Travel Distances for Interhospital Transfers of Critically Ill Children: A Geospatial Analysis.

Q4 Medicine Critical care explorations Pub Date : 2024-10-25 eCollection Date: 2024-11-01 DOI:10.1097/CCE.0000000000001175
Allan M Joseph, Christopher M Horvat, Billie S Davis, Jeremy M Kahn
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Abstract

Importance: The U.S. pediatric acute care system has become more centralized, placing increasing importance on interhospital transfers.

Objectives: We conducted a geospatial analysis of critically ill children undergoing interfacility transfer with a specific focus on understanding travel distances between the patient's residence and the hospitals in which they receive care.

Design, setting, and participants: Retrospective geospatial analysis using five U.S. state-level administrative databases; four states observed from 2016 to 2019 and one state from 2018 to 2019. Participants included 10,665 children who experienced 11,713 episodes of critical illness involving transfer between two hospitals.

Main outcomes and measures: Travel distances and the incidence of "potentially suboptimal triage," in which patients were transferred to a second hospital less than five miles further from their residence than the first hospital.

Results: Patients typically present to hospitals near their residence (median distance from residence to first hospital, 4.2 miles; interquartile range [IQR], 1.8-9.6 miles). Transfer distances are relatively large (median distance between hospitals, 28.9 miles; IQR, 11.2-53.2 miles), taking patients relatively far away from their residences (median distance from residence to second hospital, 30.1 miles; IQR, 12.2-54.9 miles). Potentially suboptimal triage was frequent: 24.2 percent of patients were transferred to a hospital less than five miles further away from their residence than the first hospital. Potentially suboptimal triage was most common in children living in urban counties, and became less common with increasing medical complexity.

Conclusions and relevance: The current pediatric critical care system is organized in a hub-and-spoke model, which requires large travel distances for some patients. Some transfers might be prevented by more efficient prehospital triage. Current transfer patterns suggest the choice of initial hospital is influenced by geography as well as by attempts to match hospital resources with perceived patient needs.

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重症儿童院间转运的旅行距离:地理空间分析
重要性:美国儿科急症护理系统变得越来越集中,医院间转院也变得越来越重要:我们对接受医院间转院的重症患儿进行了地理空间分析,重点了解患者居住地与接受治疗的医院之间的距离:使用五个美国州级行政数据库进行回顾性地理空间分析;其中四个州的观察期为 2016 年至 2019 年,一个州的观察期为 2018 年至 2019 年。参与者包括 10,665 名儿童,他们经历了 11,713 次危重病发作,涉及在两家医院之间转院:旅行距离和 "潜在次优分流 "的发生率,即患者被转到距离其居住地比第一家医院远不到五英里的第二家医院:结果:患者通常会到居住地附近的医院就诊(从居住地到第一家医院的距离中位数为 4.2 英里;四分位数间距 [IQR],1.8-9.6 英里)。转院距离相对较远(医院之间的中位距离为 28.9 英里;IQR 为 11.2-53.2 英里),患者距离住所相对较远(从住所到第二家医院的中位距离为 30.1 英里;IQR 为 12.2-54.9 英里)。潜在的次优分流很常见:24.2%的患者被转到了距离其住所比第一家医院远不到五英里的医院。潜在的次优分流在居住在城市县城的儿童中最为常见,随着医疗复杂程度的增加,这种情况越来越少:目前的儿科重症监护系统采用的是 "枢纽-辐射 "模式,这就要求一些患者必须长途跋涉。更有效的院前分诊可以避免一些转院。目前的转院模式表明,初始医院的选择受到地理位置以及医院资源与患者需求相匹配的影响。
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5.70
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8 weeks
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