EMS Compass Steering Committee Meets in Washington

Experts in EMS and performance improvement gathered in Washington in August for the second in-person meeting of the EMS Compass Steering Committee. During the all-day session, committee members delved into the challenges of designing evidence-based performance measures that can be used to improve EMS systems of care.

Robert Bass, MD, Chair of the Steering Committee, began the meeting by reminding its members that “the goal of the project is not to develop a long set of measures,” but rather to “develop the process… [and] a core set of measures.”

Kedar Mate, a senior vice president with the Institute for Healthcare Improvement, reminded everyone that measurement, at its core, should be about improving care through learning and collaboration—not benchmarking systems in order to punish or reward performance.

“Measurement and the development of useful measures form a bedrock, a foundation on which collaborative learning occurs,” Mate said. “The measures form the way of communicating across systems.”

The Future of EMS Compass

The bulk of the discussion focused on that process, as members of the committee contemplated what level of evidence review was required before a measure could be finalized and how to make EMS Compass sustainable when the initial two-year initiative, funded by the National Highway Traffic Safety Administration (NHTSA) ends in 2016.

Daniel Spaite, MD, a veteran of several national EMS initiatives and a professor of emergency medicine at the University of Arizona, called on national EMS organizations to begin thinking about ways to sustain EMS Compass into the future.

“There are two ways these things live,” Spaite said. “One is real federal funding (NEMSIS is one example)… and then the other way is that the constituency national organizations care and buy in.”

Spaite and other members of the committee suggested that tying EMS Compass to national evidence-based guidelines would be a natural fit. After NHTSA funded the evidence-based guidelines (EBG) project, the final report recommended that a Prehospital Guideline Consortium be created to continue its work. Some members of the committee agreed that linking EMS Compass to the EBG project or using the consortium idea as a model might be good solutions for establishing a long-term process for designing and re-evaluating EMS performance measures.

Reaction to the First Measures

The Steering Committee members also discussed the performance measures that were up for public comment last month. They commended the work that had been done but also had a provocative and thoughtful discussion about whether EMS Compass should strive to produce ideal measures, which might use data (such as hospital outcomes) not available to most EMS systems, or measures that can be used by the majority of EMS systems today.

For example, stroke measure might assess what percentage of hospital-diagnosed stroke patients had a stroke scale documented by EMS providers who transported them. But without access to information from the hospital, EMS systems wouldn’t know which patients had strokes and which did not. So the vast majority of EMS systems could not use the measure today. Instead, they might look at whether a stroke scale was documented for patients whose EMS records indicated stroke as the primary impression—omitting patients who had strokes that went completely unrecognized by EMS.

This difference between what is the best measure available now, and what the best measure would be in an ideal system, was acknowledged by committee members as an issue they would have to address. One possibility would be to design both measures, with guidance that systems should use one or the other, depending on whether they have access to the right data. Members of the committee agreed, though, that having one measure with two options for what data to use was not the solution, as it would lead to confusion when systems compared their performance to state or national measures.

The EMS Compass working groups are currently revising the stroke measures and will be releasing them for further comment and testing. In addition, the Steering Committee directed the Measurement Design Group to begin working on measures in non-clinical domains.

“We want to make sure we get this process right, which is why the Steering Committee has some of the best minds from the worlds of EMS and performance measurement,” Bass said after the meeting. “The discussion we had today will only make the EMS Compass process better and lead to better performance measures—and therefore, better patient care, which is the goal of every EMS system.”

The EMS Compass Steering Committee meets again in Washington, DC in January 2016. Sign up below to receive EMS Compass updates, including details on how to attend the meeting in person or watch online.