Geographic Distance Between Perinatal and Pediatric Palliative Care Services and Implications for Practice Standards.

BackgroundPractice standards recommend early integration of perinatal and pediatric palliative care (PC) with seamless transitions across settings. Little is known about the proximity between these services nationally.MethodsThis study utilized data from the National Plan and Provider Enumeration System (NPPES) and a publicly-available directory of perinatal PC programs to investigate geospatial variations between services. Infant mortality rates per perinatal PC programs in the community were calculated.Results418 pediatric PC physicians and 296 perinatal PC programs were included. Five states (CA, TX, NY, FL, OH) had the highest concentrations of pediatric PC physicians. Five states had none in the NPPES system (AL, DE, NM, ND, WV). Three states (CA, NY, TX) contained the largest share of perinatal PC programs, each accounting for over 5% of programs. Perinatal PC programs were more widely dispersed with a lower mean concentration per community (m = 1.37, SD = 0.83, range: 1-6). Omaha and Kansas City contained the largest state-level proportions of programs (57.1% and 50.0%). Median drive times to the nearest pediatric PC physician for programs lacking on-site expertise reached approximately 5 hours in NM and SD; 3 hours in ND and MT; and 2 hours in AL, CO, WV, and TN.ConclusionThe distance between perinatal and pediatric palliative care services warrants further exploration into partnerships and patient care implications.