Division of Congenital Cardiac Surgery, Levine Children's Hospital/Atrium Health, Charlotte, North Carolina.
Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan C. S. Mott Children's Hospital, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan Medical School, Ann Arbor, Michigan.
Ann Thorac Surg. 2021 May;111(5):1628-1635. doi: 10.1016/j.athoracsur.2020.06.057. Epub 2020 Aug 26.
Over 150 hospitals perform congenital heart surgery (CHS) in the United States. Many hospitals are close together, with a median patient travel distance of 38.5 miles. We began with a theoretical blank slate and used objective methodology guided by population density and volume thresholds to estimate the optimal number and locations of hospitals to provide CHS in the United States.
Guided by published data, we estimated the number of CHS operations in the United States in to be 32,500 per year. 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.
We estimated 57 hospitals could serve the contiguous United States. Median theoretical hospital volume after regionalization was 451 operations (interquartile range, 366-648). Median patient travel distance was 35.1 miles. Some patients (6396/31,895, 20%) traveled more than 100 miles.
Our model suggests the United States could be served by approximately 100 fewer CHS hospitals than currently exist. With hospitals optimally placed, patient travel burden would decrease. This model serves as a platform to improve care delivery by regionalization of CHS.
美国有超过 150 家医院开展先天性心脏病手术（CHS）。许多医院彼此相邻，患者的平均出行距离为 38.5 英里。我们从理论空白开始，使用基于人口密度和容量阈值的客观方法来估计美国提供 CHS 的最佳医院数量和位置。
根据已发表的数据，我们估计美国每年有 32500 例 CHS 手术。我们根据人口密度在地理上分配患者。大都市区（人口中心和周边地区，具有密切的经济/社会联系）被用作潜在的医院位置。患者被分配到最近的医院位置，以使所有医院的 CHS 容量都≥300 例。
我们估计有 57 家医院可以为美国大陆提供服务。区域化后的理论医院容量中位数为 451 例（四分位距，366-648）。患者的平均出行距离为 35.1 英里。一些患者（31895 例中的 6396 例，20%）的出行距离超过 100 英里。
我们的模型表明，美国可能只需要比目前减少约 100 家 CHS 医院即可满足需求。随着医院的最佳布局，患者的出行负担将会减轻。该模型为通过 CHS 的区域化改善医疗服务提供了一个平台。
