Travel Burden to American Cleft Palate and Craniofacial Association-Approved Cleft and Craniofacial Teams: A Geospatial Analysis.

Abstract

Background: Despite the existence of cleft and craniofacial teams approved by the American Cleft Palate and Craniofacial Association (ACPA), access to multidisciplinary team-based care remains challenging for patients from rural areas, leading to disparities in care. The authors investigated the geospatial relationship between US counties and ACPA-approved centers.

Methods: The geographic location of all ACPA-approved cleft and craniofacial centers in the United States was identified. Distance between individual US counties ( n = 3142) and their closest ACPA-approved team was determined. Counties were mapped based on distance to nearest cleft or craniofacial team. Distance calculations were combined with US Census data to model the number of children served by each team and economic characteristics of families served. These relationships were analyzed using independent t tests and analysis of variance.

Results: Over 40% of US counties did not have access to an ACPA-approved craniofacial team within a 100-mile radius ( n = 1267) versus 29% for cleft teams ( n = 909). Over 90% of counties greater than 100 miles from a craniofacial team had a population less than 7500 ( n = 1150). Of the counties more than 100 miles from a cleft team, 64% had a child poverty rate greater than the national average ( n = 579). Counties with the highest birth rate and more than 100 miles to travel to an ACPA team are in the Mountain West.

Conclusions: Given the time-sensitive nature of operative intervention and access to multidisciplinary care, the lack of equitable distribution in certified cleft and craniofacial teams is concerning. Centers may better serve families from distant areas by establishing satellite clinics, conducting telehealth visits, and training local primary care providers in referral practices.