title: Trends in utilization of specialty care centers in California for adults with congenital heart disease.
abstract: The American College of Cardiology and American Heart Association guidelines recommend that management of adult congenital heart disease (ACHD) be coordinated by specialty ACHD centers and that ACHD surgery for patients with moderate or complex congenital heart disease (CHD) be performed by surgeons with expertise and training in CHD. Given this, the aim of this study was to determine the proportion of ACHD surgery performed at specialty ACHD centers and to identify factors associated with ACHD surgery being performed outside of specialty centers. This retrospective population analysis used California's Office of Statewide Health Planning and Development's discharge database to analyze ACHD cardiac surgery (in patients 21 to 65 years of age) in California from 2000 to 2011. Designation as a "specialty ACHD center" was defined on the basis of a national ACHD directory. A total of 4,611 ACHD procedures were identified. The proportion of procedures in patients with moderate and complex CHD delivered at specialty centers increased from 46% to 71% from 2000 to 2011. In multivariate analysis among those discharges for ACHD surgery in patients with moderate or complex CHD, performance of surgery outside a specialty center was more likely to be associated with patients who were older, Hispanic, insured by health maintenance organizations, and living farther from a specialty center. In conclusion, although the proportion of ACHD surgery for moderate or complex CHD being performed at specialty ACHD centers has been increasing, 1 in 4 patients undergo surgery at nonspecialty centers. Increased awareness of ACHD care guidelines and of the patient characteristics associated with differential access to ACHD centers may help improve the delivery of appropriate care for all adults with CHD.
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California; Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Palo Alto, California; Center for Health Policy, Primary Care Outcomes Research Center, Stanford University, Palo Alto, California. Electronic address: sfernandes@stanford.edu.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Fernandes
authors.affiliation: Center for Health Policy, Primary Care Outcomes Research Center, Stanford University, Palo Alto, California; Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Chamberlain
authors.affiliation: Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Stafford
authors.initials: S
authors.lastname: Grady
authors.affiliation: Center for Health Policy, Primary Care Outcomes Research Center, Stanford University, Palo Alto, California.
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.affiliation: Boston Adult Congenital Heart Service, Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Opotowsky
authors.affiliation: Center for Health Policy, Primary Care Outcomes Research Center, Stanford University, Palo Alto, California; Division of General Pediatrics, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Lee
authors.initials: L
authors.lastname: Sanders
authors.affiliation: Center for Health Policy, Primary Care Outcomes Research Center, Stanford University, Palo Alto, California; Division of Neonatology, Department of Pediatrics, Stanford University, Palo Alto, California.
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002140:California / Q000453:epidemiology; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data* / Q000639:trends; D006348:Cardiac Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D055815:Young Adult