Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction
Renee Y Hsia1,2, Sarah Sabbagh1, Nandita Sarkar3
1University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.
Insights
California
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- California has pioneered regionalized care for time-critical conditions like ST-segment elevation myocardial infarction (STEMI).
- No standardized protocols currently exist for STEMI care regionalization across the state.
- Understanding regionalization trends and disparities is crucial for improving STEMI outcomes.
Purpose of the Study:
- To analyze trends in STEMI care regionalization in California from 2005-2014.
- To identify demographic, hospital, and county-level differences in STEMI regionalization.
- To explore barriers affecting the implementation of regionalized STEMI care.
Main Methods:
- Survey data from California Emergency Medical Services (EMS) agencies (2005-2014) categorized regionalization levels (none, partial, substantial, complete).
- Survey data linked with 2006 California hospital discharge data to assess baseline patient distribution.
- Analysis of trends in regionalization coverage and patient population within regionalized areas.
Main Results:
- STEMI regionalization networks expanded significantly across California between 2006 and 2014.
- In 2006, 14% of counties were regionalized, covering 42% of STEMI patients; by 2014, over 50% of counties achieved complete regionalization, covering 86% of patients.
- No significant differences in patient characteristics were observed across regionalization levels, but hospital characteristics varied substantially.
Conclusions:
- Regionalization of STEMI care in California has demonstrably increased, expanding coverage significantly over a decade.
- Patient demographics did not appear to influence the pace or extent of regionalization.
- Hospital characteristics and factors like competition and financial challenges represent key barriers to achieving widespread regionalization.
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.
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