Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction
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Authors
Hisa, Renee Y.
Sabbagh, Sarah
Sarkar, Nandita
Sporer, Karl
Rokos, Ivan C.
Brown, John F.
Brindis, Ralph G.
Guo, Joanna
Yu-Chen, Shen
Subjects
Article
Advisors
Date of Issue
2017-10
Date
Publisher
Language
Abstract
Introduction
California has led successful regionalized efforts for several time-critical medical conditions, including ST-segment elevation myocardial infarction (STEMI), but no specific mandated protocols exist to define regionalization of care. We aimed to study the trends in regionalization of care for STEMI patients in the state of California and to examine the differences in patient demographic, hospital, and county trends.
Methods
Using survey responses collected from all California emergency medical services (EMS) agencies, we developed four categories – no, partial, substantial, and complete regionalization – to capture prehospital and inter-hospital components of regionalization in each EMS agency’s jurisdiction between 2005–2014. We linked the survey responses to 2006 California non-public hospital discharge data to study the patient distribution at baseline.
Results
STEMI regionalization-of-care networks steadily developed across California. Only 14% of counties were regionalized in 2006, accounting for 42% of California’s STEMI patient population, but over half of these counties, representing 86% of California’s STEMI patient population, reached complete regionalization in 2014. We did not find any dramatic differences in underlying patient characteristics based on regionalization status; however, differences in hospital characteristics were relatively substantial.
Conclusion
Potential barriers to achieving regionalization included competition, hospital ownership, population density, and financial challenges. Minimal differences in patient characteristics can establish that patient differences unlikely played any role in influencing earlier or later regionalization and can provide a framework for future analyses evaluating the impact of regionalization on patient outcomes.
Type
Article
Description
The article of record as published may be found at http://dx.doi.org/10.5811/westjem.2017.8.34592
Series/Report No
Department
Naval Postgraduate School (U.S.)
Organization
Naval Postgraduate School (U.S.)
Identifiers
NPS Report Number
Sponsors
Emergency Medical Services agencies in the state of California
Funding
Format
8 p.
Citation
Hsia, Renee Y., Sarah Sabbagh, Nandita Sarkar, Karl Sporer, Ivan C. Rokos, John F. Brown, Ralph G. Brindis, Joanna Guo, and Yu-Chu Shen. "Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction." Western Journal of Emergency Medicine 18, no. 6 (2017): 1010.
Distribution Statement
Rights
This publication is a work of the U.S. Government as defined in Title 17, United States Code, Section 101. Copyright protection is not available for this work in the United States.