Abstract
BackgroundDiagnostic precision and the identification of rare diseases is a daily challenge, which needs specialized expertise. We hypothesized, that there is a correlation between the distance of residence to the next tertiary medical facility with highly specialized care and the diagnostic precision, especially for rare diseases.ResultsUsing a nation-wide hospitalization database, we found a negative association between diagnostic diversity and travel time to the next tertiary referral hospital when including all cases throughout the overall International Classification of Diseases version 10 German Modification (ICD-10-GM) diagnosis codes. This was paralleled with a negative association of standardized incidence rates in all groups of rare diseases defined by the Orphanet rare disease nomenclature, except for rare teratologic and rare allergic diseases.ConclusionOur findings indicate a higher risk of being mis-, under- or late diagnosed especially in rare diseases when living more distant to a tertiary medical facility. Greater distance to the next tertiary medical facility basically increases the chance for hospitalization in a non-comprehensive regional hospital with less diagnostic capacity, and, thus, impacts on adapted health care access. Therefore, solutions for overcoming the distance to specialized care as an indicator of health care access are a major goal in the future.
Highlights
Diagnostic precision and the identification of rare diseases is a daily challenge, which needs specialized expertise
Association between travel time and incidence rate of rare diseases In order to investigate whether the above-mentioned observation of a negative association between diagnostic diversity and travel time was on the expenses of rare diseases, we restricted our analysis on rare diseases as defined by Orphanet., We found a significant inverse association between standardized incidence rates and travel time from residence to the closest tertiary inpatient institution (Fig. 2d)
The effect is pronounced in patients with rare diseases, where standardized incidence rates for several orphan disease groups fell below 50% at travel times of > 60 min to the tertiary health center
Summary
Diagnostic precision and the identification of rare diseases is a daily challenge, which needs specialized expertise. That there is a correlation between the distance of residence to the tertiary medical facility with highly specialized care and the diagnostic precision, especially for rare diseases. We hypothesized that diagnostic precision, measured by the diagnostic diversity index (DDI) as a reproducible quality indicator of the diagnostic precision of inpatient care, depending on the caseload of the hospital [17], is affected by spatial disparities along the geographical dispersion of specialized medical centers. The aim of the current project was to examine whether there is a correlation between the mean diagnostic diversity and standardized incidence rates for rare diseases from inpatient cases of residents from a particular area and their travel time to the tertiary inpatient facility
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