美国儿科麻醉医师的区域分布与其儿科人数的关系
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The Geographic Distribution of Pediatric Anesthesiologists Relative to the US Pediatric Population
背景与目的
儿科麻醉医师与儿科人数之间的区域关系具有重要的临床和策略影响和意义。最近我们研究了儿科麻醉医师相对于美国儿科患者人数（0-17岁）和其中一部分患者人数（0-4岁）的区域分布。
方 法
美国儿科患者离居住最近的麻醉医师的不同驾驶距离（0到25英里, 25到50英里,50到100英里,100到250英里,和250英里以上）的百分比是由围绕儿科麻醉师实践点的同中心行驶距离服务区所决定的。美国人口普查机构确定了每名麻醉医师驾驶到服务区治疗的总儿科人口量。然后根据美国306个医院转诊区域（HRR）中儿科麻醉师与儿科人群的比例，并与其他科室医师与儿科人群的比例进行比较。使用ArcGIS Desktop 10.2.2映射软件（Redlands，CA）完成所有地理位置的显示和分析。
结 果
绝大部分（71.4%）患儿居住离儿科麻醉医师25公里的范围内；然而，1020万美国患儿（0-17岁）居住离最近的麻醉医师远超过50公里。超过270万名0-4岁的患儿居住在离最近的麻醉医师50公里以上。儿科麻醉医师与10万名转诊患儿人数的中位比率是2.25（四分位范围0-5.46）。小儿麻醉医师区域分布相对儿科人数来说较低，且低于所有麻醉医师、新生儿科医师以及儿科医师。
结 论
美国大部分儿童的住所离最近的麻醉医师超过50公里，儿科麻醉医师与儿科人数的比率在全美范围内也是极其不一致的。这些研究很重要，美国外科医学院儿科手术质量改进会的最新指南指出，儿科麻醉医师必须兼顾儿科患者的一个子集。因为在儿科麻醉医师区域分布不平衡的情况下，尤其是对于那些资源有限或情况紧急时，一个儿科麻醉医师监管所有的患儿是不可行的。
原始文献摘要
Muffly, Matthew K; Medeiros, David; Muffly, Tyler M; The Geographic Distribution of Pediatric Anesthesiologists Relative to the US Pediatric Population；Anesthesia & Analgesia . 125(1):261-267, July 2017.
BACKGROUND: The geographic relationship between pediatric anesthesiologists and the pediatric population has potentially important clinical and policy implications. In the current study, we describe the geographic distribution of pediatric anesthesiologists relative to the US pediatric population (0–17 years) and a subset of the pediatric population (0–4 years).
METHODS: The percentage of the US pediatric population that lives within different driving distances to the nearest pediatric anesthesiologist (0 to 25 miles, >25 to 50 miles, >50 to 100 miles, >100 to 250 miles, and >250 miles) was determined by creating concentric driving distance service areas surrounding pediatric anesthesiologist practice locations. US Census block groups were used to determine the sum pediatric population in each anesthesiologist driving distance service area. The pediatric anesthesiologist-to-pediatric population ratio was then determined for each of the 306 hospital referral regions (HRRs) in the United States and compared with ratios of other physician groups to the pediatric population. All geographic mapping and analysis was performed using ArcGIS Desktop 10.2.2 mapping software (Redlands, CA).
RESULTS: A majority of the pediatric population (71.4%) lives within a 25-mile drive of a pediatric anesthesiologist; however, 10.2 million US children (0–17 years) live greater than 50 miles from the nearest pediatric anesthesiologist. More than 2.7 million children ages 0 to 4 years live greater than 50 miles from the nearest identified pediatric anesthesiologist. The median ratio of pediatric anesthesiologists to 100,000 pediatric population at the HRR level was 2.25 (interquartile range, 0–5.46). Pediatric anesthesiologist geographic distribution relative to the pediatric population by HRR is lower and less uniform than for all anesthesiologists, neonatologists, and pediatricians.
CONCLUSIONS: A substantial proportion of the US pediatric population lives greater than 50 miles from the nearest pediatric anesthesiologist, and pediatric anesthesiologist-to-pediatric population ratios by HRR vary widely across the United States. These findings are important given that the new guidelines from the American College of Surgeons Children’s Surgery Verification™ Quality Improvement Program state that pediatric anesthesiologists must care for a subset of pediatric patients. Because of the geographic distribution of pediatric anesthesiologists relative to the pediatric population, access to care by a pediatric anesthesiologist may not be feasible for all children, particularly for those with limited resources or in emergent situations.
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