A Novel Survey Tool to Quantify the Degree and Duration of STEMI Regionalization Across California

Rokos, Ivan C.; Sporer, Karl A.; Savino, Paul; Mercer, Mary P.; Shontz, Selinda S.; Sabbagh, Sarah; Hsia, Renee Y.

doi:10.1097/hpc.0000000000000085

Cited by 7 publications

(4 citation statements)

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“…Rokos et al 14 provided a detailed approach on the development of the STEMI Regionalization Survey. The survey was developed to serve as an evidence-based assessment tool to evaluate and assess the degree and duration of STEMI regionalization of care for each EMS agency.…”

Section: Methodsmentioning

confidence: 99%

Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction

Hsia¹,

Sabbagh²,

Sarkar³

et al. 2017

WestJEM

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IntroductionCalifornia 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.MethodsUsing 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.ResultsSTEMI 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.ConclusionPotential 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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Section: Methodsmentioning

confidence: 99%

Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction

Hsia¹,

Sabbagh²,

Sarkar³

et al. 2017

WestJEM

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“…These inpatient data were linked with vital statistics data to capture date of death using a unique patient identifier as well as nonpublic emergency department (ED) data from OSHPD to capture a complete patient cohort of anyone who had been seen or admitted to any nonfederal ED or hospital in California. We then used data from a validated survey (fully described elsewhere) 9,10 from all 33 local EMS agencies, comprising all 58 counties in the state. This data set identifies dates of implementation of STEMI regionalization and details of these protocols from each local EMS agency.…”

Section: Data Sourcesmentioning

confidence: 99%

“…A regionalized STEMI network requires complex coordination of resources across the majority of hospitals, physician groups, health systems, and EMS agencies within a region implementing shared protocols, with regular feedback and measurement. We designed a survey (described fully elsewhere 9,10 ) that uses Class I recommendations from the AHA and ACC to objectively categorize the degree of regionalization of a STEMI network requiring: 1) an EMS in which patients with STEMI are directly transported to facilities that offer emergent PCI, bypassing hospitals that do not offer this care; and 2) interhospital transfer protocols specifically for patients with STEMI. 12 All local EMS agencies in California were surveyed, with a 100% response rate.…”

Section: Definition Of Regionalizationmentioning

confidence: 99%

Differential benefits of cardiac care regionalization based on driving time to percutaneous coronary intervention

Shen

Hsia²

2021

Academic Emergency Medicine

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Patients with ST-elevation myocardial infarction (STEMI), a life-threatening subtype of acute myocardial infarction (AMI), require access to timely reperfusion, particularly percutaneous coronary intervention (PCI). PCI has been shown to decrease mortality as well as other adverse events but is not provided in all hospitals. 1 For conditions requiring limited availability specialized interventions, the Institute of Medicine has supported regionalization, broadly defined as "an established network of resources that delivers specific care

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“…We designed a survey (described fully elsewhere 53,54 ) that objectively categorized a system's regionalization based on class I recommendations from the American College of Cardiology and American Heart Association categorization requiring that a STEMI regionalized network have an emergency medical system that instructs prehospital transport to directly transport patients with STEMI to facilities that offer emergency PCI, bypassing hospitals that do not offer it, and have interhospital transfer protocols specifically for patients with STEMI. 25 This survey was deployed across all local EMS agencies in California and achieved a 100% response rate.…”

Section: Definition Of Regionalizationmentioning

confidence: 99%

Evaluation of STEMI Regionalization on Access, Treatment, and Outcomes Among Adults Living in Nonminority and Minority Communities

2020

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IMPORTANCE Cardiac care regionalization, specifically for patients with ST-segment elevation myocardial infarction (STEMI), has been touted as a potential mechanism to reduce systematic disparities by protocolizing the treatment of these conditions. However, it is unknown whether such regionalization arrangements have widened or narrowed disparities in access, treatment, and outcomes for minority communities.OBJECTIVE To determine the extent to which disparities in access, treatment, and outcomes have changed for patients with STEMI living in zip codes that are in the top tertile of the Black or Hispanic population compared with patients in nonminority zip codes in regionalized vs nonregionalized counties. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used a quasi-experimental approach exploiting the different timing of regionalization across California. Nonpublic inpatient data for all patients with STEMI from January 1, 2006, to October 31, 2015, were analyzed using a difference-indifference-in-differences estimation approach. EXPOSURE Exposure to the intervention was defined as on and after the year a patient's county was exposed to regionalization. MAIN OUTCOMES AND MEASURES Access to percutaneous coronary intervention (PCI)-capablehospital, receipt of PCI on the same day and at any time during the hospitalization, and time-specific all-cause mortality. RESULTSThis study included 139 494 patients with STEMI; 61.9% of patients were non-Hispanic White, 5.6% Black, 17.8% Hispanic, and 9.0% Asian; 32.8% were women. Access to PCI-capable hospitals improved by 6.3 percentage points (95% CI, 5.5 to 7.1 percentage points; P < .001) when patients in nonminority communities were exposed to regionalization. Patients in minority communities experienced a 1.8-percentage point smaller improvement in access (95% CI, −2.8 to −0.8 percentage points; P < .001), or 28.9% smaller, compared with those in nonminority communities when both were exposed to regionalization. Regionalization was associated with an improvement to same-day PCI and in-hospital PCI by 5.1 percentage points (95% CI, 4.2 to 6.1 percentage points; P < .001) and 5.0 percentage points (95% CI, 4.2 to 5.9 percentage points; P < .001), respectively, for patients in nonminority communities. Patients in minority communities experienced only 33.3% and 15.1% of that benefit. Only White patients in nonminority communities experienced mortality improvement from regionalization.

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A Novel Survey Tool to Quantify the Degree and Duration of STEMI Regionalization Across California

Cited by 7 publications

References 4 publications

Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction

Trends in Regionalization of Care for ST-Segment Elevation Myocardial Infarction

Differential benefits of cardiac care regionalization based on driving time to percutaneous coronary intervention

Evaluation of STEMI Regionalization on Access, Treatment, and Outcomes Among Adults Living in Nonminority and Minority Communities

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