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Abstract
Introduction: Children with congenital heart disease (CHD) typically require care from a multi-disciplinary team of providers and treatment at specialized care centers. Although access to specialty care is known to influence patient outcomes, little is known regarding geographic access to care for children with congenital heart disease. This study calculated travel time to specialized care centers and the relationship with mortality for children residing in Colorado. Methods: We analyzed all payer claims data (APCD) from Colorado (CO) from 2012-2019. Travel times were calculated using a network analysis of the road distance weighted by travel speeds from the geographic centroid of every ZIP code in CO to that of the actual specialized care center. Specialty care centers were uniquely identified by their National Provider ID (NPI) and defined by categorizations from the American Medical Association (AMA). Mortality was defined by discharge status. Results: There were 27,344 children with CHD who received specialized care in the study period, accounting for 437,071 total encounters. Of the children with CHD, there were 355 deaths. Children that died had an average of 98 visits per year, while children that survived had an average of 70 visits (p=<0.001). Among the children who lived, 62.8% of their total specialty care visits were <30 minutes away, compared to 59.7% among those who died. CHD who died had a consistently higher proportion of visits that required greater travel to care. Conclusion: Specialized care centers are often located in urban areas and treat patients from diverse geographic areas. There is significant travel burden for children with CHD.
Published Version
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