Factors influencing age at referral of children with congenital heart disease
M. A. Perlstein, S. J. Goldberg, F. J. Meaney, M. F. Davis and C. Zwerdling Kluger
Department of Pediatrics, Steele Memorial Research Center, University of Arizona, Tucson, USA.
OBJECTIVES: To chronicle current referral practices for children with
congenital cardiac disease and to determine which factors (lesion,
physician type, insurance, or physician location) influenced the age at
referral. METHODS: Data were collected from our congenital cardiac registry
for all children born from January 1, 1989, through December 31, 1994, with
1 of 4 isolated lesions: valvular aortic stenosis, secundum atrial septal
defect, tetralogy of Fallot, and ventricular septal defect. Variables
included insurance plan at referral, referring physician (nonpediatrician
vs pediatrician), and physician location (urban vs nonurban). RESULTS: The
study population included 544 children. In the neonatal period, mean age at
referral was 9 days for patients with private insurance and those with
managed care. Nonurban neonates were referred a mean of 5.2 days later than
urban neonates. After the neonatal period, those with managed care were
referred later (279 days) than those with commercial insurance (165 days).
Mean nonurban referral age was 213 days vs 136 days for urban referrals
(P=.008). After the neonatal period, mean age at referral increased
progressively each year for those with managed care. Mean referral age by
all nonpediatricians was 222 days vs 136 days for all pediatricians
(P=.008), but nonurban pediatricians referred patients at a similar age as
nonpediatricians. CONCLUSIONS: For neonates the major risk factor for
delayed referral was nonurban location; for the whole group, major risk
factors were insurance other than commercial, nonurban location, and lesion
type.
