Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits

Willems, Ruben; Ombelet, Fouke; Goossens, Eva; Groote, Katya De; Budts, Werner; Moniotte, Stéphane; Hosson, Michèle de; Bulck, Liesbet Van; Marelli, Ariane J.; Moons, Philip; Backer, Julie De; Annemans, Lieven

doi:10.1007/s10198-021-01300-5

Cited by 6 publications

(4 citation statements)

References 29 publications

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“…Ongoing regular care with a congenital cardiologist reduces death 2 , 38 and improves outcomes across the CHD anatomic severity levels. 41 Individuals may be out of routine congenital cardiology care for a variety of socioeconomic reasons, including limited access to transportation to centralized tertiary care centers, lack of insurance access, language barriers, lack of paid sick leave, inability to take time off work, economic constraints, and limited understanding of the purpose and benefits of routine surveillance care for their CHD. 5 Thus, individuals who are out of specialty care may seek care through the ED at a higher rate and in a sicker state than those individuals who have remained in congenital cardiology care.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Health Care Usage and Death by Neighborhood Poverty Among Individuals With Congenital Heart Defects, 4 US Surveillance Sites, 2011 to 2013

Raskind‐Hood,

Kancherla,

Ivey

et al. 2024

JAHA

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Background Socioeconomic factors may lead to a disproportionate impact on health care usage and death among individuals with congenital heart defects (CHD) by race, ethnicity, and socioeconomic factors. How neighborhood poverty affects racial and ethnic disparities in health care usage and death among individuals with CHD across the life span is not well described. Methods and Results Individuals aged 1 to 64 years, with at least 1 CHD‐related International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD‐9‐CM ) code were identified from health care encounters between January 1, 2011, and December 31, 2013, from 4 US sites. Residence was classified into lower‐ or higher‐poverty neighborhoods on the basis of zip code tabulation area from the 2014 American Community Survey 5‐year estimates. Multivariable logistic regression models, adjusting for site, sex, CHD anatomic severity, and insurance‐evaluated associations between race and ethnicity, and health care usage and death, stratified by neighborhood poverty. Of 31 542 individuals, 22.2% were non‐Hispanic Black and 17.0% Hispanic. In high‐poverty neighborhoods, non‐Hispanic Black (44.4%) and Hispanic (47.7%) individuals, respectively, were more likely to be hospitalized (adjusted odds ratio [aOR], 1.2 [95% CI, 1.1–1.3]; and aOR, 1.3 [95% CI, 1.2–1.5]) and have emergency department visits (aOR, 1.3 [95% CI, 1.2–1.5] and aOR, 1.8 [95% CI, 1.5–2.0]) compared with non‐Hispanic White individuals. In high poverty neighborhoods, non‐Hispanic Black individuals with CHD had 1.7 times the odds of death compared with non‐Hispanic White individuals in high‐poverty neighborhoods (95% CI, 1.1–2.7). Racial and ethnic disparities in health care usage were similar in low‐poverty neighborhoods, but disparities in death were attenuated (aOR for non‐Hispanic Black, 1.2 [95% CI=0.9–1.7]). Conclusions Racial and ethnic disparities in health care usage were found among individuals with CHD in low‐ and high‐poverty neighborhoods, but mortality disparities were larger in high‐poverty neighborhoods. Understanding individual‐ and community‐level social determinants of health, including access to health care, may help address racial and ethnic inequities in health care usage and death among individuals with CHD.

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Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Health Care Usage and Death by Neighborhood Poverty Among Individuals With Congenital Heart Defects, 4 US Surveillance Sites, 2011 to 2013

Raskind‐Hood,

Kancherla,

Ivey

et al. 2024

JAHA

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“…[ 51 ] assessed healthcare utilisation of ACHD patients in Israel and demonstrated that this population had higher rates of healthcare utilisation than the general population, with those on geographic peripheries being associated with fewer specialist attendances. Linkage with administrative data has also shown that specialised CHD care is associated with lower medical costs and better economic outcomes for patients [ 52 ]. Inclusion of insights drawn from linked administrative data in a clinic planning tool such as the one presented here would allow ACHD services to be delivered with a greater level of precision.…”

Section: Discussionmentioning

confidence: 99%

An interactive geographic information system to inform optimal locations for healthcare services

2023

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Large health datasets can provide evidence for the equitable allocation of healthcare resources and access to care. Geographic information systems (GIS) can help to present this data in a useful way, aiding in health service delivery. An interactive GIS was developed for the adult congenital heart disease service (ACHD) in New South Wales, Australia to demonstrate its feasibility for health service planning. Datasets describing geographic boundaries, area-level demographics, hospital driving times, and the current ACHD patient population were collected, linked, and displayed in an interactive clinic planning tool. The current ACHD service locations were mapped, and tools to compare current and potential locations were provided. Three locations for new clinics in rural areas were selected to demonstrate the application. Introducing new clinics changed the number of rural patients within a 1-hour drive of their nearest clinic from 44·38% to 55.07% (79 patients) and reduced the average driving time from rural areas to the nearest clinic from 2·4 hours to 1·8 hours. The longest driving time was changed from 10·9 hours to 8·9 hours. A de-identified public version of the GIS clinic planning tool is deployed at https://cbdrh.shinyapps.io/ACHD_Dashboard/. This application demonstrates how a freely available and interactive GIS can be used to aid in health service planning. In the context of ACHD, GIS research has shown that adherence to best practice care is impacted by patients’ accessibility to specialist services. This project builds on this research by providing opensource tools to build more accessible healthcare services.

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“…39,40 Ongoing regular care with a congenital cardiologist reduces mortality 2,38 and improves outcomes across the CHD anatomic severity levels. 41 Individuals may be out of routine congenital cardiology care for a variety of socioeconomic reasons, including limited access to transportation to centralized tertiary care centers, lack of insurance access, language barriers, lack of paid sick leave, inability to take time off work, economic constraints and limited understanding of the purpose and benefits of routine surveillance care for their CHD. 5 Thus, individuals who are out of specialty care may seek care through the ED at a higher rate and in a sicker state than those individuals who have remained in congenital cardiology care.…”

Section: Discussionmentioning

confidence: 99%

Racial and Ethnic Disparities in Healthcare Utilization and Mortality by Neighborhood Poverty among Individuals with Congenital Heart Defects, four U.S. Surveillance Sites, 2011-2013

Raskind-Hood,

Kancherla,

Ivey

et al. 2023

Preprint

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BACKGROUNDSocioeconomic factors may lead to a disproportionate impact on healthcare utilization and mortality among individuals with congenital heart defects (CHD) by race, ethnicity, and socio-economic factors. How neighborhood poverty affects racial and ethnic disparities in healthcare utilization and mortality among individuals with CHD across the lifespan is not well described.METHODSIndividuals, 1-64 years, with at least one CHD-related ICD-9-CM code were identified from healthcare encounters between 01/01/2011-12/31/2013 from four U.S. sites. Residence was classified into lower or higher poverty neighborhoods based on ZCTA from the 2014 American Community Survey 5-Year Estimates. Multivariable logistic regression models, adjusting for site, sex, CHD anatomic severity, and insurance evaluated associations between race and ethnicity, and healthcare utilization and mortality, stratified by neighborhood poverty.RESULTSOf 31,542 individuals, 22.2% were non-Hispanic Black (nHB) and 17.0% Hispanic. In high poverty neighborhoods, nHB (44.4%) and Hispanic (47.7%) individuals, respectively, were more likely to be hospitalized (aOR)=1.2 [95%CI=1.0-1.3] and aOR=1.3 [95%CI=1.2-1.5]) and have ED visits (aOR=1.3 [95%CI=1.2-1.5] and aOR=1.7 [95%CI=1.5-2.0]) compared to non-Hispanic White (nHW) individuals. In high poverty neighborhoods, nHB individuals with CHD had 1.7 times the odds of mortality compared to nHW individuals in high poverty neighborhoods (95%CI=1.1-2.7). Racial and ethnic disparities in healthcare utilization were similar in low poverty neighborhoods, but disparities in mortality were attenuated (aOR for nHB=1.2 [95%CI=0.9-1.7]).CONCLUSIONSRacial and ethnic disparities in healthcare utilization were found among individuals with CHD in low and high poverty neighborhoods, but mortality disparities were larger in high poverty neighborhoods. Understanding individual- and community-level social determinants of health, including access to healthcare, may help address racial and ethnic inequities in healthcare utilization and mortality among individuals with CHD.

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Different levels of care for follow-up of adults with congenital heart disease: a cost analysis scrutinizing the impact on medical costs, hospitalizations, and emergency department visits

Abstract: Baudouin Foundation (Fund Joseph Oscar Waldmann-Berteau & Fund Walckiers Van Dessel).JDB is supported as senior clinical researcher, EG as postdoctoral researcher, and LVB as predoctoral researcher by the Research Foundation Flanders.

Cited by 6 publications

References 29 publications

Racial and Ethnic Disparities in Health Care Usage and Death by Neighborhood Poverty Among Individuals With Congenital Heart Defects, 4 US Surveillance Sites, 2011 to 2013

Racial and Ethnic Disparities in Health Care Usage and Death by Neighborhood Poverty Among Individuals With Congenital Heart Defects, 4 US Surveillance Sites, 2011 to 2013

An interactive geographic information system to inform optimal locations for healthcare services

Racial and Ethnic Disparities in Healthcare Utilization and Mortality by Neighborhood Poverty among Individuals with Congenital Heart Defects, four U.S. Surveillance Sites, 2011-2013

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