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Published on: September 16, 2020
Analysis of regional coverage for retinopathy of prematurity in the United States
Arsalan A Ali1, Muhammad Z Chauhan2, Jonathan M Bindi3
1Department of Ophthalmology, Loyola University Medical Center, Maywood, Illinois.
Insights
Pediatric ophthalmologists and retina specialists are unevenly distributed, leading to significant regional disparities in retinopathy of prematurity care. Strategic workforce planning is essential to ensure equitable access to ROP screening and treatment nationwide.
Area of Science:
- Ophthalmology
- Public Health
- Healthcare Workforce Analysis
Background:
- Retinopathy of prematurity (ROP) is a leading cause of vision impairment in premature infants.
- Effective ROP care requires timely screening and treatment by specialized ophthalmologists.
- Understanding the distribution of pediatric ophthalmologists (POs) and retina specialists (RSs) is crucial for assessing ROP care capacity.
Purpose of the Study:
- To estimate the geographic distribution of POs and RSs in the United States.
- To assess the capacity for ROP care based on NICU bed availability and ROP prevalence.
- To identify regional disparities in ROP screening and treatment access.
Main Methods:
- A cross-sectional study utilizing databases from major ophthalmology professional societies.
- NICU bed capacity data sourced from the Neonatology Solutions Database (focusing on level 3 and 4 NICUs).
- ROP case numbers estimated from the 2019 IRIS Registry; provider-to-patient and NICU bed-to-provider ratios calculated.
Main Results:
- A total of 3,983 providers (1,072 POs, 2,911 RSs) were identified, with the highest concentration in the South.
- The South region had the most ROP cases and the highest case-per-provider ratio.
- Significant regional variations in NICU beds-to-provider ratios were observed, with Mississippi, North Dakota, and Arkansas showing the highest.
Conclusions:
- Substantial regional disparities in ROP care capacity exist across the US.
- High-burden areas, particularly the South, face projected shortages of ROP care providers.
- Targeted workforce interventions are necessary to achieve equitable ROP screening and treatment access nationwide.
Purpose:
To estimate the distribution of pediatric ophthalmologists (POs) and retina specialists (RSs) in the United States and assess capacity for retinopathy of prematurity (ROP) care based on neonatal intensive care unit (NICU) bed availability and ROP prevalence.
Methods:
We conducted a cross-sectional study using data from the American Association for Pediatric Ophthalmology and Strabismus, the American Academy of Ophthalmology, and the American Society of Retina Specialists databases to identify POs and RSs. NICU bed capacity was assessed using the Neonatology Solutions Database, focusing on level 3 and level 4 NICUs. ROP case numbers were derived from the 2019 IRIS Registry data summary in the Vision and Eye Health Surveillance System. Provider-to-patient ratios, NICU beds-to-provider ratios, and a forecast model for provider workload were calculated using state- and region-specific ROP data.
Results:
We identified 3,983 providers (1,072 POs and 2,911 RSs), with the highest provider concentration in the South (n = 1,430). The South also had the highest number of ROP cases (71,520 of 177,940 estimated cases nationally) and case per provider ratio (50.01) compared with the Midwest (45.65), West (42.32), and Northeast (37.41). Of 836 total NICUs, 709 were level 3 and 127 were level 4, with an adjusted bed capacity of 25,708 for ROP screening and treatment. States with the highest bed-to-provider ratios were Mississippi (19.35), North Dakota (18.67), and Arkansas (14.70). Across all regions, reducing the assumed percentage of providers offering ROP care led to substantial increases in patient load per provider, with the South experiencing the greatest projected shortage.
Conclusions:
Significant regional disparities exist in ROP care, particularly in high-burden areas such as the South. Strategic workforce interventions are needed to ensure equitable access to ROP screening and treatment services nationwide.
