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Parental preference regarding hospitals for children undergoing surgery: a trade-off between travel distance and
Ruey-Kang R Chang1, James J Joyce, Julia Castillo
1Division of Cardiology, Department of Pediatrics, David Geffen School of Medicine at the University of California-Los Angeles, USA. rkchang@ucla.edu
Insights
Parents often prefer local hospitals for pediatric heart surgery, even with slightly higher risks. However, they may choose referral centers if local mortality rates significantly increase or travel distances double.
Area of Science:
- Pediatric cardiology
- Health services research
- Patient decision-making
Background:
- Parental choice of hospital for pediatric heart surgery is complex.
- Understanding factors influencing this decision is crucial for healthcare planning.
Purpose of the Study:
- To explore parental preferences between local and referral hospitals for pediatric heart surgery.
- To identify the trade-offs parents consider regarding mortality risk and travel distance.
Main Methods:
- 103 parents of children referred for pediatric cardiology care were interviewed.
- Hypothetical scenarios presented choices between local and referral hospitals with varying mortality rates and travel times.
- Participants selected their preferred hospital under different conditions.
Main Results:
- 82.5% initially chose the local hospital when mortality rates were equal (3%) and travel time was 2 hours.
- Preference for the local hospital decreased as its mortality rate increased.
- Increased travel time to the referral hospital (4 hours) slightly boosted local hospital preference.
Conclusions:
- Parental decisions involve a trade-off between perceived outcome improvement and travel distance.
- This highlights the importance of considering patient perspectives in regionalization strategies for specialized pediatric care.
Objective:
To explore parental preference in the choice between a local and a referral hospital for children undergoing heart surgery.
Methods:
One hundred three parents or adult primary caregivers of children referred to a pediatric cardiology clinic were interviewed. Participants were presented with hypothetical scenarios in which they or their children had a heart condition requiring elective surgery. The surgery could be performed at either a local hospital or a regional referral hospital. The travel time to the referral hospital was initially presented as 2 h, and the mortality rate was set at 3% for both the local and the referral hospitals. The parents were then presented with scenarios that sequentially increased the mortality of the local hospital and the distance to the referral hospital, and were asked to choose between the local and regional referral hospitals.
Results:
When the regional referral hospital was 2 h away and the mortality rates for the referral hospital and the local hospital were equal at 3%, 82.5% of participants chose the local hospital for their children. The percentage of participants choosing the local hospital decreased progressively as the mortality rate of the local hospital increased (to 9.7% at 18% mortality). Between 5% and 10% more participants chose the local hospital when the distance to the referral hospital was increased from 2 h to 4 h. There was no difference in age, sex, ethnicity, language, type of insurance, level of education and availability of personal transportation between participants who chose the regional referral hospital and those who chose the local hospital. Participants who lived closer to the hospital at which the survey was conducted were more likely to choose the local hospital.
Conclusion:
The present study defines a relation between potential outcome improvement and increasing travel distance from a patient or parent's perspective. This trade-off is an important consideration when planning for regionalization.
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