Factors Associated with Referral to Expert Providers among Patients with Pulmonary Hypertension

• DOI: 10.1513/annalsats.202408-901oc
• Publication Date: 2025-02-11T15:53:22Z
• Authors: Kari R Gillmeyer; Seppo T Rinne; Justin M Rucci; Elizabeth S Klings; A. Rani Elwy; Renda Soylemez Wi...
• Keywords: Patient referral

Guidelines recommend early referral to pulmonary hypertension (PH) experts for patients with confirmed or suspected arterial (PAH) chronic thromboembolic PH (CTEPH), among others. Yet, often have advanced disease at the time of referral. The drivers these delays are not well known. Building upon our prior qualitative findings on barriers timely care along continuum, we sought identify patient-level factors associated experts. We leveraged Massachusetts All-Payer Claims Database all incident in 2015-2017 using a validated algorithm (sensitivity 28%; specificity 100%) and further identified subgroups risk factor PAH CTEPH. Our outcome was presence absence expert during study period. Based work, three primary exposures were 1) Medicaid recipient, 2) mental health diagnoses, 3) distance nearest center. conducted separate multivariable logistic regression models determine association between each outcome, entire cohort those Among (n=12,505), 704 (5.6%) seen by expert. subset (n=2,393) CTEPH (n=3,167), 242 (10.1%) 185 (5.8%) expert, respectively. Patients less likely be referred included recipients (adjusted Odds Ratio [aOR] 0.64, 95% Confidence Interval [CI] 0.53-0.77), diagnoses (aOR 0.69, CI 0.58-0.83), living from center 0.78, 0.74-0.82 10 miles increase center). Findings similar Few experts, including Factors this highlight offer targeted areas future improve timeliness care.