Research regarding Emergency medical services systems design is inadequate and is largely focused on individual components or patient conditions (e.g., cardiac arrest) rather than on an interconnected system designed to serve the patient. In addition, patient demand has expanded from life-threatening illness and injury to include general medicine, which current Emergency medical services Systems (EMSSs) are not designed to serve. The purpose of this research was to examine the individual, organizational, and system obstacles to developing a more patient-centric EMSS design.
Fifteen factors potentially associated with patient-centric EMSSs were identified from clinical and systems literature. Using a multi-case study, five United States EMSSs, representing five major design models (fire department, hospital, private organization, public/third-service department, and public utility model), were studied. Data collection included four sources of evidence: (a) data metrics, (b) document review, (c) interviews (n=11), and (d) archival records. Data analysis involved coding 582 independent obstacles into 38 distinct categories and using a Pareto distribution to identify the leading obstacles to each patient-centric feature. Fifty percent of interview transcripts were externally reviewed for reliability. Results were presented in written narrative and displayed in Pareto charts.
The top five categories, representing 33.5% of the total obstacles identified, were cost/funding, data measurement, process/outcome focus, systems view/design, and public information/education. Six recommendations resulted from the findings, including quantifying a reasonable cost, changing the funding model, developing an EMS research consortium, initiating data measurement to improve, integrating quality improvement as an operational strategy, and documenting and sharing learning on practices that work and do not work.
This inquiry provided new insight into the current state of EMSS design, how it aligns with patient-centric factors, and what obstacles exist for medical directors, operational leaders, and policy makers in positions to transform future EMSS design and operations. The obstacles identified provide information for additional EMSS research and the results will further the vision of creating a more patient-centric EMSS design that better serves patients through prevention, reduction of morbidity and mortality, and facilitating access to the most appropriate care.
|Advisor:||Adams, John D.|
|Commitee:||Southern, Nancy L., Walton, Douglas|
|School Location:||United States -- California|
|Source:||DAI-B 71/10, Dissertation Abstracts International|
|Subjects:||Public health, Health care management, Systems science|
|Keywords:||Ambulances, Emergency medical services, Health care systems, Paramedics, Patient-centered|
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