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- Title
Creating an Infrastructure for Comparative Effectiveness Research in Emergency Medical Services La Creación de una Infraestructura para la Investigación en Efectividad Comparada en los Servicios de Emergencias Médicas.
- Authors
Seymour, Christopher W.; Kahn, Jeremy M.; Martin‐Gill, Christian; Callaway, Clifton W.; Angus, Derek C.; Yealy, Donald M.; Shah, Manish N.
- Abstract
Objectives Emergency medical services ( EMS) providers deliver the initial care for millions of people in the United States each year. The Institute of Medicine noted a deficit in research necessary to improve prehospital care, created by the existence of data silos, absence of long-term outcomes, and limited stakeholder engagement in research. This article describes a regional effort to create a high-performing infrastructure in southwestern Pennsylvania addressing these fundamental barriers. Methods Regional EMS records from 33 agencies in January 2011 were linked to hospital-based electronic health records ( EHRs) in a single nine-hospital system, with manual review of matches for accuracy. The use of community stakeholder engagement was included to guide scientific inquiry, as well as 2-year follow up for patient-centered outcomes. Results Local EMS medicine stakeholders emphasized the limits of single-agency EMS research and suggested that studies focus on improving cross-cutting, long-term outcomes. Guided by this input, more than 95% of EMS records (2,675 of 2,800) were linked to hospital-based EHRs. More than 80% of records were linked to 2-year mortality, with more deaths among EMS patients with prehospital hypotension (30.5%) or respiratory distress (19.5%) than chest pain (5.4%) or nonspecific complaints (9.4%). Conclusions A prehospital comparative effectiveness research infrastructure composed of patient-level EMS data, EHRs at multiple hospitals, long-term outcomes, and community stakeholder perspectives is feasible and may be scalable to larger regions and networks. The lessons learned and barriers identified offer a roadmap to answering community and policy-relevant research questions in prehospital care.
- Subjects
HOSPITAL emergency services; COMMITTEES; EMERGENCY medical services; EMERGENCY medicine; HOME care services; HOSPITALS; RESEARCH methodology; MEDICAL care; MEDICAL records; PATIENTS; STATISTICS; DATA analysis; RETROSPECTIVE studies; ELECTRONIC health records; DESCRIPTIVE statistics
- Publication
Academic Emergency Medicine, 2014, Vol 21, Issue 5, p599
- ISSN
1069-6563
- Publication type
Article
- DOI
10.1111/acem.12370