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Differential benefits of cardiac care regionalization based on driving time to percutaneous coronary intervention
Author(s) -
Shen YuChu,
Hsia Renee Y.
Publication year - 2021
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.14195
Subject(s) - conventional pci , medicine , percutaneous coronary intervention , emergency medicine , myocardial infarction , receipt , medical emergency , cardiology , computer science , world wide web
Abstract Background Patients with ST‐elevation myocardial infarction (STEMI) require timely reperfusion, and percutaneous coronary intervention (PCI) decreases morbidity and mortality. Regionalization of STEMI care has increased timeliness and use of PCI, but it is unknown whether benefits to regionalization depend on a community's distance from its nearest PCI center. We sought to determine whether STEMI regionalization benefits, measured by access to PCI centers, timeliness of treatment (same‐day or in‐hospital PCI), and mortality, differ by baseline distance to nearest PCI center. Methods Using a difference‐in‐difference‐in‐differences model, we examined access to PCI‐capable hospitals, receipt of PCI either on the day of admission or during the care episode, and health outcomes for patients hospitalized from January 1, 2006, to September 30, 2015. Results Of 139,408 patients (2006 to 2015), 51% could reach the nearest PCI center in <30 minutes, and 49% required ≥30 minutes driving time. For communities with baseline access ≥30 minutes, regionalization increased the probability of admission to a PCI‐capable hospital by 9.4% and also increased the likelihood of receiving same‐day PCI (by 11.2%) and PCI during the hospitalization (by 7.4%). Patients living within 30 minutes did not accrue significant benefits (measured by admission to a PCI‐capable hospital or receipt of PCI) from regionalization initiatives. Regionalization more than halved access disparities and completely eliminated treatment disparities between communities ≥30 minutes and communities <30 minutes from the nearest PCI hospital. Conclusions Measured by likelihood of admission to a PCI‐capable facility and receipt of PCI, benefits of STEMI regionalization in California accrued only to patients whose nearest PCI center was ≥30 minutes away. We found no mortality benefits of regionalization based on distance from PCI center. Our results suggest that policymakers focus STEMI regionalization efforts in communities that are not already well serviced by PCI‐capable hospitals.