Title: Developing new ways of measuring the impact of ambulance service care
Funder: Department of Health (England)

Abstract: Aims & Objectives The aim of the programme is to develop new ways of measuring the impact of care provided by the ambulance service to support quality improvement through monitoring, audit and service evaluation. The objectives are to: 1) Review and synthesise the research literature on pre-hospital care outcome measures and identify measures relevant to the NHS and patients for further development; 2) Create a dataset linking routinely collected pre-hospital data, hospital data and mortality data to provide outcome information; 3) Develop new ways of measuring process and outcome indicators including building risk adjustment models that predict the outcomes using the linked data; 4) Explore the practical use of the linked dataset and the risk adjustment models to measure the effectiveness and quality of ambulance service care and assess how they can be best used to support qualty improvement strategies. Background Pre-hospital care is provided by ambulance services who deliver a diverse range of services to over 6 million patients a year but there is limited evidence about the effectiveness of this care. Historically ambulance performance has been measured by response times rather than clinical need or effectiveness. Progress on developing more appropriate performance measures is constrained by a lack of information about what happens to patients and their outcome after the pre-hospital component of care. If ambulance service information about patients could be linked to process and outcome data further along the care pathway then relevant measurement tools could be developed that allow a better assessment of the impact of pre-hospital care. Research Plans The programme will be conducted in 4 linked stages; 1. Synthesis of evidence on outcome measures and identification of measures for further development - review and assessment of the evidence base on outcome measurement for pre-hospital care and a consensus study to identify measures relevant to patients and NHS staff. 2: Linking pre-hospital data with other patient data sources – creating a single dataset that links ambulance service electronic care records with routinely collected Hospital Episode Statistics (HES) and national mortality data. 3. Development of risk adjustment models for outcomes in patients attended by the ambulance service – using the linked data to develop risk adjustment tools that will allow patient differences to be taken into account and differences between expected and actual outcomes to be detected 4. Testing the risk adjustment models to assess if they can be used to measure effectiveness and quality – exploring the practical application of the measures by using them to assess if different ways of providing ambulance service care result in different consequences for patients and assessing the views of potential users about how they can best be implemented in the NHS. Research team An NHS and academic partnership with the broad and relevant expertise needed to support the programme of work. Members of the team have a strong track record of previous successful collaborations and current involvement in related research and ambulance policy development Research Environment The academic departments at Sheffield and Swansea are the leading UK centres for pre-hospital care research within the UK and have completed a number of NIHR funded projects in this area. The partner NHS ambulance services are already involved in related projects with the academic partners. Outputs, outcomes and impact - The programme will • Provide a summary of relevant evidence on pre-hospital care outcome measurement • Develop a method for linking healthcare information into a format that can be used to support quality improvement, is acceptable to patients and complies with information legislation • Develop population based models for measuring the impact of pre-hospital care that can be used to monitor quality and safety, evaluate new service innovations and support quality improvement • Provide added value by using routine information and NHS infrastructure to operationalise the process and outcome models so that they will be of use across the NHS Public Involvement Public involvement plays an important contribution to the programme. Both partner ambulance services have active user groups who have contributed to development of the programme. Users will be represented in the programme management arrangements and we will use a PPI reference group to support the programme. Ethical implications The main ethical implication is use of patient information. Understanding of these issues is included in the research plan and appropriate ethical and data management permissions will be sought. Justification for resources Costs take into account research team time, research staff salaries, public involvement support and direct costs such as travel, meetings and consumables.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;8.4 RESEARCH DESIGN AND METHODOLOGIES (HEALTH SERVICES)
Health categories: GENERIC HEALTH RELEVANCE