Various forms of regionalization systems. Squares represent central, specialty hospitals, and the triangles represent non–specialty hospitals. Arrows represent the direction of patients within the system. The spoke-and-hub system and the web system are characterized by a specialty center that manages patients referred to them by outlying non–specialty hospitals. The degree of coordination between the 2 types of hospitals distinguishes between these 2 systems. The minihub model is characterized by an expansion of specialty hospitals that have differing degrees of interaction with the transport system, non–specialty hospitals, and other specialty hospitals. The integrated web approach is characterized by seamless communication and coordination between specialty and non–specialty hospitals.
Conceptual framework for the development of regional systems. Various factors contribute to the development of both the type of regionalized system described in Fig 1 and the overall degree of regionalization. SES indicates socioeconomic status.