A Novel Survey Tool to Quantify the Degree and Duration of STEMI Regionalization Across California.
A Novel Survey Tool to Quantify the Degree and Duration of STEMI Regionalization Across California.
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DOI：
10.1097/hpc.0000000000000085
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发表时间：
2016-09-01
影响因子：
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通讯作者：
Hsia, Renee Y
中科院分区：
文献类型：
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作者：
Rokos, Ivan C;Sporer, Karl;Hsia, Renee Y
引言：加利福尼亚在针对时间紧迫的医疗状况的区域化工作方面一直是全球的领导者。总共存在33个地方紧急医疗服务机构（LEMSAs），近40年来在全州提供了一个有组织的急救医疗服务框架。我们试图开发一种调查工具，以量化过去十年加利福尼亚州ST段抬高型心肌梗死（STEMI）区域化的程度和持续时间。
方法：该项目首先通过多学科专家共识过程开发了一个包含8个问题的调查工具。接下来，在加利福尼亚州LEMSAs的管理人员和医疗主任的年度会议上发放该调查工具，以获取截至2014年12月有效的回复。第一种评分方法是总区域化评分（TRS），使用全部8个问题的答案。第二种方法称为核心评分，它仅关注4个调查问题，假设STEMI接收中心的指定必定发生在任何LEMSA区域化工作的初期。对分数进行排名并分为三组。
结果：加利福尼亚州所有33个LEMSAs都参与了这项调查。TRS的范围从15到162。核心评分的范围要窄得多，从2到30。在比较TRS和核心评分排名时，最高组非常相似。中组和低组之间的排名差异更大。
结论：本研究评估了2004年至2014年加利福尼亚州STEMI网络区域化的程度和持续时间，并根据33个LEMSAs的TRS和核心评分将它们分为三组。在加利福尼亚州成功应用8项调查和排名策略表明，这种方法可用于评估世界其他州或国家的区域化情况。
INTRODUCTION: California has been a global leader in regionalization efforts for time-critical medical conditions. A total of 33 local emergency medical service agencies (LEMSAs) exist, providing an organized EMS framework across the state for almost 40 years. We sought to develop a survey tool to quantify the degree and duration of ST-elevation myocardial infarction (STEMI) regionalization over the last decade in California.METHODS: The project started with the development of an 8-question survey tool via a multi-disciplinary expert consensus process. Next, the survey tool was distributed at the annual meeting of administrators and medical directors of California LEMSAs to get responses valid through December, 2014. The first scoring approach was the Total Regionalization Score (TRS) and used answers from all 8 questions. The second approach was called the Core Score, and it focused on only 4 survey questions by assuming that the designation of STEMI Receiving Centers must have occurred at the beginning of any LEMSA's regionalization effort. Scores were ranked and grouped into tertiles.RESULTS: All 33 LEMSAs in California participated in this survey. The TRS ranged from 15 to 162. The Core Score range was much narrower, from 2 to 30. In comparing TRS and Core Score rankings, the top-tertiles were quite similar. More rank variation occurred between mid- and low-tertiles.CONCLUSION: This study evaluated the degree and duration of STEMI network regionalization from 2004 to 2014 in California, and ranked 33 LEMSAs into tertiles based upon their TRS and their Core Score. Successful application of the 8-item survey and ranking strategies across California suggests that this approach can be used to assess regionalization in other states or countries around the world.