Data Collection and EMS Research

1. 16 Data Collection and EMS Research

2. Learning Objectives 16.1 Evaluate the different types of research. 16.2 Understand the domains of EMS research. 16.3 Deploy specific research methodologies to the prehospital setting. 16.4 Define validity and reliability in scientific research and data.

3. Learning Objectives (Cont.) 16.5 Apply GIS concepts to EMS-related activities. 16.6 Recognize the federal, state, and local data-collection systems. 16.7 Link data to quality-improvement initiatives in EMS.

4. EMS and the Research Agenda • Despite years of dedicated service, EMS systems are treating and transporting patients with almost no evidence that the care provided is effective and efficient • Very little scientific research on EMS management procedures has been produced, and efforts to sustain an EMS journal devoted to the management sciences have yet to be established

5. EMS and the Research Agenda (Cont.) • As health-care costs increase and every expense becomes scrutinized by private insurance, federal, state, and local governments’ money will be put toward services that prove their worth in making an impact on patient outcomes • The EMS Agenda for the Future identified the need for advancing quality research in the field of EMS

6. EMS Reports and Collection Techniques • EMS reports connect patient care with dispatch data and patient outcomes • They serve as a defense mechanism for litigation and help reduce patient-care errors by ensuring a smooth transition of the patient-care information from EMS provider to hospital

7. EMS Reports and Collection Techniques (Cont.) • Three are three basic types of EMS reporting technology • Optically scanned reports • Forms are filled out in the field by EMS providers and sent to a clerical person, who in turn feeds the form into an optical scanner that tabulates the data and enters it into the computer

8. EMS Reports and Collection Techniques (Cont.) • Three are three basic types of EMS reporting technology • Manual-entry method • Personnel manually enter specific data elements from PCR’s generated in the field

9. EMS Reports and Collection Techniques (Cont.) • Three are three basic types of EMS reporting technology • Paperless system • This type of data collection relies on pen-based or laptop computers • Many use software that has a point-and-click data-entry system • Ensures a consistent narrative format and allows the EMS provider to narrate the information

10. EMS Reports and Collection Techniques (Cont.) • Three are three basic types of EMS reporting technology • Paperless system • Automated processes help reduce the time on task for EMS crews • Drop-down menus in the computer-based programs help standardize the data

11. Integrated Informational Management Systems • Integrated information management system (IIMS) • System that collects data for an EMS system • IIMS manages databases that are a collection of records and that must be organized

12. Integrated Informational Management Systems (Cont.) Integrated information management system (IIMS) Must establish validity by managing information that is related to the EMS agency’s needs Information must be produced in a timely and accurate fashion to establish reliable data

13. TABLE 16.1

14. Domains of EMS Research • There are three areas of interest in the EMS research community that should be applied to an EMS organization: • Clinical research • Involves the study of direct patient-care activities.

15. Domains of EMS Research (Cont.) • There are three areas of interest in the EMS research community that should be applied to an EMS organization: • Systems research • Studies the effects of EMS systems designs and operational methods on resource utilization • Educational research • Examines the methods of preparing, remediating, and providing recertification activities to EMS providers

16. Types of Research • Research can be qualitative or quantitative • Qualitative research • Often anecdotal, composed of soft data that does not have enough numerical or objective measurements to be statistically significant

17. Types of Research (Cont.) • Research can be qualitative or quantitative • Qualitative studies • Often based on observation of a single phenomena or a case study • Composed from material from interviews and reviews of documents • Often has problems with reliability

18. Types of Research (Cont.) • Mixed method • Is becoming the most common type of research, it uses one type of research to set up the other

19. Types of Research (Cont.) • Quantitative research • Is based on objective and measurable factors • Are one of three types • Experimental design • Defines a population and applies a treatment, intervention, or change, then measures the effects

20. Types of Research (Cont.) • Quantitative research • Are one of three types • Quasi experiment • Measures a population that has already been treated or received an intervention, and then measures the difference between groups • Non-experiment • Measures the difference between two groups without identifying the intervention, change, or treatment applied to the groups

21. Research Methodologies • Several different methods are used by drug companies, medical-equipment manufacturers, epidemiologists, and quality-improvement professionals • Most often EMS managers need to refer to publications on research • A case study is the beginning of what is considered scientific research and is usually a factual account of an event described in detail

22. Research Methodologies (Cont.) • When reviewing information on the science of EMS, managers should look for the most expensive and complex research method, known as the randomized control trial

23. Research Methodologies (Cont.) • Case-control studies are observational designs in which a group of individuals or events are chosen according to whether they do or do not have a characteristic or risk factor of which the cause is to be studied; those individuals or events are compared with controls that share important characteristics with the group being studied.

24. Research Methodologies (Cont.) • A cohort study involves a group of individuals with common characteristics or exposures that are observed over time • The case group is exposed to the injury problem and the comparison group is not • Cohort studies allow for incident rates to be determined

25. Research Methodologies (Cont.) A cross-sectional study makes an observation of a group during a certain period of time

26. Central Tendency • Measures of central tendency provide a single summary figure that best describes the central location of an entire distribution • The three most common measures of central tendency are the mode, the median, and the mean • Mode is the value that occurs most frequently in a distribution • Mean is also known as the arithmetic mean or average. • Median is defined as the middle value (50th percentile) of a distribution

27. Central Tendency • The three most common measures of central tendency are the mode, the median, and the mean • Mode is the value that occurs most frequently in a distribution • Mean is also known as the arithmetic mean or average. • Median is defined as the middle value (50th percentile) of a distribution

28. Measures of Dispersion • Measures of dispersion provide a summary of the variability or spread of the values in a distribution • Express quantitatively the extent to which the values in a distribution scatter about or cluster together

29. Measures of Dispersion (Cont.) • The three main measures of dispersion are the range, variance, and standard deviation • Rangeis the most basic measure of dispersion • Variance is the measure of the variability of a distribution • Deviation is the difference between the values in a distribution and its mean

30. Data Entry and Data Quality • Research and data on fire incidents and casualties relies very heavily on the street-level paramedic or EMT entering information into the computer and the inputs being available for analysis • While manual analysis certainly is possible, it usually is avoided because the tedious calculations quickly overwhelm the ability to perform analysis in any significant manner

31. Data Entry and Data Quality (Cont.) • The advantage of a computer is that it processes data quickly and accurately • Any program you purchase should contain a good error-checking routine • Data quality is always a problem, and the old adage “garbage in, garbage out” certainly applies to EMS organization reports

32. Data Entry and Data Quality (Cont.) • The entry program should, for example, check each item to make sure a valid code has been entered • Whenever the program encounters an error, it should give an opportunity to correct the error before it becomes part of the database

33. National EMS Information System • National EMS Information System (NEMSIS) • A fully implemented and useful EMS database that resides or is controlled at a local, state, and national level • The purpose was to evaluate patient and EMS system outcomes, facilitate research, and develop a nationwide EMS training curriculum

34. FIGURE 16.3National EMS Information System (NEMSIS). (Source: NEMSIS, www.nemsis.org. Reprinted with permission.)

35. EMS Outcomes Project • EMS Outcomes Project (EMSOP) • A major research initiative funded by the National Highway Traffic Safety Administration designed to measure patient outcomes from EMS interventions • The goal is to identify the frequency of EMS events, the impact of EMS treatments, and the clinical outcomes of the treatment provided • The EMS Outcomes Project is being managed by the National Association of State and EMS Administrators

36. Trauma Registry • Trauma registry • Set of data collected on trauma-center patients • A level-one trauma center designation requires that the trauma center conduct research in trauma care • As part of this system, each EMS provider is given a designation number, and outcome scores are correlated with each agency based on the injuries the patient receives • Prehospital factors such as response time, scene time, and transport times are all analyzed

37. Motor-Vehicle Crash Data • Motor-vehicle crash data is collected and maintained through state departments of transportation and law- enforcement agencies • Crash Outcomes Data Evaluation System (CODES) • Data in 25 states from law-enforcement, EMS, and emergency departments • Helps generate outcome data for collisions and aids in developing highway traffic- safety programs

38. Cardiac-Arrest Data • Utstein criteria • The gold standard for measuring cardiac- arrest survival since 1991 • Data on cardiac arrest is generally collected and reported as a registry for quality improvement and as a research report that looks at outcomes and the interventions that are related to those outcomes

39. Cardiac-Arrest Data (Cont.) • Criteria help EMS managers conduct quality-improvement activities and compare arrest statistics against other systems • Outcome data after a cardiac arrest is dependent on critical interventions like defibrillation, CPR, and advanced life support • Reporting template in an algorithm format that instructs a quality-improvement coordinator or EMS researcher on which cardiac-arrest patients to include in the database

40. FIGURE 16.5Time Elements for Cardiac Arrest Applied to Utstein Criteria.

41. FIGURE 16.6Utstein Criteria for Measuring Cardiac-Arrest Outcomes.

42. Managing GIS • EMS managers need to periodically review and budget for upgrades in GIS • Expect to budget for and manage increases in data-collection cost, computer memory, upgrades in video cards, larger data storage, color printers, and increased processor speeds

43. Managing GIS (Cont.) • State-of-the-art GIS programs have high-end computers, a large sever, and digitizing tablets for run reports and inventories • High-end systems may need laser printers and a larger printer called a plotter, used to print maps

44. Managing GIS (Cont.) • The common GIS software packages on the market are ESRI ArcView, MARVLIS, MapInfo, Caliper, Intergraph, and Tactician • A common application of GIS is to use the technology and data to create a fluid deployment plan or assist the communication center with the dispatch of the unit closest to the call

45. Resource Outcomes • Once data is collected, a key component of that data is defining in the research what an outcome is and how it is measured • The most common research terms are morbidly and mortality • Mortality is a death • Morbidity is often seen as a disability or loss that does not result in death

46. Literature Reviews • When reviewing research that is involved with drugs or equipment, it is important to consider evidence-based practice • Evidence should come from a credible source and with predetermined criteria in human studies, if possible with sound methodology • There are eight steps or levels involved with medical scientific research

47. FIGURE 16.12National Institutes of Health (NIH) Steps in Clinical research

48. Evidence-Based Medicine • Once clinical evidence and research have been reviewed, drugs, medical procedures, and equipment are classified into seven different categories • The American Heart Association uses these terms to classify the effectiveness based on evidence-based medicine

49. FIGURE 16.13American Heart Association Classification of Therapies.

50. Run Chart • When data about a work process is collected, the results can be displayed in a graph • A run chart is one type of graph that is used to see if work is performed in a consistent way