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Geographic access to high capability severe acute respiratory failure centers in the United States

Wallace, DJ and Angus, DC and Seymour, CW and Yealy, DM and Carr, BG and Kurland, K and Boujoukos, A and Kahn, JM (2014) Geographic access to high capability severe acute respiratory failure centers in the United States. PLoS ONE, 9 (4).

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Abstract

Objective: Optimal care of adults with severe acute respiratory failure requires specific resources and expertise. We sought to measure geographic access to these centers in the United States. Design: Cross-sectional analysis of geographic access to high capability severe acute respiratory failure centers in the United States. We defined high capability centers using two criteria: (1) provision of adult extracorporeal membrane oxygenation (ECMO), based on either 2008-2013 Extracorporeal Life Support Organization reporting or provision of ECMO to 2010 Medicare beneficiaries; or (2) high annual hospital mechanical ventilation volume, based 2010 Medicare claims. Setting: Nonfederal acute care hospitals in the United States. Measurements and Main Results: We defined geographic access as the percentage of the state, region and national population with either direct or hospital-transferred access within one or two hours by air or ground transport. Of 4,822 acute care hospitals, 148 hospitals met our ECMO criteria and 447 hospitals met our mechanical ventilation criteria. Geographic access varied substantially across states and regions in the United States, depending on center criteria. Without interhospital transfer, an estimated 58.5% of the national adult population had geographic access to hospitals performing ECMO and 79.0% had geographic access to hospitals performing a high annual volume of mechanical ventilation. With interhospital transfer and under ideal circumstances, an estimated 96.4% of the national adult population had geographic access to hospitals performing ECMO and 98.6% had geographic access to hospitals performing a high annual volume of mechanical ventilation. However, this degree of geographic access required substantial interhospital transfer of patients, including up to two hours by air. Conclusions: Geographic access to high capability severe acute respiratory failure centers varies widely across states and regions in the United States. Adequate referral center access in the case of disasters and pandemics will depend highly on local and regional care coordination across political boundaries. © 2014 Wallace et al.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Wallace, DJwallaced@pitt.eduWALLACED0000-0003-0314-1004
Angus, DCangusdc@pitt.eduANGUSDC0000-0002-7026-5181
Seymour, CWseymourc@pitt.eduSEYMOURC0000-0002-6257-6764
Yealy, DMdmy@pitt.eduDMY
Carr, BG
Kurland, K
Boujoukos, Aboujouko@pitt.eduBOUJOUKO
Kahn, JMjeremykahn@pitt.eduJMK1900000-0001-9688-5576
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorSalluh, Jorge I. F.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Date: 4 April 2014
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 9
Number: 4
DOI or Unique Handle: 10.1371/journal.pone.0094057
Schools and Programs: School of Medicine > Critical Care Medicine
School of Medicine > Emergency Medicine
Refereed: Yes
Date Deposited: 23 Jun 2014 21:07
Last Modified: 06 Oct 2020 18:55
URI: http://d-scholarship.pitt.edu/id/eprint/21975

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