Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties
Proximity to Pediatric Cardiac Surgical Care among Adolescents with Congenital Heart Defects in 11 New York Counties
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DOI：
10.1002/bdr2.1129
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发表时间：
2017-11-01
影响因子：
2.1
通讯作者：
Van Zutphen, Alissa R.
中科院分区：
文献类型：
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作者：
Sommerhalter, Kristin M.;Insaf, Tabassum Z.;Van Zutphen, Alissa R.
背景 许多患有先天性心脏病 (CHD) 的人在青春期停止心脏护理，使他们面临不良健康结果的风险。由于地理障碍可能导致护理的停止，我们试图描述患有 CHD 的青少年获得综合心脏护理的地理特征。方法使用纽约基于人口的 11 个县的 CHD 监测系统，我们描述了 11 至 19 岁患有 CHD 的青少年与最近的儿科心脏外科护理中心的接近程度。居住地址是从记录 2008 年至 2010 年医疗保健经历的监控记录中提取的。使用 ArcGIS 和纽约州街道和地址维护计划（全州地址点数据库）对地址进行地理编码。使用 R 包 gmapsdistance 和 rgeos 以及 Google 地图距离矩阵应用程序编程接口计算从居住地到最近中心的单程驾驶和公共交通时间。构建了一个边际模型来识别与单程旅行时间相关的预测因素。结果我们确定了 2522 名青少年，他们有 3058 个相应的居住地址和 12 个儿科心脏外科护理中心。从居住地到最近中心的平均驾驶时间为 18.3 分钟，2475 个地址 (80.9%) 的驾驶时间为 30 分钟或更少。高贫困人口普查区西部农村地址的预计驾车时间最长（68.7 分钟）。城市地区的大多数住宅都可以使用公共交通，但农村地区的住宅很少。结论 我们确定了对手术治疗存在地理障碍的地区。未来的研究需要确定这些障碍如何影响患有先心病的青少年的护理连续性。出生缺陷研究 109:1494-1503, 2017.(c) 2017 Wiley periodicals, Inc.
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. Birth Defects Research 109:1494-1503, 2017.(c) 2017 Wiley Periodicals, Inc.