The Starter Kit of EMS Outcome Measures

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The Starter Kit of EMS Outcome Measures

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The “Starter Kit” of EMS Clinical Performance Measures

1.Т Т Т Т ТTime

ТЗТ Т Т Т Т Т ТSystem issue:

1. Performance Measures Project ID	R8(a)
2. Question	Time of symptoms to access of 911 system
3. Proposed Indicator Name	Average Time to Access
4. Key Process Path	Operations: Response Intervals > All
5. Patient/Customer Need	Speed of access to and response of system following onset of emergency
6. Type of Measure	Process
7. Objective	Reduce all times
8. Indicator Formula	Summed differences between two date/time values divided by the number of events for which times are recorded
9. Indicator FormulaТ Т Т ТDescription	Average times
10. Denominator Т Т Т Т ТDescription	Number of events for which times are recorded
10.a Denominator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Count all events for which the values for E05-01 and E05-02 are present and pass logic test
10.b Denominator Exclusion Т Т Т Т Т Т ТCriteria	None
10.c Denominator Data Т Т Т Т Т Т ТSources	NEMSIS state or agency level
11. Numerator Description	Sum of time differences: value of E05-02 minus value of E05-01
11.a Numerator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Values for E05-01 and E05-02 are present and pass logic test Т
11.b Numerator Exclusion Т Т Т Т Т Т ТCriteria	None
11.c Numerator Data Т Т Т Т Т Т ТSources	NEMSIS state or agency level
12. Sampling Allowed	Т
13. Sampling Description	Т
14. Minimum Number of Т Т Т Т ТData Points	Two plus agency/locale and time/date identifiers
15. Suggest Reporting Т Т Т Т ТFormat: Numerical	Minutes/seconds
16. Suggest Reporting Т Т Т Т ТFormat: Graphical	Т
17. Suggest Reporting Т Т Т Т ТFrequency	Monthly/Annual
18. Testing	Т
19. Stratification	Т
20. Stratification Options	Т
21. Current Development Т Т Т Т ТStatus	Т
22. Additional Information	Т
23. References	Т
24. Contributors	Т

ТЗТ Т Т Т Т Т ТBenchmark issue: time of dispatch to arrive patient

1. Performance Measures Project ID	R8(b)
2. Question	Time of dispatch to arrive patient
3. Proposed Indicator Name	Average response time
4. Key Process Path	Operations: Response Intervals > All
5. Patient/Customer Need	Speed of access to and response of system following onset of emergency
6. Type of Measure	Process
7. Objective	Reduce all times
8. Indicator Formula	Summed differences between two date/time values divided by the number of events for which times are recorded
9. Indicator FormulaТ Т Т ТDescription	Average times
10. Denominator Т Т Т Т ТDescription	Number of events for which times are recorded
10.a Denominator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Count all events for which values for E05-04 (time responding unit was notified by dispatch) and E05-06 (time when responding vehicle arrives on scene and stops moving) are present and pass logic test
10.b Denominator Exclusion Т Т Т Т Т Т ТCriteria	None
10.c Denominator Data Т Т Т Т Т Т ТSources	NEMSIS state or agency level Т
11. Numerator Description	Value of E05-06 minus value of E05-04 Т
11.a Numerator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Values for E05-04 and E05-06 are present and pass logic test Т
11.b Numerator Exclusion Т Т Т Т Т Т ТCriteria	None
11.c Numerator Data Т Т Т Т Т Т ТSources	NEMSIS state or agency level
12. Sampling Allowed	Т
13. Sampling Description	Т
14. Minimum Number of Т Т Т Т ТData Points	Two plus agency/locale and time/date identifiers
15. Suggest Reporting Т Т Т Т ТFormat: Numerical	Minutes/seconds
16. Suggest Reporting Т Т Т Т ТFormat: Graphical	Т
17. Suggest Reporting Т Т Т Т ТFrequency	Monthly/Annual
18. Testing	Т
19. Stratification	Т
20. Stratification Options	Т
21. Current Development Т Т Т Т ТStatus	Т
22. Additional Information	Т
23. References	Т
24. Contributors	Т

1.Т Т Т Т ТRespiratory

ТЗТ Т Т Т Т Т ТThe percentage of patients who require respiratory support that receive it

1. Performance Measures Project ID	Q6
2. Question	The percentage of patients who require oxygen for respiratory support that receive it
3. Proposed Indicator Name	Appropriate Oxygen Administration Rate
4. Key Process Path	Clinical Care: Respiratory Management > Appropriate Oxygen Rate
5. Patient/Customer Need	Patients with respiratory compromise in the EMS setting who require oxygen
6. Type of Measure	Process
7. Objective	Increase rate in appropriate patients
8. Indicator Formula	Number of respiratory distress/arrest patients receiving oxygen in a given period divided by total respiratory distress/arrest patients in that period
9. Indicator FormulaТ Т Т ТDescription	Percentage of patients for whom a provider impression of respiratory distress/arrest or breathing problems is created that receive oxygen
10. Denominator Т Т Т Т ТDescription	Number of patients creating a provider impression of respiratory distress/arrest or breathing problems.
10.a Denominator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Patients with NHTSA value т799.10- Respiratory arrestт or т786.09- Respiratory distressт for either element E09-15 or E09-16 or value 1410 - Breathing Problem for E09-13 or E09-14.Т
10.b Denominator Exclusion Т Т Т Т Т Т ТCriteria	None
10.c Denominator Data Т Т Т Т Т Т ТSources	NEMSIS state level
11. Numerator Description	Number of patients creating a provider impression of respiratory distress/arrestТwho receive oxygen
11.a Numerator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Patients with NHTSA value т799.10- Respiratory arrestт or т786.09- Respiratory distressт for either element E09-15 or E09-16 or value 1410 - Breathing Problem for E09-13 or E09-14 and who have a NHTSA value for тoxygenт for element E18-03.ТThis should also include oxygen administered prior to arrival of EMS unit (E09-01).
11.b Numerator Exclusion Т Т Т Т Т Т ТCriteria	None
11.c Numerator Data Т Т Т Т Т Т ТSources	NEMSIS state level
12. Sampling Allowed	No
13. Sampling Description	NA
14. Minimum Number of Т Т Т Т ТData Points	Three plus agency/locale and time/date identifiers
15. Suggest Reporting Т Т Т Т ТFormat: Numerical	Raw Ratio maintaining the original numbers
16. Suggest Reporting Т Т Т Т ТFormat: Graphical	Т
17. Suggest Reporting Т Т Т Т ТFrequency	Monthly
18. Testing	Т
19. Stratification	Т
20. Stratification Options	Т
21. Current Development Т Т Т Т ТStatus	Т
22. Additional Information	Т
23. References	Т
24. Contributors	Т

ТЗТ Т Т Т Т Т ТHow long did it take to provide respiratory support?

1. Performance Measures Project ID	None
2. Question	How long did it take to provide respiratory support?
3. Proposed Indicator Name	Average Time to Respiratory Support
4. Key Process Path	Respiratory care provided
5. Patient/Customer Need	Early intervention of oxygen to improve SPO2 saturations
6. Type of Measure	Process
7. Objective	Decrease time it takes to apply oxygen
8. Indicator Formula	Time of arrival of EMS unit to the time that oxygen was applied for respiratory distress/arrest patients in a given period.
9. Indicator FormulaТ Т Т ТDescription Т	Mean average times
10. Denominator Т Т Т Т ТDescription	The number of Respiratory distress/arrest patients in which oxygen is administered and times are recorded.
10.a Denominator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Count all events for which: Values for E05-06 and E18-01 are present and pass logic test
10.b Denominator Exclusion Т Т Т Т Т Т ТCriteria	None
10.c Denominator Data Т Т Т Т Т Т ТSources	NEMSIS state level
11. Numerator Description	Value of E05-06 minus value of E18-01
11.a Numerator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Value of E05-06 and E18-01 are present and pass the logic test.
11.b Numerator Exclusion Т Т Т Т Т Т ТCriteria	None
11.c Numerator Data Т Т Т Т Т Т ТSources	NEMSIS state level
12. Sampling Allowed	No
13. Sampling Description	N/A
14. Minimum Number of Т Т Т Т ТData Points	Т
15. Suggest Reporting Т Т Т Т ТFormat: Numerical	Minutes/seconds
16. Suggest Reporting Т Т Т Т ТFormat: Graphical	Т
17. Suggest Reporting Т Т Т Т ТFrequency	Т
18. Testing	Т
19. Stratification	Т
20. Stratification Options	Т
21. Current Development Т Т Т Т ТStatus	Т
22. Additional Information	Т
23. References	Т
24. Contributors	Т

1.Т Т Т Т ТAccuracy

1. Performance Measures Project ID	None
2. Question	Accuracy score of PCR
3. Proposed Indicator Name	Completion percentage of the PCR
4. Key Process Path	Т
5. Patient/Customer Need	Completeness of the PCR
6. Type of Measure	Process
7. Objective	To determine how many records have values listed in each of fields E01-01, E02-01, E02-04, E02-05, E02-12, E02-20, E03-01, E05-02, E05-04, and E05-11.
8. Indicator Formula	The total number of events in a given period in which there of value listed for each of elements E01-01, E02-01, E02-04, E02-05, E02-12, E02-20, E03-01, E05-02, E05-04, and E05-11 divided by the total number of events.
9. Indicator Formula Т Т Т ТDescription Т	Look at the selected fields and determine whether all are filled in.
10. Denominator Т Т Т ТТ Description	All reported events.
10.a Denominator Inclusion Т Т Т Т Т ТТ Criteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	All events
10.b Denominator Exclusion Т Т Т Т Т Т ТCriteria	None
10.c Denominator Data Т Т Т Т Т ТТ Sources	NEMSIS State Level
11. Numerator Description	The total number of events for which all of the values are complete for the NHTSA elements listed.
11.a Numerator Inclusion Т Т Т Т Т ТТ Criteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	All events where there is a value for E01-01, E02-01, E02-04, E02-05, E02-12, E02-20, E03-01, E05-02, E05-04, and E05-11.
11.b Numerator Exclusion Т Т Т Т Т Т ТCriteria	None
11.c Numerator Data Т Т Т Т Т ТТ Sources	NEMSIS State Level
12. Sampling Allowed	Т
13. Sampling Description	Т
14. Minimum Number of Т Т Т Т ТData Points	Т
15. Suggest Reporting Т Т Т Т ТFormat: Numerical	Percentage
16. Suggest Reporting Т Т Т Т ТFormat: Graphical	Т
17. Suggest Reporting Т Т Т Т ТFrequency	Т
18. Testing	Т
19. Stratification	Т
20. Stratification Options	Т
21. Current Development Т Т Т Т ТStatus	Т
22. Additional Information	Т
23. References	Т
24. Contributors	Т

ТЗТ Т Т Т Т Т ТALS Subset: the percentage of patients whose condition indicated ALS that actually received it

1. Performance Measures Project ID	CC11
2. Question	ALS Subset: the percentage of patients whose condition indicated ALS that actually received it
3. Proposed Indicator Name	EKG Performance Rate
4. Key Process Path	Clinical Care: ACS > EKG Lead Performance Rate
5. Patient/Customer Need	Early performance of diagnostic EKG can accelerate definitive care
6. Type of Measure	Process
7. Objective	Increase rate in appropriate patients
8. Indicator Formula	Number of chest pain patients having EKG, 3 т 12 leads, in a given period divided by total chest pain patients in that period
9. Indicator FormulaТ Т Т ТDescription	Percentage of patients for whom a provider impression of chest pain/discomfort is created that have a 3-12 lead EKG performed
10. Denominator Т Т Т Т ТDescription	Number of patients creating a provider impression of Chest Pain /discomfort
10.a Denominator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Patients with NHTSA value т1650 786.50- Chest pain / discomfortт for either element E09-15 or E09-16.ТEKG performed by ALS Providers.
10.b Denominator Exclusion Т Т Т Т Т Т ТCriteria	Patients < 18 years of age (E06-14/E06-15 - E05-02, or E06-16) .ТEKG is performed by someone other than ALS Providers.
10.c Denominator Data Т Т Т Т Т Т ТSources	NEMSIS state level
11. Numerator Description	Number of patients creating a provider impression of chest pain/discomfort who have an EKG (3-12 lead) performed by ALS Providers
11.a Numerator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	Patients with NHTSA value т1650 786.50- Chest pain / discomfortт for element E09-15 (Primary impression) or т1785 786.50- Chest pain / discomfortт for E09-16 (Secondary impression) and have т3 -12 lead EKGт indicated in Procedures list (Performed) (D04-04) (E19-03))/89.510 т Cardiac Monitor or 89.820 - 12 lead ECG.
11.b Numerator Exclusion Т Т Т Т Т Т ТCriteria	Patients < 18 years of age (E06-14/E06-15 т E05-04, or E06-16).ТEKG performed by someone other than ALS Providers
11.c Numerator Data Т Т Т Т Т Т ТSources	NEMSIS state level
12. Sampling Allowed	No
13. Sampling Description	NA
14. Minimum Number of Т Т Т Т ТData Points	Six plus agency/locale and time/date identifiers
15. Suggest Reporting Т Т Т Т ТFormat: Numerical	Percentage
16. Suggest Reporting Т Т Т Т ТFormat: Graphical	Т
17. Suggest Reporting Т Т Т Т ТFrequency	Т
18. Testing	Т
19. Stratification	Т
20. Stratification Options	Т
21. Current Development Т Т Т Т ТStatus	Т
22. Additional Information	Т
23. References	Т
24. Contributors	Т

ТЗТ Т Т Т Т Т ТBLS Subset: time to defibrillation

1. Performance Measures Project ID	CC4
2. Question	BLS Subset: Time to defibrillation
3. Proposed Indicator Name	Time to Defibrillation
4. Key Process Path	Clinical Care: ACS > Defibrillation Time
5. Patient/Customer Need	Speed of access to defibrillation when needed.
6. Type of Measure	Process
7. Objective	Reduce time
8. Indicator Formula	Time intervals from onset of V-fib to defibrillation summed for a given period, divided by the number of time intervals reported during the period
9. Indicator FormulaТ Т Т ТDescription Т	The mean average time interval from onset of V-fib, in which a patient is defibrillated, to the first defibrillation, for a given period of time.
10. Denominator Т Т Т Т ТDescription	The number of V-fib events in a given period in which defibrillation is attempted
10.a Denominator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	NHTSA E19-03 has values for тdefibrillationт (manual or AED) Manual Defibrillation т 99.622 and AED Defibrillation т 99.621
10.b Denominator Exclusion Т Т Т Т Т Т ТCriteria	When data is excluded from numerator, associated event count is excluded from denominator
10.c Denominator Data Т Т Т Т Т Т ТSources	NEMSIS state level
11. Numerator Description	The time from onset of V-fib to first defibrillation
11.a Numerator Inclusion Т Т Т Т Т Т ТCriteria Т Т Т Т Т Т Т Т Т Т Т Т Т Т Т	NHTSA E5-01 with E11-01 (see notes below)Тvalues of either 2240 т yes, prior to EMS arrival or 2245 т yes, after EMS arrival and E19-01 present for E19-03 тdefibrillationт procedure
11.b Numerator Exclusion Т Т Т Т Т Т ТCriteria	Values for E5-01 or E19-01 missing or fail sequence logic test.
11.c Numerator Data Т Т Т Т Т Т ТSources	NEMSIS state level
12. Sampling Allowed	No
13. Sampling Description	NA
14. Minimum Number of Т Т Т Т ТData Points	Three plus agency/locale ID elements
15. Suggest Reporting Т Т Т Т ТFormat: Numerical	Minutes/seconds
16. Suggest Reporting Т Т Т Т ТFormat: Graphical	Т
17. Suggest Reporting Т Т Т Т ТFrequency	Annual
18. Testing	No
19. Stratification	Т
20. Stratification Options	Т
21. Current Development Т Т Т Т ТStatus	Т
22. Additional Information	Т
23. References	Т
24. Contributors	Т

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