Whyte Brett S, Ansley Randall
Department of Emergency Medicine, Winona Health, Winona, Minnesota 55987, USA.
Prehosp Emerg Care. 2008 Oct-Dec;12(4):495-7. doi: 10.1080/10903120802290810.
To evaluate the effect of a system of financial reward for emergency medical technicians (EMTs) who meet selected quality marker goals.
This project was reviewed by an institutional review board (IRB) and was found to be exempt from IRB review. Two operational and four clinical markers were targeted for improvement. Baseline performance measurements were retrospectively measured for the preceding year, and challenging but achievable goals for improvement were established. Operational markers included completing run reports within three hours after completion of the run and call-to-en route ("out-of-chute") times of less than 90 seconds for emergency calls on our first-line ambulance. Clinical markers included the use of aspirin in adults with nontraumatic chest pain, electrocardiogram (ECG) performance in adults with nontraumatic chest pain, documentation of pain assessment and intervention in patients with traumatic hip pain, and documentation of the time of onset of symptoms in stroke calls. Each full-time EMT could earn up to $1,000 in addition to baseline pay, with part-time EMTs eligible for prorated amounts.
Postincentive run reports were completed within three hours 99.7% of the time, with 21 of 24 providers meeting the goal 100% of the time. Before the incentive, reports were completed within three hours 64% of the time, with only two of 23 providers meeting the goal 100% of the time. The out-of-chute goal of less than 90 seconds was met 98.7% of the time, compared with 90.1% before the incentive. Aspirin use in adult nontraumatic chest pain improved from 68% to 96.3%, and ECG performance in this group improved from 43% to 87.8%. Documentation of the time of onset of symptoms in stroke patients improved from 97% to 100%, and the assessment of and intervention for pain in traumatic hip pain patients improved from 56% to 100%.
Financial motivation improved targeted quality measures in this rural emergency medical service. It appears to be a useful adjuvant to traditional quality improvement mechanisms.
评估对达到选定质量指标目标的急救医疗技术人员（EMT）实施经济奖励制度的效果。
该项目经机构审查委员会（IRB）审查，被认定无需IRB审查。针对两个操作指标和四个临床指标进行改进。回顾性测量上一年的基线绩效指标，并设定具有挑战性但可实现的改进目标。操作指标包括在出诊结束后三小时内完成出诊报告，以及一线救护车接到紧急呼叫后从接到呼叫到出发（“出溜”）时间少于90秒。临床指标包括对非创伤性胸痛成人患者使用阿司匹林、非创伤性胸痛成人患者的心电图表现、创伤性髋部疼痛患者疼痛评估和干预的记录，以及中风呼叫中症状发作时间的记录。每位全职EMT除基本工资外最多可额外赚取1000美元，兼职EMT按比例领取相应金额。
激励措施实施后，99.7%的出诊报告在三小时内完成，24名工作人员中有21名100%的时间达到目标。在激励措施实施前，64%的报告在三小时内完成，23名工作人员中只有两名100%的时间达到目标。“出溜”时间少于90秒的目标实现率为98.7%，而激励措施实施前为90.1%。非创伤性胸痛成人患者阿司匹林的使用率从68%提高到96.3%，该组的心电图表现从43%提高到87.8%。中风患者症状发作时间的记录从97%提高到100%，创伤性髋部疼痛患者疼痛评估和干预从56%提高到100%。
经济激励改善了该农村急救医疗服务中的目标质量指标。它似乎是传统质量改进机制的有益辅助手段。
