title: Access to care for patients with time-sensitive conditions in Pennsylvania.
abstract: OBJECTIVE
  Collective knowledge and coordination of vital interventions for time-sensitive conditions (ST-segment elevation myocardial infarction [STEMI], stroke, cardiac arrest, and septic shock) could contribute to a comprehensive statewide emergency care system, but little is known about population access to the resources required. We seek to describe existing clinical management strategies for time-sensitive conditions in Pennsylvania hospitals.
  
  
  METHODS
  All Pennsylvania emergency departments (EDs) open in 2009 were surveyed about resource availability and practice patterns for time-sensitive conditions. The frequency with which EDs provided essential clinical bundles for each condition was assessed. Penalized maximum likelihood regressions were used to evaluate associations between ED characteristics and the presence of the 4 clinical bundles of care. We used geographic information science to calculate 60-minute ambulance access to the nearest facility with these clinical bundles.
  
  
  RESULTS
  The percentage of EDs providing each of the 4 clinical bundles in 2009 ranged from 20% to 57% (stroke 20%, STEMI 32%, cardiac arrest 34%, sepsis 57%). For STEMI and stroke, presence of a board-certified/board-eligible emergency physician was significantly associated with presence of a clinical bundle. Only 8% of hospitals provided all 4 care bundles. However, 53% of the population was able to reach this minority of hospitals within 60 minutes.
  
  
  CONCLUSIONS
  Reliably matching patient needs to ED resources in time-dependent illness is a critical component of a coordinated emergency care system. Population access to critical interventions for the time-dependent diseases discussed here is limited. A population-based planning approach and improved coordination of care could improve access to interventions for patients with time-sensitive conditions.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Rama A
authors.initials: RA
authors.lastname: Salhi
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Edwards
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Roger A
authors.initials: RA
authors.lastname: Band
authors.affiliation: Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Policy Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA. Electronic address: carrb@upenn.edu.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
mesh_terms: D000328:Adult; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006323:Heart Arrest / Q000628:therapy; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D064872:Patient Care Bundles / Q000706:statistics & numerical data; D010414:Pennsylvania / Q000453:epidemiology; D012772:Shock, Septic / Q000628:therapy; D020521:Stroke / Q000628:therapy; D013997:Time Factors