Initial Mobility Analysis for ORNL VA-EDH Synthetic Populations
Travel burdens are a major barrier to healthcare access among US Veteran patient populations, particularly those residing in rural areas. Spatial accessibility to points of care for US Veteran populations is commonly assessed in two ways. The first approach uses open data from the US Census to represent collective travel burdens, for example the distance between population-weighted census tract centroids and VHA points of care. The second approach uses restricted-access VHA patient data to measure travel costs (e.g., distance, time) for accessing points of care with respect to geolocated patient addresses and real or approximated transportation networks. While the advantage of the open data approach lies in its reproducibility, it has notable limitations in its tendency to infer individual travel behavior from aggregate population characteristics, a problem known as ecological fallacy. Conversely, while the patient data approach is able to account for individual travel behavior, its ability to account for localized access disparities (e.g., a neighborhood with exceptionally high transportation costs) and patient demographics is limited as protecting individual patient data requires their storage in closed systems with limited capacity for adequately modeling real-world travel patterns or for supplementing patient attributes. Additionally, the patient data approach cannot account for veterans who are not enrolled in the VHA system but who may be eligible for care. These challenges limit the ability to perform “what if” analyses on the effects of place-specific interventions on veteran populations with high access barriers to healthcare. To address these challenges, we explore the application of realistic synthetic populations to examine travel burdens and spatial accessibility issues among veteran patient populations. Synthetic populations provide a virtual, individually-resolved and cross-sectional representation of the veteran patient population that enables investigation of spatial access to points of care in ways in which aggregate data and patient data do not. First, synthetic populations allow one to directly assess how individuals access points of care, from synthesized residential locations to outpatient facilities on real-world transportation networks. Modeling access to points of care at the individual scale addresses the ecological fallacy problem associated with using aggregated census data to represent veteran populations and patterns of movement. Second, synthetic populations provide a means of completely representing an area’s veteran population using only publicly available, anonymized census microdata from the American Community Survey (ACS) to ensure the privacy of real-world individuals. Generating synthetic populations from the ACS also expands descriptive characteristics beyond what patient data typically offers to include socio-demographic, economic, housing, and mobility attributes. More detailed profiles of both VHA patient populations and veterans not enrolled in the VA system will provide a comprehensive picture of groups that may benefit from interventions or outreach. As an initial exercise for using synthetic populations to measure veteran travel burdens to VA care, we apply Oak Ridge National Laboratory’s (ORNL) UrbanPop capability to generate a series of synthetic VHA patient populations for 9 Veterans Integrated Services Networks (VISN) market areas in 9 Census Divisions across the continental United States, which are listed in Table 1. We use UrbanPop to produce synthetic populations for the VISN markets selected for each US Census Division, then assign VA outpatient clinic destinations to synthetic VHA patients based on travel about each VISN market’s road network. To demonstrate using the synthetic populations to evaluate healthcare travel burdens, we compare the time-based impedance between simulated home locations and VA outpatient clinics in each VISN market. We then perform validation exercises on the synthetic populations with respect to neighborhood (block group) demographic composition as well as patient mobility, comparing aggregate origin-destination statistics for the synthetic population to outpatient visits available in restricted patient data from the VA’s Corporate Data Warehouse (CDW) database.