Rokos Ivan C, Sporer Karl, Savino Paul B, Mercer Mary P, Shontz Selinda S, Sabbagh Sarah, Hsia Renee Y
From the Department of Emergency Medicine, UCLA, Sylmar, CA.
Crit Pathw Cardiol. 2016 Sep;15(3):103-5. doi: 10.1097/HPC.0000000000000085.
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.
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.
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.
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.
在针对时间紧迫的医疗状况进行区域化努力方面，加利福尼亚一直是全球领先者。该州共有33个地方紧急医疗服务机构（LEMSA），在全州范围内提供有组织的紧急医疗服务框架近40年。我们试图开发一种调查工具，以量化加利福尼亚过去十年中ST段抬高型心肌梗死（STEMI）区域化的程度和持续时间。
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，该调查工具在加利福尼亚地方紧急医疗服务机构的管理人员和医疗主任年会上分发，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得分（TRS），使用所有8个问题的答案。第二种方法称为核心得分，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地方紧急医疗服务机构区域化努力的开始阶段。得分进行排名并分为三分位数。
加利福尼亚的所有33个地方紧急医疗服务机构都参与了此次调查。TRS范围为15至162。核心得分范围窄得多，为2至30。在比较TRS和核心得分排名时，高分组非常相似。中分组和低分组之间的排名差异更大。
本研究评估了2004年至2014年加利福尼亚STEMI网络区域化的程度和持续时间，并根据其TRS和核心得分将33个地方紧急医疗服务机构分为三分位数。在加利福尼亚成功应用这一包含8个项目的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。
