159870 Orofacial Clefts and Time Traveled to Craniofacial Centers in North Carolina

Monday, November 5, 2007

Dianne Enright , North Carolina Division of Public Health, DHHS, Health and Spatial Analyis Unit, State Center for Health Statistics, Raleigh, NC
Cynthia Cassell, PhD , Department of PH Sciences, College of Health and HuNational Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
Robert Meyer, PhD , State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, NC
  
Background: One study examined distances to health care providers as a potential barrier to care among children with orofacial clefts (OFC), which was in the late 1960's. That study was before geographic information systems (GIS) and failed to control for demographic variables.

Objectives: To determine: 1) actual time traveled to a craniofacial center or team (CFC); 2) difference in time traveled for proposed CFCs; and 3) factors associated with time traveled to CFC.

Methods: North Carolina birth defects registry data were used to identify resident children with OFC born 1995-2002 (n=1,252). Residential addresses were located by geocoding. About 86% of children were successfully geocoded. GIS analysis was conducted using ESRI ArcGIS and Network Analyst 9.2. TeleAtlas Multinet 2005 2.1 was used for the road network. Using birth residential address and closest facility network analysis, actual time traveled to the closest CFC was calculated. Proposed CFCs were mapped by calculating where maximum population would be served. Bivariate and multivariate analyses were conducted to determine associations between travel time and selected sociodemographic characteristics.

Results: About 39% of families traveled > 61 minutes to receive services from a CFC. Travel times ranged from one minute to five hours and varied significantly by maternal age, education, Medicaid status, and cleft type. If additional CFCs were located in the southeastern and western regions of the state, where none currently exist, mean travel time would be decreased by 16 minutes.

Conclusions: Despite small decrease in travel time resulting from proposed CFCs, over 140 families (13%) of children with OFC would be able to receive coordinated services closer to home. This could improve access, timeliness of services, and potentially lead to better health outcomes in this population. Using GIS provides a useful tool for evaluating travel distance as a potential barrier to care among children with OFC.

Learning Objectives:
1) Discuss how geographic information systems can be used to assess time traveled to craniofacial centers or teams in North Carolina 2) Articulate methods employed to examine drive time to craniofacial centers or teams in the state 3) Describe the difference in drive time if two proposed craniofacial centers were added in the western and southeastern regions of North Carolina

Keywords: Birth Defects, Access to Care

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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