In a recent study, researchers examined the decisionmaking strategy that a parent might use to assess the trade-off between the chance for a better surgical outcome and the need to travel further to a regional referral hospital. Using a hypothetical scenario, they found that parents are willing to travel 2 hours further to specialized cardiac regional hospitals to reduce their child's risk of dying from cardiac surgery by 1 percent.
In a previous study by the same researchers, Ruey-Kang R. Chang, M.D., M.P.H., of the University of California-Los Angeles, and colleagues found that when all pediatric cardiac surgeries in California were theoretically regionalized to five hospitals that performed a high volume of such surgeries, the overall mortality rate could be reduced from 5.3 to 4.1 percent. However, this regionalization scheme increased the average travel time of children who were transferred by about 2 hours. In the new study, the researchers found that nearly two-thirds (63.1 percent) of parents were willing to travel for an extra 2 hours to a referral hospital to reduce the risk of mortality from 4 to 3 percent.
When the regional referral hospital was set at a 2-hour driving distance and a 3 percent mortality rate was equal for the regional and local hospitals, 82.5 percent of parents chose to have their child's surgery at the local hospital. However, the percentage of parents who chose to have their children remain at the local hospital dropped dramatically to 36.9 percent when the mortality rate for the local hospital increased to 4 percent and to 19.4 percent when the mortality rate rose to 6 percent.
On the other hand, about 5 to 10 percent more parents were willing to stay at the local hospital at each mortality rate when the travel time to the referral hospital increased from 2 to 4 hours. The parent's age, sex, insurance status, education, and availability of personal transportation were not associated with their decisions. The study was supported in part by the Agency for Healthcare Research and Quality (HS13217). The findings are based on interviews with 103 parents or adult primary caregivers of children referred to a pediatric cardiology clinic. Those interviewed were presented with hypothetical scenarios in which they or their children had a heart condition requiring elective surgery, which would be performed either at a local or a regional referral hospital.
See "Parental preference regarding hospitals for children undergoing surgery: A trade-off between travel distance and potential outcome improvement," by Dr. Chang, James J. Joyce, M.D., Julia Castillo, M.D., and others, in the July 2004 Canadian Journal of Cardiology 20(9), pp. 877-882.