D98. Access to Certified Burn Centers in The United States: The Geospatial and Transport Cost of Transfer

Abstract

PURPOSE: Although ABA-verified burn centers are critical in minimizing burn-associated morbidity and mortality, disparities in burn care access remain – particularly for rural and pediatric patients. The present study quantifies inequitable burn care access as a function of physical proximity and assesses its impact on burn-associated transport costs. METHODS: County-level distances (n=3,106) to the nearest ABA-verified adult (n=59) or pediatric (n=43) burn center were determined and mapped. Average per mile transport cost for each population (urban vs. rural) was estimated from CMS ambulance fee schedules. Total transport cost was determined based on county-level distance calculations, and cost burden was compared between cohorts. RESULTS: Pediatric patients reside 30.57 miles (p < 0.001) further than adults from the nearest center, accounting for a 10.5% - 15.9% transport cost increase. Transport costs increased dramatically between urban and rural counties, with rural patients facing a cost increase of 32.7% and 80.88% for ground and air transportation, respectively. CONCLUSION: Physical proximity to burn care may appear to differ only modestly across age and region. However, the seemingly marginal increase in distance significantly impacts the cost of patient transport. The present study highlights both physical and economic barriers to access faced by rural and pediatric burn patients. Increasing ABA burn center certification in targeted areas across the US may decrease the disparities in access to burn care faced by these groups.