710 - A Comparative Effectiveness Study of Access to Fetal Echocardiography in Hospital-based versus Ambulatory sites at a Single Cardiac Center

Early detection of critical congenital heart disease by fetal echocardiography (FE) improves outcomes and allows families time to plan for delivery. This retrospective comparative effectiveness study evaluates the two primary methods of FE delivery, ambulatory vs. hospital-based, to determine whether differences exist in patient access and demographics.

Objective:

The primary aim was to compare the socioeconomic status (SES) and geographic characteristics of two distinct patient populations, those receiving FE at 1) a large surgical center, Children’s National Hospital (CNH) and 2) community-based outreach maternal-fetal medicine (MFM) clinics. Secondary aims were to assess access patterns of timing and distance to FE.

Design/Methods:

A retrospective chart review was performed on clinic visits between January-February 2022, including visit location, patient addresses, maternal age, and gestational age (GA). Software derived a composite SES score from census block group characteristics using variables representing wealth, income, education, and occupation. We gathered community-level data for individual patients. We examined rurality of patients’ addresses using the USDA rurality score. Secondary analysis compared GA and distance to clinic within the cohorts as proxies to evaluate timing of diagnosis and patient costs.

Results:

We assessed 272 patients (CNH, n=178 and MFM, n=94). No significant differences were found in SES composite score between the two cohorts. Additionally, no patients in either cohort lived in a rural census tract. Patients who received FE at a community outreach clinic were older on average than those who received an echo at CNH (35.1 ± 5.7 vs 33.6 ±5.8 years, p=0.02). The MFM clinic cohort lived in areas with a higher percentage of people having completed a bachelors’ degree or higher (p=0.03). GA was earlier among the community outreach clinic cohort (23.7± 3.2 vs 25.6 ± 4.4, p=0.001). Furthermore, driving time and public transport time to clinic were lower in the community outreach clinic cohort (p< 0.001 and p< 0.001, respectively) (Table 1).

Conclusion(s):

            Patients receiving FE by MFM clinics were older, more highly educated and received their FE at an earlier GA as compared to those at CNH. Neither care method was accessed by patients in rural or lowest SES areas, with limitation of sample size. The findings likely reflect practice patterns of MFM specialists that do not reach populations at risk. Novel methods of outreach for FE are needed leveraging the strengths of current community-based methods to improve access for rural populations.