282 - Pediatric subspecialty outreach clinics: reach and impact on geographic access to specialists

Poster Number: 282
Publication Number: 282.1621

Background: Pediatric subspecialty care can be crucial to child well-being, but may be limited by an insufficient and maldistributed subspecialist workforce. Subspecialty outreach clinics bring subspecialists to remote communities on a periodic basis to reduce geographic barriers to care. However, the impact of outreach clinics is not well understood, and outreach clinics have not been included in recent research highlighting the distribution of specialists.

Objective: This study aimed to assess the frequency and distribution, as well as the impact on travel times, of subspecialty outreach clinics in the rural state of Maine.

Design/Methods: In Maine, most pediatric specialty care, including all pediatric cardiology, gastroenterology, endocrinology, neurology, pulmonology, and nephrology, is provided through two organizations. We obtained the schedule and locations of all outreach clinic sessions held by these organizations for these specialties in 2022. For each specialty, we calculated the travel time from each ZIP code in Maine to the nearest hub and to the nearest clinic location (hub or satellite). Using 2020 census data, we calculated the range and median of travel times for children across the state, as well as the decrease in travel time due to the availability of outreach clinics.

Results: Outreach clinics were held in 8 locations throughout the state. Specialties held outreach clinics at their sites a median 11 times (IQR 4.5-23 times) in 2022 (Table 1). Among the 207,409 children under 20 years old in Maine, the travel time to the closest hub was a median 50.1 minutes (IQR 37.1 -72.2). 68.8% of children were closer to at least one outreach clinic location than to a hub. Table 2 and Figure 1 compare the travel times to the nearest hub with the travel times to the nearest outreach clinic or hub for all children in Maine. The inclusion of outreach clinics decreased the median travel time by anywhere from 4.9 minutes (neurology) to 26 minutes (pulmonology), and decreased the 75 %ile of travel time by anywhere from 11.3 minutes (neurology) to 53.4 minutes (nephrology).

Conclusion(s): Outreach clinics in Maine substantially decrease the travel burden of children accessing subspecialty care. However, these clinics are offered as few as four times per year, which may pose an additional barrier to care for those in outlying areas. Outreach clinics should be accounted for in assessments of geographic access in other locations and clinical settings.