EMSC Performance Measures The Federal Perspective

1
EMSC Performance MeasuresThe Federal Perspective

• Summit at the Lake
• Coeur dAlene
• May 22, 2008
• Tasmeen Singh, MPH, NREMTP
• Director
• EMSC Naational Resource Center

2
Objectives

• Describe the need and process for performance
  measures
• Describe the current performance measures
• Describe the experience to date with the
  performance measures

3
Government Performance and Results Act (GPRA) of
1993

• . . . chart a course for every endeavor that we
  take the people's money for, see how well we are
  progressing, tell the public how we are doing,
  stop the things that don't work, and never stop
  improving the things that we think are worth
  investing in.
• President William J. Clinton, on signing the GPRA

4
Development Process

• The process for developing and selecting
  performance measures for the EMSC Program
  involved four main steps
• Reviewing documentation to identify a universal
  set of potential measures
• Narrowing the universal set to a working set of
  measures
• Convening of an EMSC Consensus Meeting to select
  a core set of measures
• Convening of workgroups to refine the core set of
  measures

5
Development Process

• Draft of 71 measures were reduced to 3 measures
  (with sub-measures that total 10).
• Beta testing in
• Colorado
• New Hampshire
• Illinois
• Implementation manual to all States in 2006.

6
Performance Measures

• 66 By 2011, The State/Territory has ensured the
  operational capacity to provide pediatric
  emergency care.
• 66aprovision of online and offline medical
  direction for BLS and ALS providers
• 66bavailability of pediatric equipment on BLS
  and ALS patient care units
• 66cstate-wide recognition system for hospitals
  capable of dealing with pediatric emergencies
• 66davailability of interfacility transfer
  guidelines at hospitals
• 66eavailability of interfacility transfer
  agreements at hospitals

7
Performance Measures

• PM 67 requirements for recertification of EMTs
  and paramedics
• PM68 institutionalization of EMSC within State
• 68aestablishment of an advisory committee
• 68bpediatric representation on EMS board
• 68cfull time EMSC Manager
• 68dintegration of EMSC priorities into rules and
  regulations

8
State Requirements

• 2006-2007 Data collection
• Identify whether EMS providers have access to
  online pediatric medical direction
• Identify whether EMS providers have access to
  offline medical direction (protocols)
• Identify whether ambulances had required
  equipment (as identified by 1996 ACEP list)
• Identify hospitals that have interfacility
  hospital agreements and guidelines
• Advisory committee
• Establish an advisory committee with 14 required
  members
• Have advisory committee meet 4 times a year

9
First Year Experience
10
First Year Experience

• December/January 2007 NRC and NEDARC separate
  technical assistance assessments
• Many States had not begun data collection
• Problems with implementation manual
• Turnover in EMSC Managers
• July 2006 data assessment
• Many states report meeting 2011 target
• Majority of States did not use an approved data
  collection method due to vagueness of
  implementation manual
• Some States mis-analyzed data
• Letters sent by program to all grantees

11
First Year ExperienceGrantee Feedback

• Implementation manual not clear
• Data collection onerous
• Measures not relevant to some States
• Some have already met measures
• Some can never meet the measure
• Measures do not address certain aspects of State
  system
• NRC/NEDARC not helpful

12
Response to Feedback

• Revised implementation manual 4 month roll out
  with letter describing changes
• 3 conference calls to get grantee feedback
• Requirement that all grantees work with NEDARC
• Exemption from data collection
• 3 conference calls to roll out final manual
• Enhanced technical assistance
• Monthly calls to States from NRC
• Joint phone calls with NRC/NEDARC and States
• Joint NRC/NEDARC site visits to States
• Revision to data collection requirement

13
Results of Changes

• States were challenged with mid-stream changes
• Confusion on what to do if they already started
  collecting data
• States worried about what happens if they dont
  meet measures
• More contact with NRC/NEDARC
• NRC had over 200 contacts a MONTH with SP
  grantees
• NEDARC helped 14 States with data collection in
  year one and 51 States in year two

14
Lessons Learned

• We have to be clear on what we want

15
Lessons Learned

• We need to give States the ability to continue
  some activities that are important to them
• We need to give States time to make system
  changes not just collect data
• We need to educate and train new EMSC managers
  one on one
• Hospital measures difficult for EMS based
  grantees

16
Lessons Learned

• We have to be consistent and clear in our message
• We have to allow tweaking when the data shows we
  didnt get what we needed

17
Lessons Learned

• We have to convene a group of grantees to tell us
  what can be done for 115,000

18
Performance Measures Advisory CommitteePMAC

• PMAC seated to provide recommendations to Federal
  program
• 18 members
• 10 EMSC managers
• 3 EMS administrators/directors
• 4 physicians
• 1 family representative
• Mix of new and experienced managers
• Mix of large, medium, small States and 1
  Territory
• Geographical mix
• Opportunity for all grantees to provide feedback
  at June annual meeting

19
Continued Challenges

• Diverse EMS system capacities
• Lack of resources in EMS systems to make
  improvements
• EMSC grantee resources
• State needs and priorities

20
Opportunities

• Provide feedback for current measures
• Development process for 2011 performance measure
  is starting now. Opportunity to provide feedback
  to NRC.
• States can beta test future measures

21
Thank you!

• Contact
• Tasmeen Singh
• 202-476-6866
• tsingh_at_cnmc.org