Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: California has led successful regionalized efforts for several time-critical medicalconditions, including ST-segment elevation myocardial infarction (STEMI), but no specific mandatedprotocols exist to define regionalization of care. We aimed to study the trends in regionalizationof care for STEMI patients in the state of California and to examine the differences in patientdemographic, 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’sjurisdiction between 2005-2014. We linked the survey responses to 2006 California non-publichospital 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, reachedcomplete regionalization in 2014. We did not find any dramatic differences in underlying patientcharacteristics based on regionalization status; however, differences in hospital characteristics wererelatively substantial.

Conclusion: Potential barriers to achieving regionalization included competition, hospital ownership,population density, and financial challenges. Minimal differences in patient characteristics canestablish that patient differences unlikely played any role in influencing earlier or later regionalizationand can provide a framework for future analyses evaluating the impact of regionalization on patientoutcomes.