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Policy, Practice, and Research Agenda for Emergency Medical Services Oversight: A Systematic Review and Environmental Scan

Published online by Cambridge University Press:  02 January 2018

Rekar K. Taymour ,
Mahshid Abir ,
Margaret Chamberlin ,
Robert B. Dunne ,
Mark Lowell ,
Kathy Wahl  and
Jacqueline Scott
Rekar K. Taymour
Affiliation:
RTI Health Solutions, Research Triangle Park, North CarolinaUSA
Mahshid Abir*
Affiliation:
University of Michigan, Department of Emergency Medicine, Ann Arbor, MichiganUSA University of Michigan, Institute for Healthcare Policy and Innovation, Acute Care Research Unit, Ann Arbor, MichiganUSA RAND Corporation, Santa Monica, CaliforniaUSA
Margaret Chamberlin
Affiliation:
RAND Corporation, Santa Monica, CaliforniaUSA
Robert B. Dunne
Affiliation:
Detroit East Medical Control Authority, Detroit, MichiganUSA Wayne State University, Emergency Medicine, Detroit, MichiganUSA St. John Hospital and Medical Center, Detroit, MichiganUSA
Mark Lowell
Affiliation:
University of Michigan, Department of Emergency Medicine, Ann Arbor, MichiganUSA Michigan Medicine, Survival Flight, Ann Arbor, MichiganUSA
Kathy Wahl
Affiliation:
Michigan Department of Health and Human Services, Lansing, MichiganUSA
Jacqueline Scott
Affiliation:
Michigan Department of Health and Human Services, Lansing, MichiganUSA
*
Correspondence: Mahshid Abir, MD, MSc 2800 Plymouth Rd. North Campus Research Complex 014-G226 Ann Arbor, Michigan 48109 USA E-mail: mahshida@med.umich.edu
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Abstract

Introduction

In a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care.

Objective

This systematic literature review and environmental scan addresses NAM’s recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight?

Methods

To answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved.

Results

A total of 58 peer-reviewed articles met inclusion criteria; 46 included process, 36 outcomes, and 18 structural measures. Most studies applied quality measures at the personnel level (40), followed by the agency (28) and system of care (28), and few at the oversight level (5). Numerous grey literature articles provided principles for high-quality EMS oversight.

Conclusions:

Limited quality measurement at the oversight level is an important gap in the peer-reviewed literature. The grey literature is ahead in this realm and can guide the policy and research agenda for EMS oversight quality measurement.

TaymourRK, AbirM, ChamberlinM, DunneRB, LowellM, WahlK, ScottJ. Policy, Practice, and Research Agenda for Emergency Medical Services Oversight: A Systematic Review and Environmental Scan. Prehosp Disaster Med. 2018;33(1):89–97.

Keywords

Emergency Medical Serviceshealth policyprehospital carequality measuressystematic review
Type
Comprehensive Reviews
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 1 , February 2018 , pp. 89 - 97
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest/funding: Funding received from the Michigan Department of Health and Human Services (Lansing, Michigan USA). Authors RT, MA, MC, RD, ML, KW, and JS report no conflicts of interest.

References

1. Institute of Medicine (IOM), McCoy, MA, Schultz, AM. Strategies to Improve Cardiac Arrest Survival: A Time to Act. Washington, DC USA: National Academies Press; 2015.Google Scholar
2. Balshem, H, Stevens, A, Ansari, M, et al. Finding Grey Literature Evidence and Assessing for Outcome and Analysis Reporting Biases When Comparing Medical Interventions: AHRQ and the Effective Health Care Program. Methods Guide for Comparative Effectiveness Reviews. Rockville, Maryland USA: Agency for Healthcare Research and Quality; 2013.Google Scholar
3. Delbridge, TR, Bailey, B, Chew, JL, et al. EMS agenda for the future: where we are… where we want to be. Ann Emerg Med. 1998;31(2):251-263.Google Scholar
4. Mears, G, Armstrong, B, Fernandez, AR, et al. 2011; National EMS Assessment. US Department of Transportation, National Highway Traffic Safety Administration. https://www.ems.gov/pdf/2011/National_EMS_Assessment_Final_Draft_12202011.pdf. Accessed February 1, 2017.Google Scholar
5. Shah, MN, Bazarian, JJ, Lerner, EB, et al. The epidemiology of Emergency Medical Services use by older adults: an analysis of the National Hospital Ambulatory Medical Care Survey. Acad Emerg Med. 2007;14(5):441-447.CrossRefGoogle ScholarPubMed
6. Platts-Mills, TF, Leacock, B, Cabanas, JG, Shofer, FS, McLean, SA. Emergency Medical Services use by the elderly: analysis of a statewide database. Prehosp Emerg Care. 2010;14(3):329-333.Google Scholar
7. Aldeen, AZ, Hartman, ND, Segura, A, et al. Video self-instruction for police officers in cardiopulmonary resuscitation and automated external defibrillators. Prehosp Disaster Med. 2013;28(5):471-476.Google Scholar
8. Centers for Disease Control and Prevention. The State of Aging and Health in America 2013. Atlanta, Georgia USA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2013.Google Scholar
9. Ortman, JM, Velkoff, VA, Hogan, H. An Aging Nation: The Older Population in the United States. Washington, DC USA: US Census Bureau; 2014: 25-1140.Google Scholar
10. Johnson, NB, Hayes, LD, Brown, K, et al. CDC National Health Report: leading causes of morbidity and mortality and associated behavioral risk and protective factors-United States, 2005-2013. MMWR Surveill Summ. 2014;63(Suppl 4):3-27.Google ScholarPubMed
11. Zachariah, BS, Pepe, PE. The development of emergency medical dispatch in the USA: a historical perspective. Eur J Emerg Med. 1995;2(3):109-112.CrossRefGoogle Scholar
12. Perry, N EJ, Busch, J. 9th Annual National EMS Systems Survey. EMS World. 2011.Google Scholar
13. Pepe, P, Copass, M, Fowler, R, Racht, E. Medical Direction of Emergency Medical Services Systems. Textbook of the National Association of EMS Physicians. Dubuque, Iowa USA: Kendall Hunt Publications; 2009: 22-52.Google Scholar
14. NASEMSO. EMS Compass Initiative. Falls Church, Virginia USA: National Association of State EMS Officials; 2015.Google Scholar
15. Slifkin, RT, Freeman, VA, Patterson, PD. Designated medical directors for Emergency Medical Services: recruitment and roles. J Rural Health. 2009;25(4):392-398.Google Scholar
16. Schooley, BL, Horan, TA. Towards end-to-end government performance management: case study of interorganizational information integration in Emergency Medical Services (EMS). Government Information Quarterly. 2007;24(4):755-784.Google Scholar
17. Ko, PC, Chen, WJ, Lin, CH, Ma, MH, Lin, FY. Evaluating the quality of prehospital cardiopulmonary resuscitation by reviewing automated external defibrillator records and survival for out-of-hospital witnessed arrests. Resuscitation. 2005;64(2):163-169.CrossRefGoogle ScholarPubMed
18. Centers for Medicare and Medicaid Services. Quality Measures 2016. Updated February 14, 2016. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityMeasures/index.html?redirect=/QUALITYMEASURES/. Accessed February 9, 2017.Google Scholar
19. NHTSA. Emergency Medical Services Performance Measures; Recommended Attributes and Indicators for System and Services Performance. United States Department of Transportation National Highway Traffic Safety Administration; 2009. Report No.: DOT HS 811 211.Google Scholar
20. Kuehl, A. Prehospital Systems and Medical Oversight. Thousand Oaks, California USA: SAGE Publications; 2002.Google Scholar
21. Pepe, PE, Curka, P. Scene Supervision of EMS. Quality Management in Prehospital Care. Toronto, Canada: CV Mosby and Co; 1993.Google Scholar
22. Stone, RM, Seaman, KG, Bissell, RA. A statewide study of EMS of oversight: medical director characteristics and involvement compared with national guidelines. Prehosp Emerg Care. 2000;4(4):345-351.Google Scholar
23. Sobo, EJ, Andriese, S, Stroup, C, Morgan, D, Kurtin, P. Developing indicators for Emergency Medical Services (EMS) system evaluation and quality improvement: a statewide demonstration and planning project. The Joint Commission Journal on Quality Improvement. 2001;27(3):138-154.CrossRefGoogle ScholarPubMed
24. Bayley, R, Weinger, M, Meador, S, Slovis, C. Impact of ambulance crew configuration on simulated cardiac arrest resuscitation. Prehosp Emerg Care. 2008;12(1):62-68.Google Scholar
25. Patton, K, Funk, DL, McErlean, M, Bartfield, JM. Accuracy of estimation of external blood loss by EMS personnel. J Trauma Acute Care Surg. 2001;50(5):914-916.Google Scholar
26. Lossius, HM, Røislien, J, Lockey, DJ. Patient safety in pre-hospital emergency tracheal intubation: a comprehensive meta-analysis of the intubation success rates of EMS providers. Critical Care. 2012;16(1):R24.CrossRefGoogle ScholarPubMed
27. McLean, SA, Maio, RF, Domeier, RM. The epidemiology of pain in the prehospital setting. Prehosp Emerg Care. 2002;6(4):402-405.Google Scholar
28. Ware, JE. Measuring patients’ views: the optimum outcome measure. BMJ. 1993;306(6890):1429.CrossRefGoogle ScholarPubMed
29. Donabedian, A. The quality of care: how can it be assessed? JAMA. 1988;260(12):1743-1748.CrossRefGoogle ScholarPubMed
30. Moher, D, Shamseer, L, Clarke, M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews. 2015;4(1):1.Google Scholar
31. Liberati, A, Altman, DG, Tetzlaff, J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009: 6.Google ScholarPubMed
32. Dedoose, V. Web Application for Managing, Analyzing, and Presenting Qualitative and Mixed Method Research Data. Los Angeles, California USA: SocioCultural Research Consultants; 2012.Google Scholar
33. Porterfield, D, Hinnant, L, Kane, H, Horne, J, McAleer, K, Roussel, A. Linkages Between Clinical Practices and Community Organizations for Prevention: Final Report. US Department of Health & Human Services Agency for Healthcare Research and Quality; 2010.Google Scholar
34. Farace, D, Frantzen, J. GL'97 Conference Proceedings: Third International Conference on Grey Literature. Perspectives on the design and transfer of scientific and technical information, Luxembourg DGXIII, November 13-14, 1997. Grey Literature Network Service. ISBN 90-74854-17-6, 1998.Google Scholar
35. AHRQ Publication No. 10(14)-EHC063-EF. In Methods Guide for Effectiveness and Comparative Effectiveness Reviews. Rockville, Maryland USA: Agency for Healthcare Research and Quality; 2014; http://www.effectivehealthcare.ahrq.gov. Accessed February 1, 2017.Google Scholar
36. Cushman, JT, Zachary Hettinger, A, Farney, A, Shah, MN. Effect of intensive physician oversight on a prehospital rapid-sequence intubation program. Prehosp Emerg Care. 2010;14(3):310-316.CrossRefGoogle ScholarPubMed
37. Greer, S, Williams, I, Valderrama, AL, Bolton, P, Patterson, DG, Zhang, Z. EMS medical direction and prehospital practices for acute cardiovascular events. Prehosp Emerg Care. 2012;17(1):38-45.Google Scholar
38. Henderson, AC. Examining policy implementation in health care: rule abidance and deviation in Emergency Medical Services. Public Administration Review. 2013;73(6):799-809.Google Scholar
39. Ailsby, RL. Transportation of the critically ill and injured. Can Fam Physician. 1987;33:1661-1664.Google Scholar
40. Aufderheide, TP, Yannopoulos, D, Lick, CJ, et al. Implementing the 2005 American Heart Association Guidelines improves outcomes after out-of-hospital cardiac arrest. Heart Rhythm. 2010;7(10):1357-1362.CrossRefGoogle ScholarPubMed
41. Munk, M-D, White, SD, Perry, ML, Platt, TE, Hardan, MS, Stoy, WA. Physician medical direction and clinical performance at an established Emergency Medical Services system. Prehosp Emerg Care. 2009;13(2):185-192.Google Scholar
42. Dunford, J, Domeier, RM, Blackwell, T, et al. Performance measurements in Emergency Medical Services. Prehosp Emerg Care. 2002;6(1):92-98.Google Scholar
43. Mears, GD, Pratt, D, Glickman, SW, et al. The North Carolina EMS Data System: a comprehensive integrated Emergency Medical Services quality improvement program. Prehosp Emerg Care. 2010;14(1):85-94.Google Scholar
44. Dawson, DE. National Emergency Medical Services Information System (NEMSIS). Prehosp Emerg Care. 2006;10(3):314-316.Google Scholar
45. Kingsbury, K, Natarajan, M, Forsey, A, Oakes, G, Bakar-Irwin, S. A provincial approach to improving stemi care in Ontario. Canadian Journal of Cardiology. 2014;30(10):S81.Google Scholar
46. Fischer, M, Kamp, J, Riesgo, LG-C, et al. Comparing Emergency Medical Service systems—a project of the European Emergency Data (EED) Project. Resuscitation. 2011;82(3):285-293.CrossRefGoogle ScholarPubMed
47. Landman, AB, Spatz, ES, Cherlin, EJ, Krumholz, HM, Bradley, EH, Curry, LA. Hospital collaboration with Emergency Medical Services in the care of patients with acute myocardial infarction: perspectives from key hospital staff. Ann Emerg Med. 2013;61(2):185-195.Google Scholar
48. Myers, JB, Slovis, CM, Eckstein, M, et al. Evidence-based performance measures for Emergency Medical Services systems: a model for expanded EMS benchmarking. A statement developed by the 2007 Consortium US Metropolitan Municipalities’ EMS Medical Directors. Prehosp Emerg Care. 2008;12(2):141-151.Google Scholar
49. Murphy, A, Wakai, A, Walsh, C, Cummins, F, O’sullivan, R. Development of key performance indicators for prehospital emergency care. Emerg Med J. 2016; emermed 2015-204793.Google Scholar
50. Aringhieri, R, Carello, G, Morale, D. Supporting decision making to improve the performance of an Italian Emergency Medical Service. Ann Oper Res. 2016;236(1):131-148.Google Scholar
51. Chen, TT, Ma, MHM, Chen, FJ, et al. The relationship between survival after out-of-hospital cardiac arrest and process measures for Emergency Medical Service ambulance team performance. Resuscitation. 2015;97:55-60.Google Scholar
52. Citerio, G, Galli, D, Cesana, GC, et al. Emergency system prospective performance evaluation for cardiac arrest in Lombardia, an Italian region. Resuscitation. 2002;55(3):247-254.Google Scholar
53. SE DGaH. The Quality of Emergency Medical Services. Philadelphia, Pennsylvania USA: University of Pennsylvania Leandard Davis Institute of Health Economics; 2011.Google Scholar
54. Callaham, M, Madsen, CD. Relationship of timeliness of paramedic Advanced Life Support interventions to outcome in out-of-hospital cardiac arrest treated by first responders with defibrillators. Ann Emerg Med. 1996;27(5):638-648.Google Scholar
55. Ebbs, P, Middleton, PM, Bonner, A, Loudfoot, A, Elliott, P. Do clinical safety charts improve paramedic key performance indicator results? A clinical improvement programme evaluation. Emerg Med J. 2012;29(7):596.CrossRefGoogle ScholarPubMed
56. Carriere, J, Bourque, C. The effects of organizational communication on job satisfaction and organizational commitment in a land ambulance service and the mediating role of communication satisfaction. Career Dev Int. 2009;14(1):29-49.CrossRefGoogle Scholar
57. Dyson, K, Bray, J, Smith, K, Bernard, S, Finn, J. A systematic review of the effect of Emergency Medical Service practitioners’ experience and exposure to out-of-hospital cardiac arrest on patient survival and procedural performance. Resuscitation. 2014;85(9):1134-1141.Google Scholar
58. Williams, KA, Rose, WD, Simon, R, Consortium, MT. Teamwork in Emergency Medical Services. Air Medical Journal. 1999;18(4):149-153.Google Scholar
59. Krarup, NHV, Lassen, JF, Clemmensen, P, et al. Out-of-hospital cardiac arrest: differences in the quality of care provided by Emergency Medical Services with Advanced versus Basic Life Support capabilities---a nationwide study. Circulation. 2014;130(Suppl 2):A112.Google Scholar
60. Braun, O. EMS system performance - the use of cardiac-arrest timelines. Ann Emerg Med. 1993;22(1):52-61.Google Scholar
61. Coster, J, Irving, A, Turner, J, Wilson, R, Phung, V-H, Siriwardena, AN. How should we measure ambulance service quality and performance? Results from a Delphi study. 8th European Congress on Emergency Medicine. 2014.Google Scholar
62. El Sayed, MJ. Measuring quality in Emergency Medical Services: a review of clinical performance indicators. Emerg Medicine Int. 2011: 2012.Google ScholarPubMed
63. Cady, G, Scott, T. 1995 Almanac. EMS in the United States. 1995 survey of providers in the 200 most populous cities. JEMS. 1995;20(1):76-82.Google Scholar
64. Flood, AB, Fennell, ML. Through the lenses of organizational sociology: the role of organizational theory and research in conceptualizing and examining our health care system. J Health Social Behavior. 1995: 154-169.Google Scholar
65. Aiken, LH, Sochalski, J, Lake, ET. Studying outcomes of organizational change in health services. Med Care. 1997;35(11 Suppl):NS6-18.Google Scholar
66. Vandenberghe, C. Organizational culture, person-culture fit, and turnover: a replication in the health care industry. J Organizational Behavior. 1999: 175-184.Google Scholar
67. Newhouse, JP. Toward a theory of nonprofit institutions: an economic model of a hospital. American Economic Review. 1970;60(1):64-74.Google Scholar
68. Mick, SS, Wyttenbach, ME. Advances in health care organization Theory. J Healthcare Quality. 2003;25(6):46-47.Google Scholar
69. Fagerhaugh, SY, Strauss, AL. Social Organization of Medical Work. Piscataway, New Jersey USA: Transaction Publishers; 1997.Google Scholar
70. Starr, P. The Social Transformation of American Medicine: the Rise of a Sovereign Profession and the Making of a Vast Industry. New York USA: Basic Books; 1982.Google Scholar
71. Freidson, E. Professional Dominance: The Social Structure of Medical Care. Piscataway, New Jersey USA: Transaction Publishers; 1974.Google Scholar
72. Freidson, E. Profession of Medicine: A Study of the Sociology of Applied Knowledge. Chicago, Illinois USA: University of Chicago Press; 1988.Google Scholar
73. Freidson, E. The reorganization of the medical profession. Medical Care Review. 1985;42(1):11-35.Google Scholar
74. NASEMSO. State Emergency Medical Services Systems: A Model. Washington, DC USA: National Association of State Emergency Medical Services; 2008.Google Scholar
75. NASEMSO. The Organization, Staffing, and Function of State and Territorial EMS Offices. Washington, DC USA: National Association of State Emergency Medical Services; 2005.Google Scholar
76. USDOT/NHTSA. Emergency Medical Services Education Agenda for the Future: A Systems Approach. Washington, DC USA: United States Department of Transportation National Highway Traffic Safety Administration; 2000.Google Scholar
77. NEMSMA. EMS 3.0: Realizing the value of EMS in our Nation’s Health Care Transformation. Platte City, Missouri USA: National Emergency Medical Services Management Association; 2016.Google Scholar
78. NHTSA. National Emergency Medical Services Education Standards. Washington, DC USA: United States Department of Transportation National Highway Traffic Safety Administration; 2009.Google Scholar
79. Goodloe, JM, Thomas, SH, Blackwell, TH, et al. Emergency Medical Services evidence-based system design white paper for EMSA. 2011.Google Scholar
80. ASPR. From Hospitals to Healthcare Coalitions: Transforming Health Preparedness and Response in Our Communities. Washington, DC USA: United States Department of Health and Human Services Assistant Secretary for Preparedness and Response; 2016.Google Scholar
81. ASTHO. Quality Improvement Plan Toolkit: Guidance and Resources to Assist State and Territorial Health Agencies in Developing a Quality Improvement Plan. Arlington, Virginia USA: Association of State and Territorial Health Officials; 2014.Google Scholar
82. Hormozdyaran, N. National Association of County and City Health Officials (NACCHO). Definitions of Health Project. 1999: 2004.Google Scholar
83. NHTSA. Progress of Evidence-Based Guidelines for Prehospital Emergency Care. Washington, DC USA: United States Department of Transportation National Highway Traffic Safety Administration; 2013.Google Scholar
84. NHTSA. National Highway Traffic Safety Administration (NHTSA): Advancing EMS Systems. 2016. Washington, DC USA: United States Department of Transportation National Highway Traffic Safety Administration; 2016.Google Scholar
85. NEMSMA. Seven Pillars of National EMS Officer Competencies. Platte City, Missouri USA: National EMS Management Association; 2014.Google Scholar
86. Higgins, JP, Green, S. Cochrane Handbook for Systematic Reviews of Interventions. Hoboken, New Jersey USA: John Wiley & Sons; 2011.Google Scholar
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