Effectiveness of regionalized systems for stroke and myocardial infarction

James Rhudy, Marie A. Bakitas, Kristiina Hyrkäs, Rita A. Jablonski-Jaudon, Erica R. Pryor, Henry E. Wang, Anne Alexandrov

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Background: Acute ischemic stroke (AIS) and ST-segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI. Methods: Literature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non- or pre-regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking "regionalization" and "myocardial infarction" or citation as a model system by any American Heart Association statement. Results: For AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre- or nonregionalized state. The final yield was nine papers from six systems. Conclusion: Although regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

Original languageEnglish (US)
JournalBrain and Behavior
Volume5
Issue number10
DOIs
StatePublished - Oct 1 2015

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Stroke
Myocardial Infarction
Guidelines
Publications
Certification
Emergency Medical Services
Standard of Care
Registries
Emergencies
Joints
Research

All Science Journal Classification (ASJC) codes

  • Behavioral Neuroscience

Cite this

Rhudy, J., Bakitas, M. A., Hyrkäs, K., Jablonski-Jaudon, R. A., Pryor, E. R., Wang, H. E., & Alexandrov, A. (2015). Effectiveness of regionalized systems for stroke and myocardial infarction. Brain and Behavior, 5(10). https://doi.org/10.1002/brb3.398

Effectiveness of regionalized systems for stroke and myocardial infarction. / Rhudy, James; Bakitas, Marie A.; Hyrkäs, Kristiina; Jablonski-Jaudon, Rita A.; Pryor, Erica R.; Wang, Henry E.; Alexandrov, Anne.

In: Brain and Behavior, Vol. 5, No. 10, 01.10.2015.

Research output: Contribution to journalReview article

Rhudy J, Bakitas MA, Hyrkäs K, Jablonski-Jaudon RA, Pryor ER, Wang HE et al. Effectiveness of regionalized systems for stroke and myocardial infarction. Brain and Behavior. 2015 Oct 1;5(10). https://doi.org/10.1002/brb3.398
Rhudy, James ; Bakitas, Marie A. ; Hyrkäs, Kristiina ; Jablonski-Jaudon, Rita A. ; Pryor, Erica R. ; Wang, Henry E. ; Alexandrov, Anne. / Effectiveness of regionalized systems for stroke and myocardial infarction. In: Brain and Behavior. 2015 ; Vol. 5, No. 10.
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AB - Background: Acute ischemic stroke (AIS) and ST-segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI. Methods: Literature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non- or pre-regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking "regionalization" and "myocardial infarction" or citation as a model system by any American Heart Association statement. Results: For AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre- or nonregionalized state. The final yield was nine papers from six systems. Conclusion: Although regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

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