Factors influencing age at referral of children with congenital heart disease

Objectives: To chronicle current referral practices for children with congenital cardiac disease and to determine which factors (lesion, physician type, insurance, or physician location) influenced the age at referral. Methods: Data were collected from our congenital cardiac registry for all children born from January 1, 1989, through December 31, 1994, with 1 of 4 isolated lesions: valvular aortic stenosis, secundum atrial septal defect, tetralogy of Fallot, and ventricular septal defect. Variables included insurance plan at referral, referring physician (nonpediatrician vs pediatrician), and physician location (urban vs nonurban). Results: The study population included 544 children. In the neonatal period, mean age at referral was 9 days for patients with private insurance and those with managed care. Nonurban neonates were referred a mean of 5.2 days later than urban neonates. After the neonatal period, those with managed care were referred later (279 days) than those with commercial insurance (165 days). Mean nonurban referral age was 213 days vs 136 days for urban referrals (P=.008). After the neonatal period, mean age at referral increased progressively each year for those with managed care. Mean referral age by all nonpediatricians was 222 days vs 136 days for all pediatricians (P=.008), but nonurban pediatricians referred patients at a similar age as nonpediatricians. Conclusions: For neonates the major risk factor for delayed referral was nonurban location; for the whole group, major risk factors were insurance other than commercial, nonurban location, and lesion type.