STUDY OBJECTIVE: Regional, coordinated care for time-sensitive and high-risk medical conditions is a priority in the United States. A necessary precursor to coordinated regional care is regions that are actionable from clinical and policy standpoints. The Dartmouth Atlas of Health Care, the major health care referral construct in the United States, uses regions that cross state and county boundaries, limiting fiscal or political ownership by key governmental stakeholders in positions to create incentive and regulate regional care coordination. Our objective is to develop and evaluate referral regions that define care patterns for patients with acute myocardial infraction, acute stroke, or trauma, yet also preserve essential political boundaries. METHODS: We developed a novel set of acute care referral regions using Medicare data in the United States from 2011. For acute myocardial infraction, acute stroke, or trauma, we iteratively aggregated counties according to patient home location and treating hospital address, using a spatial algorithm. We evaluated referral political boundary preservation and spatial accuracy for each set of referral regions. RESULTS: The new set of referral regions, the Pittsburgh Atlas, had 326 distinct regions. These referral regions did not cross any county or state borders, whereas 43.1% and 98.1% of all Dartmouth Atlas hospital referral regions crossed county and state borders. The Pittsburgh Atlas was comparable to the Dartmouth Atlas in measures of spatial accuracy and identified larger at-risk populations for all 3 conditions. CONCLUSION: A novel and straightforward spatial algorithm generated referral regions that were politically actionable and accountable for time-sensitive medical emergencies.
Public health in the early 21st century increasingly considers how social inequalities impact on individual health, moving away from the focus on how disease relates to the individual person. This 'new public health' identifies how social, economic and political factors affect the level and distribution of individual health, through their effects on individual behaviours, the social groups people belong to, the character of relationships to others and the characteristics of the societies in which people live. The rising social inequalities that can be seen in nearly every country in the world today present not just a moral danger, but a mortal danger as well. Social inequality and public health brings together the latest research findings from some of the most respected medical and social scientists in the world. It surveys four pathways to understanding the social determinants of health: differences in individual health behaviours; group advantage and disadvantage; psychosocial factors in individual health; and healthy and unhealthy societies, shedding light on the costs and consequences of today's high-inequality social models. This exciting book brings together leaders in the field discussing their latest research and is a must-read for anyone interested in public health and social inequalities internationally
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