title: Measuring geographical accessibility to palliative and end of life (PEoLC) related facilities: a comparative study in an area with well-developed specialist palliative care (SPC) provision.
abstract: BACKGROUND
  Geographical accessibility is important in accessing healthcare services. Measuring it has evolved alongside technological and data analysis advances. High correlations between different methods have been detected, but no comparisons exist in the context of palliative and end of life care (PEoLC) studies. To assess how geographical accessibility can affect PEoLC, selection of an appropriate method to capture it is crucial. We therefore aimed to compare methods of measuring geographical accessibility of decedents to PEoLC-related facilities in South London, an area with well-developed SPC provision.
  
  
  METHODS
  Individual-level death registration data in 2012 (n = 18,165), from the Office for National Statistics (ONS) were linked to area-level PEoLC-related facilities from various sources. Simple and more complex measures of geographical accessibility were calculated using the residential postcodes of the decedents and postcodes of the nearest hospital, care home and hospice. Distance measures (straight-line, travel network) and travel times along the road network were compared using geographic information system (GIS) mapping and correlation analysis (Spearman rho).
  
  
  RESULTS
  Borough-level maps demonstrate similarities in geographical accessibility measures. Strong positive correlation exist between straight-line and travel distances to the nearest hospital (rho = 0.97), care home (rho = 0.94) and hospice (rho = 0.99). Travel times were also highly correlated with distance measures to the nearest hospital (rho range = 0.84-0.88), care home (rho = 0.88-0.95) and hospice (rho = 0.93-0.95). All correlations were significant at p < 0.001 level.
  
  
  CONCLUSIONS
  Distance-based and travel-time measures of geographical accessibility to PEoLC-related facilities in South London are similar, suggesting the choice of measure can be based on the ease of calculation.
authors.affiliation: King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Pearson
authors.affiliation: Office for National Statistics, Life Events and Population Sources Division, Newport, NP10 8XG, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Verne
authors.affiliation: Public Health England, National End of Life Care Intelligence Network, 2 Rivergate, Temple Quay, Bristol, BS1 6EH, UK.
authors.forename: Claudia
authors.initials: C
authors.lastname: Wells
authors.affiliation: Care Quality Commission, 151 Buckingham Palace Road, London, SW1W 9SZ, UK.
authors.forename: Giovanna M
authors.initials: GM
authors.lastname: Polato
authors.affiliation: King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.affiliation: King's College London, Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK. wei.gao@kcl.ac.uk.
authors.forename: Wei
authors.initials: W
authors.lastname: Gao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D013727:Terminal Care / Q000706:statistics & numerical data*; D014195:Travel
keywords: Accessibility; Geographical accessibility; Health services; Methods; Palliative care