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National EMS performance measures project underway

NASEMSO launched a two-year effort to research and publish a set of measures that EMS agencies can use to gauge their own performance

The National Association of State EMS Officials (NASEMSO) held a national stakeholder meeting in Washington D.C. in early December as part of a two-year effort to develop EMS performance measures.

Representatives from the EMS community and federal agencies gathered to hear the project’s principals and discussed why standardized performance measures are critical to the future of EMS. The National Highway Traffic Safety Administration (NHTSA) Office of EMS, which is funding the project, selected NASEMSO to manage the two-year project.

“We are very, very excited to be unveiling a project of national significance,” Dia Gainor, the executive director of NASEMSO, told the group.

What to measure

The goal of the project is to publish a set of measures that can be used by EMS agencies to gauge their own performance, leaders said. It’s not intended for federal or state entities to grade or set minimum standards. The scope of measures will include ways to assess the quality of patient care and outcomes and also personnel, financial, and other measures to evaluate administrative and operational performance.

At the kick-off meeting, Gainor introduced the project’s leaders. Robert Bass, MD, recently retired after two decades as executive director of the Maryland Institute for Emergency Medical Services Systems. Bass is serving as the chair of the project’s steering committee.

“There wasn’t a whole lot that could’ve pulled me back into the ‘working environment,’ but this is exciting enough that it did,” Bass said. “EMS is an essential component of the health care system in this country. We impact millions … an estimated 30 to 40 million patients a year. Performance is important to us. It’s important to our patients.”

The steering committee, composed of performance improvement experts and EMS leaders from around the country, will oversee the project along with the project execution group, led by project manager Nick Nudell, a paramedic [GF1] and information systems and data consultant.

How to measure

Nudell outlined the steps that project leaders plan to take to produce a list of performance measures that can be used by local, regional, state, and national entities. The project steps will include:

  • A literature review to ensure measures are relevant and evidence-based
  • Stakeholder engagement to receive input from the EMS community and external partners
  • Testing the measures in the “field” to validate that they are usable with current data definitions and technology
  • A blueprint, in the form of a website and guidebook, for how agencies can use National EMS Information System (NEMSIS) and other data to create performance benchmarks

Dave Williams, PhD, a former paramedic who now advises the Institute for Healthcare Improvement and is serving as chair of the project’s Measurement Design Group, briefly discussed some earlier performance measure projects and the process of choosing and testing measures. He told the story of what happened when the National Health Service in the United Kingdom began measuring performance.

“As soon as they started to measure, everybody started to improve,” Williams explained.

In addition to the Measurement Design Group, two other committees were established to help manage the project. Debbie Gilligan of FirstWatch, a data analytics company, has been named chair of the Technology Developers Group, which will help ensure that the benchmarks established can actually be measured using the electronic patient records systems currently available. The Stakeholder Communication Group, chaired by Keith Griffiths of the RedFlash Group, will focus on soliciting and incorporating input from the public and the EMS community throughout the next two years.

“I want to emphasize that we are going to be asking you for help,” Nudell told the audience.

That help will include suggestions for what should be measured, as well as using EMS agencies around the country to test and validate the measures. NASEMSO plans on launching a website soon that will provide project updates, and avenues for EMS providers at all levels to engage with project leaders.

Measures will be designed using data elements from the latest version of the NEMSIS and definitions that meet the standards of the U.S. Centers for Medicare and Medicaid Services (CMS) and the Joint Commission. Williams and Nudell said they also hope to have the measures endorsed by the National Quality Forum, a non-profit organization funded in part by Congress with a mission of bringing together public and private organizations to reach consensus on how to measure quality in healthcare.

The final measures will be published in a peer-reviewed journal and as a document that will be available to EMS providers at all levels nationwide.

Why measure?

Representatives from several federal agencies, including the Department of Homeland Security and the Health Resources and Services Administration, were also on hand to lend their support to the effort. Brian McLaughlin, a senior official with NHTSA, called performance measures “extremely important” for EMS not only to evaluate its performance, but also to help policymakers set priorities and funding levels.

Other officials discussed the use of performance measures in healthcare reimbursement and the potential impact on EMS in the future.

“We have the opportunity to forge out own destiny, and not have it forced upon us,” said Gregg Margolis with the U.S. Department of Health and Human Services.

The steering committee and working groups for the initiative are currently being finalized. They are scheduled for their first face-to-face meetings in late January in Washington, D.C. EMS1 will provide ongoing coverage of the project.

Paramedic Michael Gerber, MPH, started in EMS in 2001, when he joined the volunteer fire service while working as a journalist on Capitol Hill. He later spent more than eight years in the career fire service, serving at times as a paramedic, field supervisor, instructor, public information officer and quality management officer. Currently, Michael works as a consultant with the RedFlash Group and M10 Solutions, an adjunct instructor of epidemiology and emergency health systems at the George Washington University and a life member and paramedic with the Bethesda-Chevy Chase Rescue Squad.