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

摘要: 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 in access, treatment, and outcomes minority communities. Objective To determine extent which changed STEMI living zip codes that are top tertile Black Hispanic population compared nonminority regionalized vs nonregionalized counties. Design, Setting, Participants This cohort study used quasi-experimental approach exploiting different timing across California. Nonpublic inpatient data all from January 1, 2006, October 31, 2015, were analyzed using difference-in-difference-in-differences estimation approach. Exposure intervention was defined on after year patient's county exposed regionalization. Main Outcomes Measures Access percutaneous coronary (PCI)-capable hospital, receipt PCI same day at any time during hospitalization, time-specific all-cause mortality. Results included 139 494 STEMI; 61.9% non-Hispanic White, 5.6% Black, 17.8% Hispanic, 9.0% Asian; 32.8% women. PCI-capable hospitals improved 6.3 percentage points (95% CI, 5.5 7.1 points; P < .001) when communities Patients experienced 1.8-percentage point smaller improvement access -2.8 -0.8 P < .001), 28.9% smaller, those both Regionalization associated an same-day in-hospital 5.1 4.2 6.1 5.0 5.9 respectively, only 33.3% 15.1% benefit. Only White mortality Conclusions Relevance Although derived significantly relative