Geographic Distance From Transplant Center Does Not Impact Pediatric Heart Transplant Outcomes

McKane, Meghann; Dodd, Debra A.; Mettler, Bret A.; Wujcik, K.; Godown, Justin

doi:10.1177/1526924818765811

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…In general, the literature suggests that, across a variety of procedures and patient acuity levels, this association, if present, is limited-especially if travel is to a high-volume facility. 3,[8][9][10][11][12] This question has received limited attention in cardiac surgery, and the studies which have been published have principally focused on the CABG population and are inconclusive. One investigation of CABG patients in Pennsylvania (n = 102,858 from 1995 to 2005) found that increased travel distance was associated with an increased risk of inhospital mortality for higher-risk CABG patients.…”

Section: Discussionmentioning

confidence: 99%

“…Whether an association exists between travel distance and patient outcomes is a question that continues to be debated in surgery. In general, the literature suggests that, across a variety of procedures and patient acuity levels, this association, if present, is limited—especially if travel is to a high‐volume facility 3,8–12 . This question has received limited attention in cardiac surgery, and the studies which have been published have principally focused on the CABG population and are inconclusive.…”

Section: Discussionmentioning

confidence: 99%

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Travel distance and outcomes after surgical aortic valve among veterans

Beaulieu‐Jones,

Siegel,

Collado

et al. 2024

Health Services Research

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ObjectiveTo investigate the association between travel distance and postoperative length of stay (LOS) and discharge disposition among veterans undergoing surgical aortic valve replacement (SAVR).Data Sources/Study SettingWe performed a retrospective cohort study of patients undergoing SAVR, with or without coronary artery bypass grafting (CABG) at VA Boston Healthcare (January 1, 2005–December 31, 2015).Study DesignPostoperative LOS and discharge disposition were compared for SAVR patients based on travel distance to the facility: <100 miles or ≥100 miles. Multivariable regression was performed to ascertain factors associated with LOS and home discharge.Data Collection/Extraction MethodsData were collected via chart review. All patients undergoing SAVR at our institution who primarily resided within the defined region were included.Principal FindingsOf 597 patients studied, 327 patients underwent isolated SAVR; 270 patients underwent SAVR/CABG. Overall median (IQR) distance between the patient's residence and the hospital was 49.95 miles (27.41–129.94 miles); 190 patients (32%) resided further than 100 miles away. There were no differences in the proportion of patients with diabetes, hypertension, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, atrial fibrillation, or prior myocardial infarction between groups. Overall LOS (IQR) was 9 (7–13) days and did not differ between groups (p = 0.18). The proportion of patients discharged home was higher among patients who resided more than 100 miles from the hospital (71% vs. 58%, p = 0.01). On multivariable analysis, residing further than 100 miles from the hospital was independently associated with home discharge (OR = 1.64, 95% CI: 1.09–2.48). Travel distance was not associated with LOS.ConclusionsBased on our institutional experience, potential concerns of longer hospital stay or discharge to other inpatient facilities for geographically distanced patients undergoing SAVR do not appear supported. Continued examination of the drivers underlying the marked shift of veterans to the private sector appears warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Travel distance and outcomes after surgical aortic valve among veterans

Beaulieu‐Jones,

Siegel,

Collado

et al. 2024

Health Services Research

View full text Add to dashboard Cite

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“…With continued program development and outcomes monitoring during transition and after transfer, it will be important to assess the educational topics and interventions that can affect outcomes after transfer to adult providers. Recommendations for topics to be included in educational sessions with HCT based on current literature are included in Table 3 (29,33,(40)(41)(42).…”

Section: Transition Clinic Implementation Transition Focus Areas and ...mentioning

confidence: 99%

Health Care Transition for Adolescents and Young Adults With Pediatric‐Onset Liver Disease and Transplantation

Vittorio

Kosmach‐Park

King

et al. 2022

J. pediatr. gastroenterol. nutr.

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Advances in medical therapies and liver transplantation have resulted in a greater number of pediatric patients reaching young adulthood. However, there is an increased risk for medical complications and morbidity surrounding transfer from pediatric to adult hepatology and transplant services. Health care transition (HCT) is the process of moving from a child/family-centered model of care to an adult or patient-centered model of health care. Successful HCT requires a partnership between pediatric and adult providers across all disciplines resulting in a transition process that does not end at the time of transfer but continues throughout early adulthood. Joint consensus guidelines in collaboration with the American Society of Transplantation are presented to facilitate the adoption of a structured, multidisciplinary approach to transition planning utilizing The Six Core Elements of Health Care TransitionTM for use by both pediatric and adult specialists. This paper provides guidance and seeks support for the implementation of an HCT program which spans across both pediatric and adult hepatology and transplant centers.

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“…However, there is no information available, to our knowledge, studying the association between patients with medulloblastoma who must travel long distances to receive treatment and their overall outcomes in comparison to patients within close proximity of a proton center. Data that currently exist suggests inconclusive evidence that increased distance to health care treatment location affects general outcomes [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience

Liu

Brooks

Rubin

et al. 2020

International Journal of Particle Therapy

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Purpose Patient travel time can cause treatment delays when providers and families decide to seek proton therapy. We examined whether travel distance or referral pattern (domestic versus international) affects time to radiation therapy and subsequent disease outcomes in patients with medulloblastoma at a large academic proton center. Patients and Methods Children with medulloblastoma treated at MD Anderson (MDA) with a protocol of proton beam therapy (PBT) between January 4, 2007, and June 25, 2014, were included in the analysis. The Wilcoxon rank-sum test was used to study the association between time to start of radiation and distance. Classification- and regression-tree analyses were used to explore binary thresholds for continuous covariates (ie, distance). Failure-free survival was defined as the time interval between end of radiation and failure or death. Results 96 patients were included in the analysis: 17 were international (18%); 19 (20%) were from Houston, Texas; 21 were from other cities inside Texas (21%); and 39 (41%) were from other US states. The median time from surgery to start of radiation was not significantly different for international patients (median = 1.45 months) compared with US patients (median = 1.15 months; P = .13). However, time from surgery to start of radiation was significantly longer for patients residing > 1716 km (> 1066 miles) from MDA (median = 1.31 months) than for patients residing ≤ 1716 km (≤ 1066 miles) from MDA (median = 1.05 months; P = .01). This 1- to 2-week delay (median = 7.8 days) did not affect failure-free survival (hazard ratio = 1.34; P = .43). Conclusion We found that short delays in proton access can exist for patients traveling long distances to proton centers. However, in this study, treatment delays did not affect outcomes. This highlights the appropriateness of PBT in the face of travel coordination. Investment by proton centers in a rigorous intake process is justified to offer timely access to curative PBT.

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Geographic Distance From Transplant Center Does Not Impact Pediatric Heart Transplant Outcomes

Cited by 5 publications

References 10 publications

Travel distance and outcomes after surgical aortic valve among veterans

Travel distance and outcomes after surgical aortic valve among veterans

Health Care Transition for Adolescents and Young Adults With Pediatric‐Onset Liver Disease and Transplantation

Referral Patterns and Treatment Delays in Medulloblastoma: A Large Academic Proton Center Experience

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