doi: 10.1161/CIRCULATIONAHA.105.596346
(Circulation. 2006;113:1189-1195.)
© 2006 American Heart Association, Inc.
Health Services and Outcomes Research |
Driving Times and Distances to Hospitals With Percutaneous Coronary Intervention in the United States
Implications for Prehospital Triage of Patients With ST-Elevation Myocardial Infarction
From the Health Services Research and Development Center of Excellence (B.K.N.), Ann Arbor VA Medical Center, Ann Arbor, Mich; Department of Internal Medicine, Division of Cardiovascular Disease (B.K.N., E.R.B.), University of Michigan Medical School, Ann Arbor, Mich; Section of Health Policy and Administration, Department of Epidemiology and Public Health (H.M.K., E.H.B.), Yale University School of Medicine, New Haven, Conn; Section of Cardiovascular Medicine (H.M.K., Y.W.) and the Robert Wood Johnson Clinical Scholars Program (H.M.K.), Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn; and the Center for Outcomes Research and Evaluation (H.M.K.), Yale New Haven Hospital, New Haven, Conn.
Correspondence to Harlan M. Krumholz, MD, SM, Yale University School of Medicine, 333 Cedar St, PO Box 208088, New Haven, CT 06520-8088. E-mail harlan.krumholz{at}yale.edu
Received October 19, 2005; revision received December 8, 2005; accepted December 16, 2005.
Background— The success of prehospital triage protocols for patients with ST-elevation myocardial infarction (STEMI) will depend, in part, on how patients are geographically distributed around hospitals that perform percutaneous coronary intervention (PCI). Accordingly, we determined the proportion of the adult population in the United States with timely access to PCI hospitals using driving times and distances.
Methods and Results— We performed a cross-sectional study using hospital-level data from the American Hospital Association Annual Survey and Census tract-level data on adults 18 years of age or older from the 2000 United States Census. Our aims were to determine the proportion of the adult population who (1) lived within 60 minutes of a PCI hospital and (2) had additional transport times within 30 minutes if directly referred to a PCI hospital as opposed to a closer, non-PCI hospital. Median times and distances to the closest PCI hospital were 11.3 (interquartile range [IQR] 5.7 to 28.5) minutes and 7.9 (IQR 3.5 to 22.4) miles, respectively. A total of 79.0% of the adult population lived within 60 minutes of a PCI hospital. Among those with a non-PCI hospital as their closest facility, 74.0% required additional transport times of <30 minutes if directly referred to a PCI hospital as opposed to the non-PCI hospital. These estimates varied substantially across regions and urban, suburban, and rural Census tracts.
Conclusions— Nearly 80% of the adult population in the United States lived within 60 minutes of a PCI hospital in 2000. Even among those living closer to non-PCI hospitals, almost three fourths would experience <30 minutes of additional delay with direct referral to a PCI hospital, which suggests that such a strategy might be feasible for these individuals.
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