基于医疗资源公平性及可达性评价的川藏铁路沿线地区医疗机构选址与优化

Site selection and optimization of medical institutions along the Sichuan-Tibet Railway based on the evaluation of the equity and accessibility of medical resources

目的分析川藏铁路雅林段沿线地区医疗卫生资源的公平性与可达性,指导铁路施工单位的科学选址,便于伤员安全转运,做到健康施工,科学施工。方法本文采用熵权TOPSIS法评价川藏铁路雅林段沿线地区医疗卫生资源的公平性,使用高斯两步移动搜索法进一步分析川藏铁路沿线地区医疗卫生资源的可达性。结果四川地区各区县的医疗资源排名总体高于西藏地区医疗资源排名。距离阈值为30 km时,47个乡镇的可达性值为0,其中西藏46个;四川省的雨城区与天全县为高可达性地区。距离阈值为60 km时,31个乡镇的可达性值为0,均位于西藏地区;四川省的康定市、泸定县、天全县和雨城区为高可达性地区。距离阈值为120 km时,仅有3个乡镇的可达性值为0,均位于江达县的西北部;四川省的可达性以理塘县和雅江县交界的区域及天全县2个区域为中心扩散分布。结论以120 km转运距离计算,西藏江达县川藏铁路施工现场患者不能得到充分转运,因此该在西藏江达县铁路施工现场设置二级医疗机构,保证伤员的安全转运及有效治疗。

Objective To analyze the equity and accessibility of medical and health resources in the areas along the Yalin section of the Sichuan-Tibet Railway,to guide the scientific site selection of railway construction units,and to facilitate the safe transfer of the injured and to achieve healthy and scientific construction.Methods The entropy-weighted TOPSIS method was used to evaluate the equity of medical and health resources in the areas along the Yalin section of the Sichuan-Tibet Railway.The accessibility of medical and health resources in the areas along the Sichuan-Tibet Railway was further analyzed by use the Gaussian two-step floating catchement area method.Results The overall ranking of healthcare resources in each district and county in Sichuan was higher than that of healthcare resources in Tibet.At a distance threshold of 30 km,47 townships had an accessibility value of 0,including 46 townships in Tibet.Yucheng District and Tianquan County in Sichuan Province were highly accessible areas.At a distance threshold of 60 km,31 townships had an accessibility value of 0,all of which were located in the Tibetan region.Kangding City,Luding County,Tianquan County and Yucheng District in Sichuan Province were highly accessible areas.At a distance threshold of 120 km,only three townships had a reachability value of 0,all of which were located in the north-western part of Jiangda County.The accessibility of Sichuan province was spread out in two centres,the area bordering Litang and Yajiang counties and Tianquan county.Conclusion Based on the 120 km transfer distance,patients at the Sichuan-Tibet Railway construction site in Jiangda countie in Tibet cannot be adequately transferred.Therefore,secondary medical institutions should be set up at the railway construction sites in Jiangda counties in Tibet to ensure the safe transfer and effective treatment of the injured.