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Gameplan. Background Methods Results Application. Origins. NHTSA Uniform Prehospital EMS Data Conference - August 1993 Attendees wanted outcome measures Emphasis on non-mortality NHTSA Morbidity Outcomes Workshop - April 1994. NHTSA Workshop: Outcome Measures. DeathDiseaseDisabilityDiscomfortDissatisfactionDestitution.
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1. Emergency Medical ServicesOutcomes Project (EMSOP):An OverviewDTNH22-96H-05245 Ronald F. Maio DO, MS
University of Michigan
Department of Emergency Medicine
2. Gameplan Background
Methods
Results
Application
3. Origins NHTSA Uniform Prehospital EMS Data Conference - August 1993
Attendees wanted outcome measures
Emphasis on non-mortality
NHTSA Morbidity Outcomes Workshop - April 1994
4. NHTSA Workshop: Outcome Measures Death
Disease
Disability
Discomfort
Dissatisfaction
Destitution
5. NHTSA Workshop: Recommendations 1) Identify priority conditions
2) Improve/standardize risk adjustment
3) Identify outcome measures
4) Support proven evaluation methods
5) Support development of databases
6) Provide info to stakeholders
7) Identify stakeholders/ build support
8) Identify barriers
6. Priority Conditions:Frequency and Magnitude of EMS Impact
7. EMSOP
Support and facilitate outcomes research
Focus on emergent acute care
Provide a blueprint
Provide a toolbox
8. EMSOP: Personnel PI and Co-PIs
Ron Maio, Herb Garrison, Dan Spaite
Co-Investigators
Jeff Desmond, Mary Ann Gregor
Consultant Panel
Gene Cayten, John Chew, Ellen MacKenzie, David Miller, Patricia OMalley, Ian Stiell
Technical Consultants Year 1
Steve Joyce, Doug Brown
9. EMSOP:Vision
10. EMSOP:Vision
11. EMSOP: Reality
12. EMSOP: Reality
13. Identifying Priorities Generate an initial list of conditions
Compile frequency data
Determine magnitude of potential impact
Develop summary score and rank
14. Priority Conditions:Frequency and Magnitude of EMS Impact
15. Development of Pool of Conditions NHTSA Uniform Prehospital EMS Data Elements
Amalgam list of illness, injury, signs and symptoms
29 conditions
16. EMS Frequency DataEMS Data Systems Inc. Emergency transports: scene to ED
7/1/95 to 6/30/96
Alabama
Mississippi
Illinois
Oklahoma
American Medical Response
Central California counties
17. The Next Step How to measure the potential impact of EMS intervention on these conditions?
18. Determining Impact Ask opinions
Physicians, Administrators, Providers
Consider
Relevance of outcome category
Potential impact
19. Priority Conditions: < 15 Condition Freq. Wght. Score Index
Minor Trauma 51.34% 9.60 34.30
Major Trauma 7.92% 17.90 25.68
Respiratory Distress 9.96% 14.97 24.40
Airway Obstruction 1.13% 17.91 22.54
Respiratory Arrest 0.44% 16.25 20.60
Cardiac Arrest 0.84% 14.39 19.09
Seizure 14.12% 8.96 18.99
20. Priority Conditions: > 15 Condition Freq. Wght. Score Index
Minor Trauma 36.10% 10.28 33.39
Respiratory Distress 12.95% 15.34 26.50
Chest Pain 10.24% 14.84 24.07
Major Trauma 3.57% 17.14 21.47
Cardiac Arrest 2.24% 15.85 19.40
Airway Obstruction 0.17% 17.63 19.27
Respiratory Arrest 0.19% 16.30 18.28
21. < 15 - Weighted Score
22. > 15 - Weighted Score
23. The Next Step Identify risk adjustment measures
Identify appropriate outcome measures
24. Risk Adjustment account for pertinent patient characteristics before making inferences about effectiveness or quality of care..
Compare apples to apples
26. Conceptual Framework
27. Identifying RAs and Outcome Measures Literature review
Panel discussion
Previous use in Prehospital or other venues
Feasibility
Focus on real world
Also considered research arena
Recommendations for evaluation
28. What Have WeAccomplished? Evaluation of methodology
Conceptual framework
Focus for research and evaluation
Priority conditions
Importance of non-mortality measures
Toolbox
29. What Have WeAccomplished?
Maio RF, Garrison HG, Spaite DW, et al: EMSOP I: Prioritizing conditions for outcomes research, Annals of Emergency Medicine 33(4):423-432, 1999.
Spaite DW, Maio RF, Garrison HG, et al. EMSOP II: Developing the foundation and conceptual models for out-of-hospital outcomes research. Annals of Emergency Medicine 37(6):657-663, 2001.
Garrison HG, Maio RF, Spaite DW, et al. EMSOP III: Risk adjustment measures for out-of-hospital outcomes research. Annals of Emergency Medicine (in press).
30. What Have WeAccomplished? (contd.)
Maio RF, Garrison HG, Spaite DW, et al. EMSOP IV: Pain measurement in out-of-hospital outcomes research. Annals of Emergency Medicine (in press).
Spaite DW, Maio RF, Garrison HG, et al. EMSOP V: Establishing the scope and methodological approach to out-of-hospital outcomes and effectiveness research (submitted).
McLean SA, Maio RF, Spaite DW, Garrison HG. EMS outcomes research: evaluating the effectiveness of prehospital care. Prehospital Emergency Care 6(2 Suppl):S52-56, 2002.
Garrison HG, Maio RF, Spaite DW. Application of measurement tools to pediatric emergency medicine. Ambulatory Pediatrics (in press).
31. Disappointments
Satisfaction measures
Cost measures
Pediatric measures (infants, special needs)
Data sets
32. Future Applications Acceptance of Priority conditions
Tracers
Philosophical Issue:
Accept importance of non-mortality measure
Relieve discomfort vs. save lives
33. Future Applications:Pain Is pain a substantial problem among prehospital patients?
1999 NHAMCS
52% no pain measure
20% moderate/ severe pain
14% mild
14% none
Conservative estimate: 1 in 5 have substantial pain
34. The Next Step Evaluate Feasibility
Describe the epidemiology
Monitor/Modify
Researchers:
identify/develop/evaluate measures
conduct observational research
conduct interventional research
35. Challenges Access to data
Funding
Manpower
Human use issues
Effective dissemination
36. Summary The Age of Accountability
Non-mortality measures important
EMSOP provides focus and simple tools
Many challenges
Get to work now