
==== Front
Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00043
10.1097/01.GOX.0001063980.34323.6d
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
A Geographic Needs Assessment for Approved Cleft Care in the United States
Parham Matthew MS 1
Williams Austin BS 1
Layon Sarah BS 1
Burns Heather MD 1
Abu-Ghname Amjed MD 1
Hollier Larry MD 1
Baylor College of Medicine/Texas Children’s Hospital
9 2024
18 9 2024
12 Suppl 32-33Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcBACKGROUND: Geographic Information Systems (GIS) have evolved as a powerful tool for characterizing epidemiological trends, patterns of care utilization, and limitations in care access. Patients with cleft lip and/or palate (CL/P) require long-term care, with numerous surgeries and therapies to treat the aesthetic and functional consequences of their diagnosis (1). Access to appropriate and timely cleft care depends on a variety of factors. In addition to physical distance, cleft epidemiology, race, financial disparities, and social history can negatively affect a patient’s ability to receive care. In this study we utilize population level analysis and GIS to generate a demand index for approved cleft care within the United States (US).

METHODS: All births between 2018-2022 were queried from the National Vital Statistics System (NVSS) Restricted-Use Vital Statistics Data. For each US county, CL/P birth prevalence per 10,000 births and population density were calculated. The Social Vulnerability Index (SVI) was utilized to account for the degree of social inequality for each county (2). Approved cleft centers were identified from the ACPA website and geocoded to calculate driving distances between county centroids and the nearest center. Birth prevalence, population density, SVI, distance to the nearest center, and centers within a 50km radius were used to generate a composite score of cleft demand.

RESULTS: Nine hundred and seventy counties had a score less than 25, 1930 counties had scores between 25 and 49.99, 172 counties had scores between 50 and 74.99, and 59 counties had scores between 75 and 100. The highest scoring county, Bibb County, GA had a CL/P birth prevalence of 16.2 per 10,000 births, population density of 241.46 persons per km2, distance to the nearest cleft center of 207.69 km, and an SVI of 0.96. Nevada (83.6), Montana (76.0), and Georgia (74.1) were the states with the highest average demand scores.

CONCLUSIONS: Understanding the interplay between the numerous spatial and non-spatial barriers to care is crucial to optimize care delivery. Our composite score quantifies cleft burden, socioeconomic disadvantage, and geographic barriers to provide a measure of the of demand for approved cleft care in each US county. By describing the geospatial relation of these barriers, our study demonstrates the power of GIS for identifying areas with limited access to approved cleft care teams. Demand indices, like this, have demonstrated a variety of applications in health policy, research, and administration to expand access to patients not covered by local supply (3). Utilizing these score components can help tailor future ACPA interventions, outreach efforts, and planning of cleft care centers.

REFERENCES:

1. Wells-Durand E, Buchel A, Tuen YJ, et al. What Does Cleft Lip and Palate Care Cost? The Time and Economic-Associated Burden of Care From Birth to Maturity. Plast Surg. Published online October 9, 2023:22925503231203216. doi:10.1177/22925503231203216

2. CDC/ATSDR Social Vulnerability Index (SVI). Published January 18, 2024. Accessed February 6, 2024. https://www.atsdr.cdc.gov/placeandhealth/svi/index.html

3. Calovi M, Seghieri C. Using a GIS to support the spatial reorganization of outpatient care services delivery in Italy. BMC Health Serv Res. 2018;18:883. doi:10.1186/s12913-018-3642-4
