597 - Disparities in Access to Healthcare Services in a Regional Neonatal Transport Network

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 597
Publication Number: 597.319

Jasmine E. James, University of Washington School of Medicine, seattle, WA, United States; Annabelle Kotler, University of Washington School of Medicine, Sammamish, WA, United States; John Feltner, University of Washington School of Medicine, Seattle, WA, United States; Zeenia Billimoria, University of Washington School of Medicine, Seattle, WA, United States; Taylor Riley, University of Washington School of Medicine, Seattle, WA, United States; Adithi P. Mahankali, University of Washington School of Medicine, Portland, OR, United States; Cailin F. White, University of Washington School of Medicine, Seattle, WA, United States; Rachel Umoren, University of Washington School of Medicine, Seattle, WA, United States; Megan Gray, University of Washington School of Medicine, Seattle, WA, United States

Presenting Author(s)

Jasmine E. James, MD, MPH (she/her/hers)

Research Assoc
University of Washington School of Medicine
Seattle, Washington, United States

Background: The disproportionate distribution of healthcare resources in the U.S. leads to an estimated 68,000 critically ill newborns transported to regional centers each year. Patients may be referred from communities with limited access to healthcare, internet and public transit. Families are screened individually for needs on NICU admission, but little is known of the general level of access to community resources by NICU families in the Pacific Northwest region.

Objective:

To describe the communities from which neonates are transferred within a regional transport network by availability of healthcare professionals, public transportation, poverty rates and internet access.

Design/Methods: Data from transport records from Jan 2014 - Feb 2020 were used to identify zip codes of referrals for neonatal transfer to a Level IV regional neonatal intensive care unit (NICU). To define the scope of healthcare access and potential disparities in the communities of families whose newborns were transferred we used the Health Transportation Shortage Index (HTSI); child poverty rate, based on US Census Small Area Income and Poverty Estimates (SAIPE); public transportation availability (American Public Transportation Association); Health Professional Shortage Area (HPSA) and number of Federally Qualified Health Centers (FQHC); Health Resources & Services Administration; and household internet subscriptions from the US Census American Community Survey (ACS; 5-year estimate 2017-2021). Transfer records with missing zip code data were excluded from the analysis.

Results: 695 neonatal transports from 52 facilities in 49 zip codes were included in the analysis. Table 1. Of the 97 families coming from a medically underserved area or population 17 (2%) had one or no FQHCs. HTSI scores were 1-2 for 400 (57%) of referred patients with limited or no public transit available to 245 (35%). Figure 1. The majority of patients came from communities with higher than national average rates of homes without internet subscriptions (651, 94% with internet access rates below 95%) and 97(14%) of transferred patients will go to school in a district with greater than the national median poverty rate of 13%. Figure 2.

Conclusion(s): Many NICU patients are referred from communities with higher rates of poverty and lower service availability. There is a need to prioritize NICU families from targeted communities for additional resources and improved coordination between healthcare and community service providers. Ongoing research into how to best support families during and after the NICU stay is essential to optimizing outcomes for NICU patients.