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119

GEOGRAPHIC ACCESS TO SEVERE ARDS REFERRAL CENTERS IN THE UNITED STATES

Wallace, David1; Angus, Derek1; Seymour, Christopher1; Carr, Brendan2; Boujoukos, Arthur3; Kurland, Kristen4; Yealy, Donald5; Kahn, Jeremy1

doi: 10.1097/01.ccm.0000439268.87993.4a
Poster Session: Administration & Education 2: PDF Only
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Introduction: Treating patients with severe acute respiratory distress syndrome (ARDS) is a resource-intensive endeavor that requires expert care for optimal outcomes. Access to hospitals with this capacity has important public health implications. The current distribution of potential centers relative to geographic area and population is unknown. Methods: We conducted a cross-sectional analysis of geographic access to potential severe ARDS referral centers in the United States. We defined potential referral centers using three criteria: (1) high annual mechanical ventilation volume based 2010 Medicare discharge claims; (2) use of extracorporeal membrane oxygenation (ECMO), also from Medicare claims; and (3) use of ECMO based on 2008–2013 Extracorporeal Life Support Organization (ELSO) facility reporting. We calculated population access to these hospitals using road and speed limit data, and the 2013 Atlas and Database of Air Medical Services. We defined access as the proportion of the adult United States population with either direct or hospital-transferred access within two hours by rotary air transport or ground transport of a potential severe ARDS referral center. Results: A total of 447 hospitals met our high volume criteria; 127 hospitals met ECMO criteria by Medicare claims; and 46 hospitals met ECMO criteria by ELSO membership; for a total of 498 unique potential severe ARDS referral centers. Between 88.0% and 99.7% of the population has direct or hospital-transferred access to a potential ARDS center within two hours by ground or rotary air transport. By state, access varied from 0% to 100% for both transport methods. Geographic areas states with limited were located primarily in the mid-western United States. Conclusions: Between 88.0% and 99.7% of the United States population has access within two hours by ground or rotary air transport of a potential ARDS referral center. Geographic accessibility varies by region and state, and was widespread only with air medical interhospital transfers. Grant support: K12-HL109068, K23-GM104022

1University of Pittsburgh School of Medicine, Dept of Critical Care Medicine, CRISMA Center, Pittsburgh, PA, 2University of Pennsylvania, Philadelphia, PA, 3University of Pittsburgh School of Medicine, Dept of Critical Care Medicine, Pittsburgh, PA, 4Carnegie Mellon University, Heinz College School of Public Policy and Mgt, Pittsburgh, PA, 5University of Pittsburgh, Dept of Emergency Medicine, Pittsburgh, PA

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins