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The relationship between survival after out-of-hospital cardiac arrest and process measures for emergency medical service ambulance team performance
Affiliation:1. Department of Public Health, Fu Jen Catholic University, New Taipei, Taiwan;2. Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan;3. Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan;4. Graduate Institute of Clinical Medicine and School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan;5. Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan;1. Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada;2. Department of Laboratory Medicine and Pathology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada;1. Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH;2. Center for Simulation and Research, Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH;1. Harborview Injury Prevention and Research Center, University of Washington, P.O. Box 359960, 325 Ninth Avenue, Seattle, WA 98104, United States;2. Department of Plastic Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States;3. Department of Trauma Surgery, Harborview Medical Center, Seattle, WA 98104-1520, United States;1. Department of Mechanical Engineering and Industrial Design, Faculty of Sciences, Campus de Puerto Real, University of Cádiz, Polígono Río San Pedro s/n, 11510 Puerto Real, Cádiz, Spain;2. Department of Environmental Technologies, Faculty of Marine and Environmental Sciences., Campus de Puerto Real, University of Cádiz, Polígono Río San Pedro s/n, 11510 Puerto Real, Cádiz, Spain;1. Philips Research, High Tech Campus 34, 5656 AE Eindhoven, The Netherlands;2. Cardiovascular Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Den Dolech 2 (De Wielen), 5612 AZ Eindhoven, The Netherlands;3. Department of Anaesthesiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5082 GC Tilburg, The Netherlands;4. Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands
Abstract:ObjectiveInternational institutes have developed their own clinical performance indicators for ambulance services. It is unknown whether these process measures are related to survival of patients after out-of-hospital cardiac arrest (OHCA). We aimed to determine whether Emergency Medical Service (EMS)-related ambulance team process measures correlate with patient survival.MethodsFour years of observational data were collected from an urban EMS OHCA registry. The two process measures were achieving an EMS response time ≤4 min and prehospital ROSC (return of spontaneous circulation). The outcome measure was survival to discharge. We used the GLMM (generalised linear mixed model) with stepwise selection to examine this process-outcome link at the patient and EMS team levels, respectively.ResultsWe analyzed 3856 OHCA patients distributed across forty-three EMS ambulance teams. Survival to discharge was observed in 193 (5%) patients. The two EMS team process measures were positively associated with an improvement in survival at the patient level after case-mix adjustment. However, they were not associated with improvement in the risk-adjusted survival rate.ConclusionsThe EMS team-level process measures proposed by international institutes may not predict the risk-adjusted survival rate. Using these measures to motivate EMS teams to improve their quality performance would be questionable. Increased efforts should be devoted to constructing more pivotal EMS team-level process measures that are tightly linked to survival.
Keywords:Cardiac arrest  Emergency medical services  Profiling  Performance measurement  Process measures
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