Mapping Surgical Need in Philadelphia

Understanding the geographical impact of the Center for Surgical Health

INTRODUCTION

Obtaining necessary surgical procedures can be stressful, time-consuming, and difficult to navigate.

Inspired by their previous work providing free surgical consultations for homeless Philadelphians at a soup kitchen in West Philadelphia, a group of University of Pennsylvania physicians, residents, and medical students came together to found the Center for Surgical Health (CSH) in the fall of 2020.

CSH makes it easier for every individual with a surgical disease to obtain the high-quality, timely, affordable, and affirming surgical care they deserve. CSH uses trained staff and volunteers to provide individualized services based on each client's needs. Services include appointment scheduling, coordinating transportation to the hospital, obtaining health insurance to cover surgical treatment, educating individuals about their surgical disease and treatment options, and screening and referrals to additional social healthcare services, public benefits, and legal assistance. 

OBJECTIVES

CSH relies on community partners to identify patients who may benefit from its services. CSH has successfully navigated a number of clients to insurance coverage and surgery. The objective of this project is to compare Philadelphia census tracts with the greatest health care need to the geographic areas that CSH has been reaching through its initiatives.

The primary aim of this project is to characterize health care need among Philadelphia census tracts through measures which have historically posed barriers to individuals obtaining necessary care. These measures include median household income, insurance coverage, and primary spoken language. The secondary aim of this project is to compare CSH clients' de-identified geographic locations to the maps of surgical need among Philadelphia census tracts. This will create an understanding of CSH's current geographical impact and potential areas for greater outreach.


Reference Maps of Philadelphia

Figure 1a (left) and 1b (right) Reference Maps of Philadelphia Neighborhoods and Census tracts of Philadelphia. Click on any neighborhood or census tract and a pop-up will appear with the neighborhood or tract name respectively. Note that census tracts do not always align with neighborhoods and that neighborhoods themselves are dynamic.


HEALTH CARE NEED IN PHILADELPHIA

Health care need in Philadelphia is displayed geographically in Figures 2-5 below through measures such as median household income, insurance coverage, and primary spoken language. Each figure is shown next to their corresponding Hot Spot Analyses. The Hot Spot Analysis tool looks at each feature (i.e., median household income, percent of individuals without insurance, percent of individuals who primarily speak Spanish at home) within the context of neighboring features. To be a statistically significant hot spot, a feature must have a high value and be surrounded by other features with high values as well. The local sum of a feature and its neighbors is compared proportionally to the sum of all features. When the local sum is too different from the expected local sum to be the result of random chance, a statistically significant z-score results. For statistically significant positive z-scores, the larger the z-score, the more intense the clustering of high values, and a hot spot is identified. For statistically significant negative z-score, the smaller the z-score is, the more intense the clustering of low values, and a cold spot is identified.

Looking at the three hot spot analysis maps together, we see there are census tracts in central Northern Philadelphia characterized by low median household incomes, high percentages of no insurance coverage, and high percentages of individuals who primarily speak Spanish. These are all factors which may pose barriers to health care for this population. These factors may present obstacles even with adequate geographic access to Federally Qualified Health Centers (FQHCs) and hospitals.

CENTER FOR SURGICAL HEALTH CLIENTS

There were data for 741 CSH clients. Clients were excluded from final analysis if their address was not available for geocoding in ArcGIS Pro (110), outcomes of insurance applications or surgical navigation attempts were not documented (69), or they resided outside of the Philadelphia census tracts (187). A total of 375 clients were included in the geospatial analysis.

CSH Client Demographics

Figures 5-7 below display census tracts where CSH clients reside by race/ethnicity and primarily spoken language.

While most CSH clients reside in the Western and Southeastern areas of Philadelphia, breaking this information down by demographic variables reveals that primarily Spanish-speaking and Hispanic individuals reside in the Southeastern area while primarily English-speaking and Black individuals reside in the Western area.

CSH Clients' Insurance Coverage and Surgery Success

Figures 8-10 display CSH clients' insurance status at time of presentation as well as CSH's success navigating individuals to insurance coverage and surgical procedures.

Figures 8-10 demonstrate that CSH has had success in navigating clients to insurance coverage and needed surgical procedures, especially among those residing in the Southeastern area of Philadelphia, where there is a large population of CSH clients who are Hispanic and primarily Spanish-speaking.

Analysis of health care need in Philadelphia pinpointed central Northern Philadelphia as one area with low median household incomes, high percentages of individuals without health insurance coverage, and high percentages of individuals who primarily speak Spanish. This seems to be one area where CSH may consider expanding their advertisement and valuable services.

CONCLUSION

Overall, a majority of CSH clients reside in Western and Southeastern Philadelphia. This is likely due to University of Pennsylvania's location in Western Philadelphia and Puentes de Salud, where many clients are first contacted, in Central Philadelphia. The Western client population is more likely to be primarily English-speaking, identify as Black, and have insurance coverage at the time of presentation, while the Southeastern population is more likely to be primarily Spanish-speaking, identify as Hispanic, and be uninsured at the time of presentation. CSH has also had more success navigating the Southeastern population to insurance coverage and surgical procedures. However, while CSH is successfully reaching a number of surgically vulnerable clients in Southeastern Philadelphia, there is a large primarily Spanish-speaking, uninsured population in central Northern Philadelphia who may greatly benefit from CSH's services.


Sources:

Open Data Philly. Philadelphia Neighborhoods. Created and maintained by Azavea, Inc. Accessed 2023, April 6.   https://www.opendataphilly.org/dataset/philadelphia-neighborhoods/resource/0eb8012a-6f1f-4c81-a18d-163d21f6a888)   

Note About Maps and Data

Data used for the maps was obtained from the US Census Bureau, OpenDataPhilly, the Centers for Medicare and Medicaid, the Health Resources and Services Administration, and the Center for Surgical Health. Since the scale of the maps is small for this analysis, distortions due to coordinate systems used are not likely present. All Hot Spot Analyses were created using ArcGIS Pro.

Content Created by Michaela Hitchner for the Center for Surgical Health

Perelman School of Medicine Master of Public Health Program University of Pennsylvania