Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties

Abstract

Background Many individuals with congenital heart defects (CHDs) discontinue cardiac care in adolescence, putting them at risk of adverse health outcomes. Because geographic barriers may contribute to cessation of care, we sought to characterize geographic access to comprehensive cardiac care among adolescents with CHDs. Methods Using a population-based, 11-county surveillance system of CHDs in New York, we characterized proximity to the nearest pediatric cardiac surgical care center among adolescents aged 11 to 19 years with CHDs. Residential addresses were extracted from surveillance records documenting 2008 to 2010 healthcare encounters. Addresses were geocoded using ArcGIS and the New York State Street and Address Maintenance Program, a statewide address point database. One-way drive and public transit time from residence to nearest center were calculated using R packages gmapsdistance and rgeos with the Google Maps Distance Matrix application programming interface. A marginal model was constructed to identify predictors associated with one-way travel time. Results We identified 2522 adolescents with 3058 corresponding residential addresses and 12 pediatric cardiac surgical care centers. The median drive time from residence to nearest center was 18.3 min, and drive time was 30 min or less for 2475 (80.9%) addresses. Predicted drive time was longest for rural western addresses in high poverty census tracts (68.7 min). Public transit was available for most residences in urban areas but for few in rural areas. Conclusion We identified areas with geographic barriers to surgical care. Future research is needed to determine how these barriers influence continuity of care among adolescents with CHDs.

Driving to Childhood Cancer Hub Hospitals: A Study on Hospital Accessibility in Japan

“…web API, as a new and simple method to conduct similar analyses (Shaw et al, 2017;Sommerhalter et al, 2017). Of particular note is the Google Maps Platform service and its various web APIs (Google Maps APIs).…”

“…By using the Google Maps API, travel times and distances were calculated in consideration of various factors (Google Maps Platform, 2020). In addition, previous studies have used the Google Distance Matrix API, a Google Maps API, to return ETT and ETD results only (Shaw et al, 2017;Sommerhalter et al, 2017). However, our study used the Google Directions API, which provided additional details for directions, in order to confirm whether ferry use was required and thus enabled us to exclude those areas from analysis when needed.…”

Proximity to risk-appropriate perinatal hospitals for pregnant women with congenital heart defects in New York state

“…Women in the HSAs surrounding NYC, including the Mid-Hudson and Nassau-Suffolk HSAs, were also more likely to travel farther than their nearest high-level facility for delivery. Previous examinations of travel patterns for CHD patients undergoing surgery showed that 51% of CHD patients who attended a specialty care center traveled farther than the nearest one [28]. While women in both of these areas have a number of appropriate care facilities within close proximity, 41% of women in the Mid-Hudson area who traveled farther to another appropriate care facility delivered at a NYC hospital, compared to only 15% of women in the Nassau-Suffolk area, demonstrating different travel patterns surrounding NYC.…”

A model for geographic and sociodemographic access to care disparities for adults with congenital heart disease

“…Ideally, this study’s methods will be repeated in the future using a known population and distribution of ACHD patients via a registry or other definitive data source. Sommerhalter et al were able to describe true CHD population distribution in an 11‐county area in New York using known addresses of adolescent CHD patients, but expanding their methods to a national scale will be challenging; they were able to link adolescent patients to a statewide birth defects registry, which not all states have, and expanding track‐and‐trace methods to adults adds another layer of complexity …”

“…Sommerhalter et al were able to describe true CHD population distribution in an 11-county area in New York using known addresses of adolescent CHD patients, but expanding their methods to a national scale will be challenging; they were able to link adolescent patients to a statewide birth defects registry, which not all states have, and expanding track-and-trace methods to adults adds another layer of complexity. 35 In addition to more accurately describing the true ACHD population, our methodology could be repeated using a different definition of ACHD centers or using board-certified ACHD physicians. As ACHA accreditation continues, using accredited centers in place of mid-to high-volume centers will be a more accurate assessment of access to the specific follow up recommended by the ACC/AHA.…”