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Ann Emerg Med. 2018 Aug;72(2):147-155. doi: 10.1016/j.annemergmed.2018.02.018. Epub 2018 Mar 29.

Referral Regions for Time-Sensitive Acute Care Conditions in the United States.

Author information

1
Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: wallacedj@upmc.edu.
2
Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA.
3
Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
4
Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
5
Clinical Research, Investigation and Systems Modeling of Acute Illness Center, and the Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
6
Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
7
School of Architecture, College of Fine Arts, Heinz College, Carnegie Mellon University, Pittsburgh, PA.

Abstract

STUDY OBJECTIVE:

Regional, coordinated care for time-sensitive and high-risk medical conditions is a priority in the United States. A necessary precursor to coordinated regional care is regions that are actionable from clinical and policy standpoints. The Dartmouth Atlas of Health Care, the major health care referral construct in the United States, uses regions that cross state and county boundaries, limiting fiscal or political ownership by key governmental stakeholders in positions to create incentive and regulate regional care coordination. Our objective is to develop and evaluate referral regions that define care patterns for patients with acute myocardial infraction, acute stroke, or trauma, yet also preserve essential political boundaries.

METHODS:

We developed a novel set of acute care referral regions using Medicare data in the United States from 2011. For acute myocardial infraction, acute stroke, or trauma, we iteratively aggregated counties according to patient home location and treating hospital address, using a spatial algorithm. We evaluated referral political boundary preservation and spatial accuracy for each set of referral regions.

RESULTS:

The new set of referral regions, the Pittsburgh Atlas, had 326 distinct regions. These referral regions did not cross any county or state borders, whereas 43.1% and 98.1% of all Dartmouth Atlas hospital referral regions crossed county and state borders. The Pittsburgh Atlas was comparable to the Dartmouth Atlas in measures of spatial accuracy and identified larger at-risk populations for all 3 conditions.

CONCLUSION:

A novel and straightforward spatial algorithm generated referral regions that were politically actionable and accountable for time-sensitive medical emergencies.

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