title: Parental preference regarding hospitals for children undergoing surgery: a trade-off between travel distance and potential outcome improvement.
abstract: OBJECTIVE
  To explore parental preference in the choice between a local and a referral hospital for children undergoing heart surgery.
  
  
  METHODS
  One hundred three parents or adult primary caregivers of children referred to a pediatric cardiology clinic were interviewed. Participants were presented with hypothetical scenarios in which they or their children had a heart condition requiring elective surgery. The surgery could be performed at either a local hospital or a regional referral hospital. The travel time to the referral hospital was initially presented as 2 h, and the mortality rate was set at 3% for both the local and the referral hospitals. The parents were then presented with scenarios that sequentially increased the mortality of the local hospital and the distance to the referral hospital, and were asked to choose between the local and regional referral hospitals.
  
  
  RESULTS
  When the regional referral hospital was 2 h away and the mortality rates for the referral hospital and the local hospital were equal at 3%, 82.5% of participants chose the local hospital for their children. The percentage of participants choosing the local hospital decreased progressively as the mortality rate of the local hospital increased (to 9.7% at 18% mortality). Between 5% and 10% more participants chose the local hospital when the distance to the referral hospital was increased from 2 h to 4 h. There was no difference in age, sex, ethnicity, language, type of insurance, level of education and availability of personal transportation between participants who chose the regional referral hospital and those who chose the local hospital. Participants who lived closer to the hospital at which the survey was conducted were more likely to choose the local hospital.
  
  
  CONCLUSIONS
  The present study defines a relation between potential outcome improvement and increasing travel distance from a patient or parent's perspective. This trade-off is an important consideration when planning for regionalization.
authors.affiliation: Division of Cardiology, Department of Pediatrics, David Geffen School of Medicine at the University of California-Los Angeles, USA. rkchang@ucla.edu
authors.forename: Ruey-Kang R
authors.initials: RK
authors.lastname: Chang
authors.forename: James J
authors.initials: JJ
authors.lastname: Joyce
authors.forename: Julia
authors.initials: J
authors.lastname: Castillo
authors.forename: Janeth
authors.initials: J
authors.lastname: Ceja
authors.forename: Patty
authors.initials: P
authors.lastname: Quan
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Klitzner
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000401:mortality; D003657:Decision Making; D005260:Female; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007407:Interviews as Topic; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010287:Parent-Child Relations; D010290:Parents; D011787:Quality of Health Care; D012017:Referral and Consultation; D014186:Transportation; D014195:Travel; D016896:Treatment Outcome