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Policy, Practice, and Research Agenda for Emergency Medical Services Oversight: A Systematic Review and Environmental Scan

Published online by Cambridge University Press:  02 January 2018

Rekar K. Taymour ,
Mahshid Abir ,
Margaret Chamberlin ,
Robert B. Dunne ,
Mark Lowell ,
Kathy Wahl  and
Jacqueline Scott
Rekar K. Taymour
Affiliation:
RTI Health Solutions, Research Triangle Park, North CarolinaUSA
Mahshid Abir*
Affiliation:
University of Michigan, Department of Emergency Medicine, Ann Arbor, MichiganUSA University of Michigan, Institute for Healthcare Policy and Innovation, Acute Care Research Unit, Ann Arbor, MichiganUSA RAND Corporation, Santa Monica, CaliforniaUSA
Margaret Chamberlin
Affiliation:
RAND Corporation, Santa Monica, CaliforniaUSA
Robert B. Dunne
Affiliation:
Detroit East Medical Control Authority, Detroit, MichiganUSA Wayne State University, Emergency Medicine, Detroit, MichiganUSA St. John Hospital and Medical Center, Detroit, MichiganUSA
Mark Lowell
Affiliation:
University of Michigan, Department of Emergency Medicine, Ann Arbor, MichiganUSA Michigan Medicine, Survival Flight, Ann Arbor, MichiganUSA
Kathy Wahl
Affiliation:
Michigan Department of Health and Human Services, Lansing, MichiganUSA
Jacqueline Scott
Affiliation:
Michigan Department of Health and Human Services, Lansing, MichiganUSA
*
Correspondence: Mahshid Abir, MD, MSc 2800 Plymouth Rd. North Campus Research Complex 014-G226 Ann Arbor, Michigan 48109 USA E-mail: [email protected]
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Abstract

Introduction

In a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care.

Objective

This systematic literature review and environmental scan addresses NAM’s recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight?

Methods

To answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved.

Results

A total of 58 peer-reviewed articles met inclusion criteria; 46 included process, 36 outcomes, and 18 structural measures. Most studies applied quality measures at the personnel level (40), followed by the agency (28) and system of care (28), and few at the oversight level (5). Numerous grey literature articles provided principles for high-quality EMS oversight.

Conclusions:

Limited quality measurement at the oversight level is an important gap in the peer-reviewed literature. The grey literature is ahead in this realm and can guide the policy and research agenda for EMS oversight quality measurement.

TaymourRK, AbirM, ChamberlinM, DunneRB, LowellM, WahlK, ScottJ. Policy, Practice, and Research Agenda for Emergency Medical Services Oversight: A Systematic Review and Environmental Scan. Prehosp Disaster Med. 2018;33(1):89–97.

Keywords

Emergency Medical Serviceshealth policyprehospital carequality measuressystematic review
Type
Comprehensive Reviews
Information
Prehospital and Disaster Medicine , Volume 33 , Issue 1 , February 2018 , pp. 89 - 97
Copyright
© World Association for Disaster and Emergency Medicine 2017 

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Footnotes

Conflicts of interest/funding: Funding received from the Michigan Department of Health and Human Services (Lansing, Michigan USA). Authors RT, MA, MC, RD, ML, KW, and JS report no conflicts of interest.

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