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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
Minimum Travel Distance Among Publicly Insured Infants with Severe Congenital Heart Disease: Potential Impact of
Joyce L Woo1, Brett R Anderson2, Daniel Gruenstein3
1Division of Pediatric Cardiology, Columbia University Medical Center, 3959 Broadway, CHN-253, New York, NY, 10032, USA. jw3554@cumc.columbia.edu.
Insights
Restricting care for infants with congenital heart disease (CHD) to in-state centers increases travel distance. Facilitating out-of-state care can reduce these barriers for publicly insured children needing timely CHD surgery.
Area of Science:
- Pediatric Cardiology
- Health Services Research
- Public Health Policy
Background:
- Children with congenital heart disease (CHD) often require specialized surgical care.
- Coverage restrictions can limit access to out-of-state congenital heart surgery centers, potentially increasing travel burdens.
- Publicly insured infants represent a vulnerable population for whom access barriers are a significant concern.
Purpose of the Study:
- To estimate the impact of in-state coverage restrictions on travel distances for publicly insured infants requiring timely CHD surgery.
- To compare travel distances under scenarios with and without restrictions to in-state centers.
- To identify demographic factors influencing travel distance for CHD surgical care.
Main Methods:
- Utilized 2012 Medicaid Analytic eXtract data from 40 states, identifying 4598 infants with CHD requiring surgery in their first year.
- Calculated minimum travel distances from patient residences to the nearest congenital heart surgery center under two scenarios: in-state only vs. unrestricted access.
- Employed linear regression to analyze demographic predictors of travel distance.
Main Results:
- Mean minimum travel distance was 43.7 miles without restrictions versus 54.1 miles with in-state restrictions.
- For 5.9% of patients, the difference in travel distance exceeded 50 miles.
- Rural status, middle-income zip codes, and specific race/ethnicities (White/non-Hispanic, American Indian/Alaskan Native) were associated with increased travel distance.
Conclusions:
- In-state coverage restrictions can significantly increase travel distances for publicly insured infants with CHD.
- Facilitating access to out-of-state care may mitigate access barriers for this population.
- Regionalization of CHD care should be implemented carefully to avoid worsening access disparities for publicly insured children.
Abstract:
Travel distance to surgical centers may be increased when coverage restrictions prevent children with congenital heart disease (CHD) from receiving care at out-of-state congenital heart surgery centers. We estimated the minimum travel distance to congenital heart surgery centers among publicly insured infants with time-sensitive CHD surgical needs, under two different scenarios: if they were and were not restricted to in-state centers. Using 2012 Medicaid Analytic eXtract data from 40 states, we identified 4598 infants with CHD that require surgery in the first year of life. We calculated the minimum travel distance between patients' homes and the nearest cardiac surgery center, assuming patients were and were not restricted to in-state centers. We used linear regression to identify demographic predictors of distance under both scenarios. When patients were not restricted to in-state centers, mean minimum travel distance was 43.7 miles, compared to 54.1 miles when they were restricted. For 5.9% of patients, the difference in travel distance under the two scenarios exceeded 50 miles. In six states, the difference in mean minimum travel distance exceeded 20 miles. Under both scenarios, distance was positively predicted by rural status, residence in middle-income zip codes, and white/non-Hispanic or American Indian/Alaskan Native race/ethnicity. For some publicly insured infants with severe CHD, facilitating the receipt of out-of-state care could mitigate access barriers. Existing efforts to regionalize care at fewer centers should be designed to avoid exacerbating access barriers among publicly insured CHD patients.
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