Clustering patient mobility patterns to assess effectiveness of health-service delivery

Background: Analysis of patient mobility in a country not only gives an idea of how the health-care system works, but also can be a guideline to determine the quality of health care and health disparity among regions. Even though determination of patient movement is important, it is not often realized that patient mobility could have a unique pattern beyond health-related endowments (e.g., facilities, medical staff). This study therefore addresses the following research question: Is there a way to identify regions with similar patterns using spatio-temporal distribution of patient mobility? The aim of the paper is to answer this question and improve a classification method that is useful for populous countries like Turkey that have many administrative areas. Methods: The data used in the study consist of spatio-temporal information on patient mobility for the period between 2009 and 2013. Patient mobility patterns based on the number of patients attracted/escaping across 81 provinces of Turkey are illustrated graphically. The hierarchical clustering method is used to group provinces in terms of the mobility characteristics revealed by the patterns. Clustered groups of provinces are analyzed using non-parametric statistical tests to identify potential correlations between clustered groups and the selected basic health indicators. Results: Ineffective health-care delivery in certain regions of Turkey was determined through identifying patient mobility patterns. High escape values obtained for a large number of provinces suggest poor health-care accessibility. On the other hand, over the period of time studied, visualization of temporal mobility revealed a considerable decrease in the escape ratio for inadequately equipped provinces. Among four of twelve clusters created using the hierarchical clustering method, which include 64 of 81 Turkish provinces, there was a statistically significant relationship between the patterns and the selected basic health indicators of the clusters. The remaining eight clusters included 17 provinces and showed anomalies. Conclusions: The most important contribution of this study is the development of a way to identify patient mobility patterns by analyzing patient movements across the clusters. These results are strong evidence that patient mobility patterns provide a useful tool for decisions concerning the distribution of health-care services and the provision of health care equipment to the provinces.