ArticleCirculation. Cardiovascular quality and outcomes2021
Association of Cardiac Care Regionalization With Access, Treatment, and Mortality Among Patients With ST-Segment Elevation Myocardial Infarction.
Article in Circulation. Cardiovascular quality and outcomes, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 19 citations in OpenAlex.
- Five-year implementation and longitudinal performance of a multidisciplinary acute myocardial infarction program in a middle-income country.International journal of cardiology. Cardiovascular risk and prevention · 2026Article
- Scalable regionalised quality improvement model for ACS management in resource-limited primary healthcare facilities.Journal of epidemiology and community health · 2026Article
- A proposed method for identifying Interfacility transfers in Medicare claims data.Health services research · 2025Observational
- National Trends in the Use of Specialty Consultations in Emergency Department Visits, 2009 to 2019.Annals of emergency medicine · 2023Article
- Association of Physician Coordination With Interfacility Transfer Acceptance Timeliness.American journal of accountable care · 2022Article
- Association of STEMI regionalization of care with de facto NSTEMI regionalization.American heart journal · 2021Article
- Paying for Telemedicine in Smaller Rural Hospitals: Extending the Technology to Those Who Benefit Most.JAMA health forum · 2021Article
- Differential benefits of cardiac care regionalization based on driving time to percutaneous coronary intervention.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2021Article
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Authors and funding
3 authors at 3 institutions in 4 countries.
Funding
Abstract
backgroundRegionalization of ST-segment elevation myocardial infarction (STEMI) systems of care has been championed over the past decade. Although timely access to percutaneous coronary intervention (PCI) has been shown to improve outcomes, no studies have determined how regionalization has affected the care and outcomes of patients. We sought to determine if STEMI regionalization is associated with changes in access, treatment, and outcomes.
methodsUsing a difference-in-differences approach, we analyzed a statewide, administrative database of 139 494 patients with STEMI in California from 2006 to 2015 using regionalization data based on a survey of all local Emergency Medical Services agencies in the state.
resultsFor patients with STEMI, the base rate of admission to a hospital with PCI capability was 72.7%, and regionalization was associated with an increase of 5.34 percentage points (95% CI, 1.58-9.10), representing a 7.1% increase. Regionalization was also associated with a statistically significant increase of 3.54 (95% CI, 0.61-6.48) percentage points in the probability of same-day PCI, representing an increase of 7.1% from the 49.7% base rate and a 4.6% relative increase (2.97 percentage points [95% CI, 0.1-5.85]) in the probability of receiving PCI at any time during the hospitalization. There was a 1.84 percentage point decrease (95% CI, -3.31 to -0.37) in the probability of receiving fibrinolytics. For 7-day mortality, regionalization was associated with a 0.53 (95% CI, -1 to -0.06) percentage point greater reduction (representing 5.8% off the base rate of 9.1%) and a 1.75 percentage point decrease in the likelihood of all-cause 30-day readmission (95% CI, -3.39 to -0.11; representing 6.4% off the base rate of 27.4%). No differences were found in longer-term mortality.
conclusionsAmong patients with STEMI in California from 2006 to 2015, STEMI regionalization was associated with increased access to a PCI-capable hospital, greater use of PCI, lower 7-day mortality, and lower 30-day readmissions.
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