title: The effect of a regional care model on cardiac catheterization rates in patients with Acute Coronary Syndromes.
abstract: BACKGROUND
  Patients with ACS often present to community hospitals without on-site cardiac catheterization and revascularization therapies. Transfer to specialized cardiac procedural centers is necessary to provide access to these procedures. We evaluated process of care within a regional care model by comparing cardiac catheterization and revascularization rates and outcomes in ACS patients presenting to community and interventional hospitals.
  
  
  METHODS
  We evaluated a total of 6154 patients with ACS admitted to Southern Alberta hospitals (where a distinct regional care model for ACS exists) between January 1, 2005 and December 31, 2009. We compared cardiac catheterization and revascularization rates during index hospitalization among patients admitted to community and interventional hospitals. Thirty day and 1-year survival were also evaluated.
  
  
  RESULTS
  Catheterization was performed more often in patients presenting to community hospitals compared to the interventional facility (respectively 69.5% and 51.4%, p < 0.0001). Catheterization within 72 hours of admission occurred in 48% of patients presenting to the interventional center and in 68.3% of community patients (P < 0.0001). In patients undergoing catheterization, revascularization (PCI and/or CABG) was also performed more frequently in the community group (74.5% vs 56.1%, P < 0.0001). Risk adjusted mortality rates were the same for patients undergoing cardiac catheterization regardless of hospital of initial presentation.
  
  
  CONCLUSIONS
  ACS patients presenting to community centers associated with a regional care model had effective access to cardiac catheterization and revascularization. These findings support the importance of regional initiatives and processes of care that facilitate access to cardiac catheterization for all ACS patients.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Curran
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Hubacek
authors.forename: Danielle
authors.initials: D
authors.lastname: Southern
authors.forename: Diane
authors.initials: D
authors.lastname: Galbraith
authors.forename: Merril L
authors.initials: ML
authors.lastname: Knudtson
authors.forename: William A
authors.initials: WA
authors.lastname: Ghali
authors.affiliation: Department of Medicine and Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. mmg2@ualberta.ca.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Graham
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000416:Alberta / Q000453:epidemiology; D006328:Cardiac Catheterization; D005260:Female; D006302:Health Services Research; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D012040:Regional Health Planning; D015996:Survival Rate; D016896:Treatment Outcome