Impact of adding Level II and III @entity130 centers on volume and disease severity at a nearby Level I XXXX center.

@entity1 @entity4966 @entity69223 @entity35805 @entity17341 @entity130
BACKGROUND: As emergency care becomes increasingly regionalized, systems planners must determine how system expansion impacts existing system assets. We hypothesized that accrediting new Level II and III @entity130 centers impacted the @entity130 @entity1 census and severity at a nearby Level I @entity130 center and estimated the magnitude of the impact. METHODS: We conducted an interrupted time series analysis using monthly @entity1 counts during the past 10 years for five @entity130 centers located near one another in Pennsylvania. The Level I center (TC-A) operated for the entire period. A Level II center 39 miles away was accredited after 70 months ( @entity17341 ), one Level III center 46 miles away was accredited after 95 months but lost accreditation after 11 months ( @entity35805 ), and two other Level III centers 40 miles and 45 miles away were accredited after 107 months ( @entity69223 and TC-E). RESULTS: Monthly @entity1 volume at the Level I center, which increased gradually over the study and summed to 25,120 @entity1 , decreased by 10.8% (p < 0.05) when @entity17341 was accredited and decreased by an additional 12.9% (p < 0.05) when @entity69223 and @entity4966 were accredited simultaneously. No change stemmed from temporarily accrediting @entity35805 . Ultimately, the Level I center treated 1,903 fewer @entity1 than expected over 51 months, an 11.9% volume reduction, and @entity1 severity remained consistent but mortality decreased. CONCLUSION: Accrediting Level II and Level III @entity130 centers reduced @entity1 volume and reduced overall mortality at a nearby Level I center. Strategic planning of statewide @entity130 systems can help balance rapid access to care with maintenance of adequate annual @entity1 volumes of critically injured @entity1 . LEVEL OF EVIDENCE: Epidemiologic study, Level IV.
