Parham Matthew J, Williams Austin D, Layon Sarah A, Burns Heather R, Abu-Ghname Amjed, Hollier Larry H
From the Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.; and Division of Plastic Surgery, Texas Children's Hospital, Houston, Tex.
Plast Reconstr Surg Glob Open. 2024 Aug 26;12(8):e6090. doi: 10.1097/GOX.0000000000006090. eCollection 2024 Aug.
Geographic information systems are powerful tools for characterizing the geospatial factors influencing access to care. As patients with cleft lip and/or palate (CL/P) require long-term care, with numerous operations and therapies, access to timely, quality care is extremely important. This study uses population level analysis and geographic information systems to identify United States counties with limited access to American Cleft Palate Association-approved cleft teams.
Natality data were queried from the National Vital Statistics System. Population and geographic data were obtained from the US Census Bureau. The Social Vulnerability Index (SVI) was utilized to account for social inequality. Total births with CL/P, population estimates, SVI, distance to the nearest center, and total centers within 50 km were used to generate the cleft care demand index (CCDI).
Ninety-two counties had CCDIs between 66.7 and 100. The highest scoring county, Hidalgo County, Texas, had 62 births with CL/P, population estimate of 888,367 persons, distance to the nearest cleft center of 368.4 km, and SVI of 0.99.
This study demonstrates the power of geographic information systems for identifying areas with limited access to approved cleft teams. The CCDI measures cleft burden, socioeconomic disadvantage, and geographic barriers to quantify the demand for approved cleft care in each county. Utilizing these scores can help direct future interventions, outreach efforts, and cleft care center planning.
地理信息系统是描述影响医疗服务可及性的地理空间因素的有力工具。由于唇腭裂（CL/P）患者需要长期护理，接受大量手术和治疗，获得及时、优质的护理极为重要。本研究采用人群水平分析和地理信息系统来确定美国获得美国腭裂协会认可的腭裂治疗团队服务机会有限的县。
从国家生命统计系统查询出生数据。人口和地理数据从美国人口普查局获取。利用社会脆弱性指数（SVI）来考虑社会不平等。患有唇腭裂的总出生数、人口估计数、SVI、到最近中心的距离以及50公里范围内的中心总数用于生成腭裂护理需求指数（CCDI）。
92个县的CCDI在66.7至100之间。得分最高的县是得克萨斯州的伊达尔戈县，有62例唇腭裂出生病例，人口估计为888367人，到最近腭裂中心的距离为368.4公里，SVI为0.99。
本研究证明了地理信息系统在识别获得认可的腭裂治疗团队服务机会有限地区方面的作用。CCDI衡量腭裂负担、社会经济劣势和地理障碍，以量化每个县对认可的腭裂护理的需求。利用这些分数有助于指导未来的干预措施、外展工作和腭裂护理中心规划。
