Modeling travel impedance to medical care for children with birth defects using Geographic Information Systems

Delmelle, Eric; Cassell, Cynthia H.; Dony, Coline; Radcliff, Elizabeth; Tanner, Jean Paul; Siffel, Csaba; Kirby, Russell S.

doi:10.1002/bdra.23168

Cited by 35 publications

(23 citation statements)

References 61 publications

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“…Lack of health insurance is a crucial determinant of patients’ choosing to stay in their residence county for hospitalization (13). In addition to age, race/ethnicity, and health insurance status (13–16), other factors that influence travel patterns are sex, severity of illness (13), patient location (15), and socioeconomic status (SES) (11,17). …”

Section: Introductionmentioning

confidence: 99%

Disparities in Patterns of Health Care Travel Among Inpatients Diagnosed With Congestive Heart Failure, Florida, 2011

Jia¹,

Xierali²

2015

Prev. Chronic Dis.

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IntroductionCongestive heart failure (CHF) is a major public health problem in the United States and is a leading cause of hospitalization in the elderly population. Understanding the health care travel patterns of CHF patients and their underlying cause is important to balance the supply and demand for local hospital resources. This article explores the nonclinical factors that prompt CHF patients to seek distant instead of local hospitalization.MethodsLocal hospitalization was defined as inpatients staying within hospital service areas, and distant hospitalization was defined as inpatients traveling outside hospital service areas, based on individual hospital discharge data in 2011 generated by a Dartmouth–Swiss hybrid approach. Multiple logistic and linear regression models were used to compare the travel patterns of different groups of inpatients in Florida.ResultsBlack patients, no-charge patients, patients living in large metropolitan areas, and patients with a low socioeconomic status were more likely to seek local hospitalization than were white patients, those who were privately insured, those who lived in rural areas, and those with a high socioeconomic status, respectively.ConclusionFindings indicate that different populations diagnosed with CHF had different travel patterns for hospitalization. Changes or disruptions in local hospital supply could differentially affect different groups in a population. Policy makers could target efforts to CHF patients who are less likely to travel to seek treatment.

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Section: Introductionmentioning

confidence: 99%

Disparities in Patterns of Health Care Travel Among Inpatients Diagnosed With Congestive Heart Failure, Florida, 2011

Jia¹,

Xierali²

2015

Prev. Chronic Dis.

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“…Research has increasingly focused on geographic access to care among individuals with birth defects (Case et al, 2008; Fixler et al, 2012; Cassell et al, 2013; Delmelle et al, 2013; Radcliff et al, 2015). We characterized one-way drive time, one-way public transit time, and public transit availability to pediatric cardiac surgical care centers in New York for adolescents with CHDs.…”

Section: Discussionmentioning

confidence: 99%

“…The association between rural residence and increased travel time to appropriate care among those with birth defects, for example, has been well documented (Delmelle et al, 2013; Radcliff et al, 2015). In contrast to prior work, we found no association between defect severity and proximity to care (Cassell et al, 2013; Radcliff et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties

Sommerhalter

Insaf

Akkaya-Hocagil

et al. 2017

Birth Defects Research

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Background Many individuals with congenital heart defects (CHDs) discontinue cardiac care in adolescence, putting them at risk of adverse health outcomes. Because geographic barriers may contribute to cessation of care, we sought to characterize geographic access to comprehensive cardiac care among adolescents with CHDs. Methods Using a population-based, 11-county surveillance system of CHDs in New York, we characterized proximity to the nearest pediatric cardiac surgical care center among adolescents aged 11 to 19 years with CHDs. Residential addresses were extracted from surveillance records documenting 2008 to 2010 healthcare encounters. Addresses were geocoded using ArcGIS and the New York State Street and Address Maintenance Program, a statewide address point database. One-way drive and public transit time from residence to nearest center were calculated using R packages gmapsdistance and rgeos with the Google Maps Distance Matrix application programming interface. A marginal model was constructed to identify predictors associated with one-way travel time. Results We identified 2522 adolescents with 3058 corresponding residential addresses and 12 pediatric cardiac surgical care centers. The median drive time from residence to nearest center was 18.3 min, and drive time was 30 min or less for 2475 (80.9%) addresses. Predicted drive time was longest for rural western addresses in high poverty census tracts (68.7 min). Public transit was available for most residences in urban areas but for few in rural areas. Conclusion We identified areas with geographic barriers to surgical care. Future research is needed to determine how these barriers influence continuity of care among adolescents with CHDs.

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“…Although data from 108 Florida hospitals are represented in these data [11], not all hospitals are required to report to the AHCA. Most non-reporting hospitals do not provide newborn care [13].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with the timeliness of postnatal surgical repair of spina bifida

et al. 2016

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Purpose Clinical guidelines recommend repair of open spina bifida (SB) prenatally or within the first days of an infant’s life. We examined maternal, infant, and health care system factors associated with time-to-repair among infants with postnatal repair. Methods This retrospective, statewide, population-based study examined infants with SB born in Florida 1998–2007, ascertained by the Florida Birth Defects Registry. We used procedure codes from hospital discharge records to identify the first recorded myelomeningocele repair (ICD-9 CM procedure code 03.52) among infants with birth hospitalizations. Using Poisson multivariable regression, we examined time-to-repair by hydrocephalus, SB type (isolated [no other coded major birth defect] versus non-isolated), and other selected factors. Results Of 199 infants with a recorded birth hospitalization and coded myelomeningocele repair, 87.9 % had hydrocephalus and 19.6 % had non-isolated SB. About 76.4 % of infants had repair by day 2 of life. In adjusted analyses, infants with hydrocephalus were more likely to have timely repair (adjusted prevalence ratio (aPR) = 1.48, 95 % confidence interval (CI) 1.02–2.14) than infants without hydrocephalus. SB type was not associated with repair timing. Infants born in lower level nursery care hospitals with were less likely to have timely repairs (aPR = 0.71, 95 % CI 0.52–0.98) than those born in higher level nursery care hospitals. Conclusions Most infants with SB had surgical repair in the first 2 days of life. Lower level birth hospital nursery care was associated with later repairs. Prenatal diagnosis can facilitate planning for a birth hospital with higher level of nursery care, thus improving opportunities for timely repair.

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Modeling travel impedance to medical care for children with birth defects using Geographic Information Systems

Cited by 35 publications

References 61 publications

Disparities in Patterns of Health Care Travel Among Inpatients Diagnosed With Congestive Heart Failure, Florida, 2011

Disparities in Patterns of Health Care Travel Among Inpatients Diagnosed With Congestive Heart Failure, Florida, 2011

Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties

Factors associated with the timeliness of postnatal surgical repair of spina bifida

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