Abstract 201: Travel Distance Among Publicly Insured Infants With Operable Congenital Heart Disease

Abstract

Background: Infants with congenital heart disease (CHD) often require surgery within the first year of life, but may live far from congenital heart centers (CHCs) that can perform these surgeries. While some advocate for regionalization of care, others are concerned with impacts on travel distance and access. Using national Medicaid claims data, we determined the magnitude and predictors of nationwide travel distances between the homes of infants with operable CHD and the nearest CHCs. Methods: Our primary data source was the 2012 Medicaid Analytic eXtract claims data from 46 states and the District of Columbia. We identified 120 CHCs from the 2012 Congenital Cardiology Today directory, which is published annually in collaboration with the American College of Cardiology. Our sample included infants <365 days old with a 2012 claim containing one of 13 ICD-9-CM diagnostic codes for CHD requiring surgery in the first year of life (e.g. pulmonary atresia). We calculated straight-line distance between centroids of each patient’s ZIP code and the ZIP code of the nearest CHC. To determine predictors of travel distance, we performed a linear regression of log-transformed distance as a function of age, gender, race/ethnicity, urban/rural status, and mean adjusted gross income by ZIP code (mAGI). Results: Our sample included 11,868 children. Of these, 228 patients did not have a CHC within their state. Mean travel distance was 50.3 (SD 86.8) miles with a median of 25.6 (IQR 7.6-72.9) miles. In our sample, 53% lived within 30 miles of a CHC, but 15.3% lived greater than 100 miles away. Race, mAGI, and urban/rural status were independently associated with travel distance. On average, minorities lived closer to CHCs compared to white patients, with the exception of American Indian and Alaskan natives. Individuals in the poorest and urban ZIP codes lived closer to CHCs compared individuals in wealthier and rural ZIP codes (Table 1). Conclusion: Regionalization of CHD care could increase travel distances and impose access barriers. Our study informs the regionalization debate by estimating the prevalence and characteristics of infant CHD patients who may have high travel distances. Future research should use quasi-experimental approaches to ascertain the relationship between travel distance, access, and outcomes among CHD patients.