Queensland University of Technology, Australia.
Circulation. 2012 Apr 24;125(16):2006-14. doi: 10.1161/CIRCULATIONAHA.111.083394. Epub 2012 Mar 26.
Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services.
An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), the team developed a numeric/alphabetic index at 2 points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alphabetic) measured access to 4 basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to his or her community. The numeric index ranged from 1 (access to principal referral center with cardiac catheterization service ≤1 hour) to 8 (no ambulance service, >3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within a 1-hour drive-time) to E (no services available within 1 hour). The panel found that 13.9 million Australians (71%) resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were overrepresented by people >65 years of age (32%) and indigenous people (60%).
The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and could be applied to other common disease states within other regions of the world.
获得心脏服务对于实施基于证据的治疗方法以改善预后至关重要。澳大利亚心脏可达性和偏远指数（Cardiac ARIA）旨在得出反映心脏服务获取情况的客观地理衡量标准。
一个专家小组定义了一个基于证据的临床路径。该团队使用地理信息系统（GIS），在护理连续体的两个点上开发了一个数字/字母索引。急性类别（数字）衡量从紧急呼叫到通过公路救护车到达适当医疗设施的时间。后续护理类别（字母）衡量患者返回社区时可获得的 4 项基本服务（家庭医生、药房、心脏康复和病理服务）的情况。数字指数范围从 1（可在 1 小时内到达有心脏导管插入术服务的主要转诊中心）到 8（无救护车服务，到达医疗设施 >3 小时，需要空运）。字母指数范围从 A（在 1 小时车程内可获得所有 4 项服务）到 E（1 小时内无法获得任何服务）。该小组发现，1390 万澳大利亚人（71%）居住在 Cardiac ARIA 1A 地区（有心脏导管插入术实验室的医院和所有后续护理在 1 小时内）。那些不在 Cardiac 1A 范围内的人以 65 岁以上人群（32%）和原住民（60%）居多。
Cardiac ARIA 指数显示澳大利亚在获得心脏服务方面存在巨大的不平等。这种方法可用于为心脏病学卫生服务规划提供信息，也可应用于世界其他地区的其他常见疾病。
