Children Deserve The Best: A Theoretical Model For Optimal Delivery Of Congenital Heart Surgery In The United States
Karl Welke1, Sara Pasquali2, Paul Lin3, Carl Backer4, David Overman5, Jennifer Romano6, Tara Karamlou7.
1Levine Children's Hospital, Charlotte, NC, USA, 2University of Michigan C.S. Mott Children's Hospital, Ann Arbor, MI, USA, 3Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, MI, USA, 4Ann and Rober H. Lurie Children's Hospital of Chicago, Chicago, IL, USA, 5Children's Hospital and Clinics of Minnesota, Minneapolis, MN, USA, 6University of Michigan C. S. Mott Children's Hospital, Ann Arbor, MI, USA, 7The Cleveland Clinic, Cleveland, OH, USA.
Objective(s): Over 150 hospitals perform congenital heart surgery (CHS) in the United States (U.S.). Many small volume hospitals are near to one another and mean/median patient travel distances are 93.2/38.5 miles. We began with a theoretical blank slate for hospital locations and used objective methodology guided by population density and known volume-outcome thresholds to estimate the optimal number and locations of hospitals to provide CHS in the U.S.
Methods: Guided by published data, we estimated the number of CHS operations in the U.S. in 2017 to be 31,895. We distributed patients geographically based on population density. Metropolitan Statistical Areas (population centers and surrounding areas with close economic/social ties) were used as potential hospital locations. Patients were assigned to the closest hospital location such that all hospitals had a CHS volume of ≥ 300 operations.
Results: We estimated 57 hospitals could serve the contiguous U.S. (Figure) Median theoretical hospital volume was 451 operations (IQR 366-648). Mean patient travel distance was 61.3 miles (median 35.1 miles). A minority of patients (6396/31895 = 20%), primarily in the mountain west, would travel more than 100 miles.
Conclusions: The U.S could be served by approximately 100 fewer CHS hospitals than currently exist. With high volume hospitals optimally placed, patient travel burden would decrease. This model serves as a platform to improve care delivery by rational regionalization of CHS.