Disparities in access to healthcare services in a regional neonatal transport network

Introduction: The disproportionate distribution of healthcare resources in the U.S. leads to an annual estimated 68,000 critically-ill newborns transported to regional centers for intensive care. As described in the Systems Engineering Initiative for Patient Safety (SEIPS) 3.0 framework, patients with limited access to healthcare experience multiple healthcare settings in their journey to specialty care. Little is known about community resources for transported neonatal patients in the Pacific Northwest region. Methods: Transport data from January 2014-December 2019 identified referral zip codes for transfers to a regional neonatal intensive care unit (NICU). Using the SEIPS 3.0 framework to explore the journey of families experiencing neonatal complications, we linked referral zip codes to data on healthcare and resource access including: Health Transportation Shortage Index (HTSI); US Census Small Area Income and Poverty Estimates; public transportation availability; Health Professional Shortage Area (HPSA) and number of Federally Qualified Health Centers. Results: 1834 neonatal transports from 75 zip codes were analyzed. Forty percent of patients were transferred from a HPSA, one-quarter from areas with limited public transit availability (28%) and household internet access (24%). Almost all infants transferred from a high HTSI area (96%) were transported by air. Conclusion: Many patients were referred from communities with high poverty and limited services. Improving patient outcomes requires population and policy level recommendations and care coordination between healthcare organizations and community services. Considering the patient family perspective within the SEIPS 3.0 framework will ensure patient centered care and an inclusive experience for families transitioning through healthcare settings.