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Emergency Medical Services Outcomes Project EMSOP: An Overview DTNH22-96H-05245

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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Emergency Medical Services Outcomes Project EMSOP: An Overview DTNH22-96H-05245

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    1. Emergency Medical Services Outcomes Project (EMSOP): An Overview DTNH22-96H-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 Data EMS 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 We Accomplished? Evaluation of methodology Conceptual framework Focus for research and evaluation Priority conditions Importance of non-mortality measures Toolbox

    29. What Have We Accomplished? 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 We Accomplished? (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

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