EMS Core Quality Measures Project
*This project is funded by a grant from the California HealthCare Foundation, #16933
The California EMS System Core Quality Measures (EMSA #166 - Appendix E) for 2012 and 2013 data years can be found here. (This is the most recent version: Updated Dec. 2013)
The purpose of the EMS system core measures project is to increase the accessibility and accuracy of pre-hospital data for public, policy, academic and research purposes to facilitate EMS system evaluation and improvement through a grant from the California Health Care Foundation (CHCF). Ultimately, the project will highlight opportunities to improve the quality of patient care delivered within an EMS system.
During a 1 year period, from April 1, 2012 to April 30, 2013, The California EMS Authority (EMSA) will perform the following activities to deliver a set of publicly available data reports:
1. Assess the capacity of the California Emergency Medical Services Information System to deliver core performance measures.
2. Create a formal data system profile and written analysis to identify areas for data quality improvement and inform an action plan to address the issues.
3. Work to reveal opportunities for both short-term and long-term data improvement plans.
4. Focus on achieving reliable measures that are high value and feasible within a short-term time frame.
5. Define and publish core measure sets that describe the coordination and effectiveness of EMS utilizing regional and local information for California. This project will focus upon the following core measure sets:
- EMS Response and Transport
- Trauma Care
- Heart Attack/Acute Myocardial Infarction Care
- Cardiac Arrest
- Stroke Care
- Respiratory Care
- Pediatric EMS
- Skill Performance by EMS Providers
6. Submit California EMS data to the National EMS Information System (NEMSIS) to evaluate the statewide system from a national perspective.
7. Conduct three data workshops for local EMS agencies across the state to implement improved data collection and reporting practices with those Local Emergency Medical Services Agencies who participate in California Emergency Medical Services Information System.
Core Measures Definition
The preliminary Core Measures were derived largely from a set of quality indicators developed through a project by the National Quality Forum. These core measures will begin to benchmark the performance of EMS systems, perform recommended treatments determined to get the best results for patients with certain medical conditions, and transport patients to the most appropriate hospital. Information about these treatments are taken from the pre-hospital care reports and converted into a percentage.
The measures are based on scientific evidence about processes and treatments that are known to get the best results for a condition or illness. Core Measures help emergency medical services systems improve the quality of patient care by focusing on the actual results of care.
Emergency medical services systems across the state will be measured and compared on their performance in these Core Measures. There will be a delay between when data is reported from EMS systems and when it is available for review. This is because EMSA will have to wait for all local systems in the state to be compiled before it can post its quality data for a given period. This way, EMS systems and consumers can compare California program from the same time period.
In the future, EMS providers should utilize these core measures to assist in continuous quality improvement activities.
The recurring themes, in evaluation of the EMS system, using these core measures consist of:
- · Arrival at the scene in a timely manner
- · Accurate patient assessment
- · Delivery of time-sensitive pre-hospital therapy
- · Transport to a hospital capable of providing necessary care
CEMSIS Evaluation (Objectives 1 and 2)
The capacity of the existing California Emergency Medical Services Information System (CEMSIS) was assessed to determine its capability to deliver core performance measures through a contractor experienced in this review. Our review found that the existing CEMSIS system had a number of weaknesses that made validated EMS information difficult to collect and to report. Unfortunately, the CEMSIS system in existence during this grant cycle was determined to be incompatible with EMS Core measure reporting.
The contractor also created a formal data system profile and written analysis to identify areas for data quality improvement. This report informed an action plan to address the issues related to our existing CEMSIS system. The action plan identified that various policy issues at the local EMS agency (LEMSA) level hindered State collection and reporting of data, and that future successes would require a more standard approach to use of a data dictionary (ie NEMSIS 3), inclusion of both first responder and transport data on a single record, and prospective preparation of core measure data.
The results of CEMSIS core measure reports is available as an Excel spreadsheet.
- Summary of Findings and Recommendations for California EMS Authority by HSAG [PDF]
- CEMSIS Results [Excel]
EMS Data Planning (Objective 3)
Using the work of the contractor, development of the EMS Core Measures, and the core measure task force, EMSA has developed a plan for both short-term and long term data improvement plans. As a result, EMSA has a list of lessons learned from the first iteration of a core measures collection process for EMS. EMSA anticipates that there will be annual improvement in the Core measure process as prospective measurement can be achieved.
Moreover, EMSA has determined that the existing CEMSIS data platform was not well suited for statewide sustainability and transition to the new NEMSIS version 3 data dictionary and future exploration of health information exchange. Consequently, EMSA has shifted data systems to allow for future growth through an agreement with the Inland Counties EMS Agency (ICEMA) to utilize Imagetrend as the State data system.
The Statewide goals for Data include:
- Transition to EMS Data Systems that are NEMSIS 3 compliant by December 31, 2014,
- Implementation of ePCR field collection systems, with “real time” data capability for electronic transmission,
- Transmission of ePCR data to the hospital emergency department in a “Dashboard” environment
- Integration of ePCR data directly into the hospital electronic health record, with a
- Bidirectional health information exchange
- Development of “real-time” patient tracking for daily and disaster usage
EMS Core Measures Task Force (Objective 4)
A task force was been convened to review the core measures and make recommendations. The task force consists of key data and quality leaders from local EMS agencies, medical directors, hospitals, and pre-hospital EMS providers.
The group made up of EMS responders, vendors, local EMS agency administrators and medical directors, as well as hospital representatives. During this grant year, the task force developed a core measures document consisting of 20 indicators, organized into 8 Core Measure sets to collect retrospective information from years 2009-2011 to compare performance from the Local EMS Agencies. Of these 20 measures, 17 were clinical and 3 were related to response and transport.
EMS Core Measures (Objective 5)
EMSA defined and published EMS Core Measures that described the coordination and effectiveness of EMS utilizing regional and local information. The Core measures document was completed and approved by the State Commission on EMS in March 2013. This document was incorporated in EMS guidelines as EMSA 166, Appendix E. As a result of this approval by the Commission, these EMS Core Measures are now required as part of the Quality Improvement regulations (CCR, Title 22, Division 9, Chapter 12).
It is anticipated that the proposed EMS system cores measures may be modified and future core measures added in the future.
Core Measures for California, EMSA 166, Appendix E [PDF]
NEMSIS Reporting (Objective 6)
CEMSIS data was submitted to the National EMS Information system initially in January 2013 to enable California data to be evaluated from a national perspective. EMSA worked with NEMSIS staff to prepare for data transmission. Test files were first submitted to ensure that there would be successful uploads. EMSA has determined that the existing CEMSIS data platform was not well suited for statewide sustainability and transition to the new NEMSIS version 3 data dictionary and future exploration of health information exchange. Consequently, EMSA has shifted data systems to allow for future growth.
EMS Core Quality Measures Workshops (Objective 7)
EMSA conducted three (3) workshops in February and March 2013 that trained approximately 150 key leaders, quality improvement coordinators, and data managers on the EMS Core Measures, quality improvement, and CEMSIS data collection.
EMS Core Measure Project Results (Project Goal)
Through the development of Core Measures, EMSA achieved reliable measures that are of high value and were relatively feasible to collect within a short period of time. However, there were limitations and barriers to collecting retrospective information pertaining to the measures.
Information was collected from local EMS agencies, by May 31, 2013, using retrospective data from 2009, 2010, 2011, and 2012 (when available). EMSA examined 20 Core Measures covering 8 Core measure sets. The available information is noted below.
Additionally, during the second phase of the Core Measure implementation, information from 2012 and 2013 will be collected by March 31, 2014 and posted in 2014. Beginning in data year 2014, the number of measures will be expanded to 28 measures. This third phase will allow for the prospective preparation and collection of data to meet the defined EMS core measures.