Regionalization

I was wondering if people would share their thoughts about regionalization in adult critical care. It is a topic that interests me. There have been studies that have shown that mechanically ventilated patients have better outcomes at high volume centers than low volume centers. There has also been some literature suggesting that closed ICUs staffed with intensivists that lead a multi-disciplinary care team (resp therapist, pharm, nursing) have better outcomes than ICUs that have not implemented these care strategies. One option that has been suggested (by the Leapfrog Group and the Society of Critical Care) is that ICUs should move towards regionalized care. This would mean the sickest of the sick would be transfered to large centers (mostly academic). If it is true that community ICUs have worse outcomes, how much effort should be placed on transferring these patients versus improving the evidence-based practices of open ICUs/ICUs where there isn't always an intensivist available? Just hoping to initiate a discussion on this.