Geographic access to US Neurocritical Care Units registered with the Neurocritical Care Society.
Geographic access to US Neurocritical Care Units registered with the Neurocritical Care Society.
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DOI：
10.1007/s12028-011-9644-2
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发表时间：
2012-04
影响因子：
3.5
通讯作者：
Carr BG
中科院分区：
文献类型：
--
作者：
Ward MJ;Shutter LA;Branas CC;Adeoye O;Albright KC;Carr BG
神经危重病护理为神经科危重患者提供多学科的专科护理，但目前尚不清楚美国有多少人能够快速获得专科神经危重病监护室(NCU)。我们试图通过州、区、地区以及整个美国来量化进入NCU的地理位置。此外，我们还研究了运输方式(地面或空中救护车)和院前运输时间如何影响人们进入NCU的机会。数据来自神经危重护理协会(NCS)、美国人口普查局和航空医疗服务地图集和数据库。经验得出的院前时间间隔和估计院前地面和空中旅行时间的验证模型被用来计算总的院前时间。计算每个地理分析小单位(区组)的离散总院前时间间隔，并将区组人口相加，以确定在离散时间间隔(45、60、75和90分钟)内能够到达NCU的美国人的比例。结果显示了不同的地理位置和不同的院前运输方式(地面或空中救护车)。美国有73个NCU仅使用地面交通，12.8%、20.5%、27.4%和32.6%的美国人口分别在NCU的45、60、75和90分钟内。使用空中救护车可以在45分钟、60分钟、75分钟和90分钟内分别增加到36.8、50.4、60和67.3。东北部地区使用地面救护车的通行率是美国最高的，加上空中救护车，运输时间为45分钟、60分钟和75分钟。在90分钟时，西部地区的访问率最高。南部地区所有运输时间的地面和空中NCU通达率都是最低的。使用在NCS注册的NCU，目前在美国获得NCU的地理位置有限，在获得护理方面存在地理差异。虽然在NCS数据库确定的那些之外可能存在更多的NCU，但我们确定了访问NCU的有限地理位置，并为美国神经危重护理系统的进一步发展提供了基于人口的规划视角。
Neurocritical care provides multidisciplinary, specialized care to critically ill neurological patients, yet an understanding of the proportion of the population able to rapidly access specialized Neurocritical Care Units (NCUs) in the United States is currently unknown. We sought to quantify geographic access to NCUs by state, division, region, and for the US as a whole. In addition, we examined how mode of transportation (ground or air ambulance), and prehospital transport times affected population access to NCUs. Data were obtained from the Neurocritical Care Society (NCS), US Census Bureau and the Atlas and Database of Air Medical Services. Empirically derived prehospital time intervals and validated models estimating prehospital ground and air travel times were used to calculate total prehospital times. A discrete total prehospital time interval was calculated for each small unit of geographic analysis (block group) and block group populations were summed to determine the proportion of Americans able to reach a NCU within discrete time intervals (45, 60, 75, and 90 min). Results are presented for different geographies and for different modes of prehospital transport (ground or air ambulance). There are 73 NCUs in the US using ground transportation alone, 12.8, 20.5, 27.4, and 32.6% of the US population are within 45, 60, 75, and 90 min of an NCU, respectively. Use of air ambulances increases access to 36.8, 50.4, 60, and 67.3 within 45, 60, 75, and 90 min, respectively. The Northeast has the highest access rates in the US using ground ambulances and for 45, 60, and 75 min transport times with the addition of air ambulances. At 90 min, the West has the highest access rate. The Southern region has the lowest ground and air access to NCUs access rates for all transport times. Using NCUs registered with the NCS, current geographic access to NCUs is limited in the US, and geographic disparities in access to care exist. While additional NCUs may exist beyond those identified by the NCS database, we identify geographies with limited access to NCUs and offer a population-based planning perspective on the further development of the US neurocritical care system.
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