'Pittsburgh Atlas' Maps Out US Trauma Care

The map divides the nation into 326 referral regions that link patient home counties to hospital counties and allow multiple patient home counties to join to the same hospital county.

Clinicians and scientists at the University of Pittsburgh School of Medicine and UPMC have mapped out a coordinated emergency and trauma care system for the nation.

The Pittsburgh Atlas, published today in the Annals of Emergency Medicine, divides the United States into 326 referral regions.

The atlas also creates the framework that will allow states and groups of counties to implement quality improvement programs accountable to regional performance measures instituted by state and local governments, the atlas's authors said. 

"Recent proposed changes to healthcare could shift more responsibility to the state level with regard to who is insured or what services are offered," said lead author David J. Wallace, MD, an assistant professor in Pitt's Department of Critical Care Medicine.

"A set of regions that maintain state lines is essential in that circumstance," Wallace said. 

More than a decade ago, a National Academy of Medicine report endorsed coordinated, regional, accountable systems as an approach to improve healthcare for severe acute conditions requiring trauma and emergency services.

In 2013, the National Quality Forum highlighted the importance of region-level performance measures that promote timely, high-quality care. 

The Pittsburgh Atlas was modeled on the Dartmouth Atlas of Health Care, a set of geographic regions based on Medicare and Medicaid hospital discharge claims that was created more than 20 years ago, and is used for epidemiological studies that compare the cost, quality and consumption of health care in different parts of the country, Wallace said.

However, the Dartmouth Atlas ignores state and county boundaries – resulting in a set of regions that do not promote coordination or accountability, the atlas authors said.

The Pittsburgh Atlas looks at nearly 731,000 Medicare patients who sought care for a heart attack, stroke or moderate to severe trauma in 2011. Referral regions were created by combining patient home counties to hospital counties, allowing multiple patient home counties to join to the same hospital county.

The researchers used six ways to divide the United States into emergency care referral regions and found one that keeps the vast majority of patients closest to home. 

"We were surprised at how well our regions performed in terms of keeping patients close to home – they did as well as those in the Dartmouth Atlas," said Wallace. "We truly expected there would be a greater trade-off since the Pittsburgh Atlas faced the additional geopolitical boundary constraints."

Wallace said the Pittsburgh Atlas may not be representative for all patients. It was built using the largest collective source of hospitalizations for heart attack, stroke and major trauma in the nation but it is limited to patients 65 years old and older with data from 2011.

Referral patterns may have changed with population changes and hospital openings and closings – meaning the Pittsburgh Atlas would need periodic updates, he said. 

The data files for the Pittsburgh Atlas are publicly available and give "researchers, policymakers, hospital systems and public health agencies a way to move beyond simply comparing apples to apples, and into thinking about orchards," Wallace said.