Barbosa, Megan B.

Donofrio, Mary

Klein, Jennifer H.

Krishnan, Anita

Schwartz, Bryanna N.

Tsemberis, Elena

English

George Washington University: Health Sciences Research Commons (HSRC)

INTRODUCTION• Prenatal detection (PND) and counseling of congenital heart disease by fetal echocardiography (FE) improves outcomes and allows families time to plan for delivery. • Less wealthy neighborhood of origin and rurality are associated with lower likelihood of obtaining PND of important fetal cardiac disease.• The two primary methods of FE delivery, ambulatory vs. hospital-based have not been compared in detail OBJECTIVES• To compare socioeconomic status (SES) and geographic characteristics of pregnant women receiving FE at a large surgical center, Children’s National Hospital (CNH) versus a community-based outreach maternal-fetal medicine (MFM) clinics. • To assess access patterns of timing and distance to FE. METHODS• A retrospective comparative effectiveness study of differences in patients using tertiary care versus MFM FE visits from January-February 2022. • Collected maternal age, FE indication, fetal gestational age, and maternal address (used to gather SES and geo. Data)• Custom software (CDXZipstream, 2018, Version 1.1 Bridgewater, Nj) was used to extract census tract variables (based on 2020 Census) reflecting wealth, income, education and occupation from maternal address.• A neighborhood summary score (NSS) (Peiris et al 2009) was calculated using 6 variables used to create composite Z score (NSS)  • Continuous variables were compared using a t test. SES variables were assessed individually and as a composite score (NSS)A Comparative Study of Access to Fetal Echocardiography in Hospital-based versus Ambulatory sites at a Single Cardiac CenterElena Tsemberis, BA; Bryanna N. Schwartz, MD, MPH; Megan B. Barbosa, MS; Jennifer H. Klein, MD, MPH; Mary Donofrio, MD; Anita Krishnan, MDA tTable 1: Comparison of SES and MFM CohortsCharacteristic CNH Community Outreach P valueTotal patients included(n) 178 94Composite SES z score 0.2 ± 2.8 0.6 ± 2.4 0.572Average maternal age at time of FE (years) 33.6 ± 5.8 35.14 ± 5.74 0.024*Average gestational age at time of FE (weeks) 25.5 ± 4.4 23.7 ± 3.2 0.0010*% HH living in poverty (%) 9.4 ±7.8 7.6± 6.7 0.070% Employed persons age 16+ in professional occupations (%)52.6 ±18.2 54.0 ± 17.1 0.527% persons 25+ Bachelor’s Degree or higher (%) 45.6 ± 24.2 52.8 ± 10.9 0.027*Poverty (>20% census block) 18/177 4/94Distance to care center (miles) 26.5 ± 80.6 14.3 ±10.9 0.153Time to care center, driving (minutes) 42.9 ± 36.6 24.7 ± 13.8 <0.001*Time to care center, public transportation (minutes)150.6 ± 230.0 97.538 ± 111.0 <0.001*Figure 1: Map of MFM Clinics with SES measured by % of population with income below poverty line (last 12 mo.) (ArcGIS)RESULTS• A total of 272 patients were studied (CNH: n=178;  and MFM: n=94)• No significant differences found in SES composite score.• No patients in either cohort lived in a rural census tract.• MFM patients 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) • MFM cohort lived in areas with a higher percentage of people having completed a bachelors’ degree or higher (52.8 ± 10.9 vs 45.6 ± 24.2, p=0.03) • GA at FE earlier among the MFM cohort (23.7± 3.2 vs 25.6 ± 4.4, p=0.001). • Driving time and public transport time to clinic were lower in the MFM cohort.CONCLUSIONS• Neither care method was accessed by patients in rural or lowest SES areas, possibly reflecting lower MFM availability in some areas• Novel methods of outreach for FE are needed leveraging the strengths of current community-based methods to improve access for rural and less wealthy populations.LIMITATIONS• Small population size, short window of data collectionREFERENCES• 1. Klein J, Dwyer G, Donofrio MT, Krishnan A. Geographic Distribution of Congenital Heart Disease: A Single Surgical Center Experience. The Journal of pediatrics. 2022;240:117-121. doi:10.1016/j.jpeds.2021.08.080• 2. Krishnan A, Jacobs MB, Morris SA, et al. Impact of Socioeconomic Status, Race and Ethnicity, and Geography on Prenatal Detection of Hypoplastic Left Heart Syndrome and Transposition of the Great Arteries. Circulation (New York, NY). 2021;143(21):2049-2060. doi:10.1161/CIRCULATIONAHA.120.053062• 3. Peiris et al. Association of Socioeconomic Position and Medical Insurance With Fetal Diagnosis of Critical Congenital Heart Disease. Circulation: Cardiovascular Quality and Outcomes. 2009;2:354–360. https://doi.org/10.1161/CIRCOUTCOMES.108.802868

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

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1302&context=gw_research_showcase

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

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