(835) Spatial Analysis of a Single Tertiary Center’s Interstate Pediatric Transports

Introduction: Children needing specialty or critical care often require interfacility transport, which may involve interstate travel. Interstate transport may face delays due to varying state regulations impacting logistics. With no public data to guide policy, this pilot study uses a geographic information system to analyze the spatial characteristics of a Maryland pediatric transport service.

Methods: We examined the Johns Hopkins Children’s Center (JHCC) Pediatric Transport database, gathering demographic and transport data from all pediatric interstate transports conducted between 7/1/2022 and 6/30/2023. Additional data came from county/state cartographic shapefiles from the U.S. Census Bureau. Patient addresses were aggregated by zip code for masking, then geocoded along with hospital addresses. Spatial data analyses using ArcGIS Pro 2.9.5 included buffer analysis within a 150-mile radius, proximity analysis to MD and JHCC, Global Moran’s I for spatial autocorrelation, and the mean and median center of patient home zip codes.

Results: We analyzed 118 transports: 101 (85.6%) were urgent/emergent, and 17 (14.4%) were elective (completed > 24 hours after request). Of these, 117 (99.2%) were within a 150-mile radius of JHCC. 88 patients (74.6%) were out-of-state residents, while 30 (25.4%) were from Maryland. There were 100 (84.7%) ground and 18 (15.3%) air transports from 33 facilities in DC, DE, PA, VA, and WV, with the furthest being Pittsburgh, PA (185 miles from JHCC) and Norfolk, VA (159 miles). The closest was in Washington, DC (32 miles from JHCC). The mean (SD) distances were 20 (20.7) miles to MD and 70 (34.9) miles to JHCC. Global Moran’s I indicated no significant clustering (p=0.449 to 0.973) suggesting a random distribution of transport origins. The mean and median centers of patient zip codes were mapped southwest of JHCC.

Conclusions: The JHCC Pediatric Transport’s interstate transports were largely within a 150-mile radius, with a quarter traveling to receive care in their home state. Due to limited data, targeted interventions are not recommended at this time. Developing a data repository for nationwide analysis could be beneficial. Future research should examine additional health systems and geographic areas to guide policy changes and minimize regulatory delays.