the province of Ontario, Canada, however they are general enough to be used in any jurisdiction with similar characteristics.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.039 | 0.060 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.003 |
| Bibliometrics | 0.005 | 0.007 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".