University of Illinois College of Medicine at Peoria, Surgery, One Illini Drive, Peoria, IL 61605, USA.
Prehosp Emerg Care. 2012 Oct-Dec;16(4):434-42. doi: 10.3109/10903127.2012.689928. Epub 2012 Jun 21.
Medical transport using helicopter emergency medical services (HEMS) has rapidly proliferated over the past decade. Because of issues of cost and safety, appropriate utilization is of increasing concern.
This study sought to describe the medical appropriateness of HEMS transports, using established guidelines, in a large national patient cohort.
A review was performed of all flights designated as inappropriate by a large national air medical company, Air Evac EMS Inc. (which operates Air Evac Lifeteam [AEL]), for the period from January 1, 2009, through December 31, 2009. Every flight was reviewed initially through a resource utilization process as well as a utilization review process. Medical appropriateness review criteria were derived from the Medicare Benefit Policy Manual and industry guidelines outlined by the Commission on Accreditation of Medical Transport Systems (CAMTS), Air Medical Physicians Association (AMPA) position papers, the Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (MMWR) Guidelines for Field Triage, and published clinical peer-reviewed articles, as well as previous interactions with Medicare contractors and reimbursement appeal decisions. Higher scrutiny was given to flights of <30 or >100 miles. Records indicating a possible inappropriate flight (i.e., review criteria were not satisfied, but special circumstances existed) were further reviewed by a senior quality assurance/quality improvement (QA/QI) nurse and/or senior medical director and were categorized.
During the study period, 27,697 flights were completed and reviewed, with 582 (2.1%) flights identified for further review by a senior QA/QI nurse and/or senior medical director. Of those, 367 (1.3%) were determined to be medically inappropriate flights. Inappropriate flights were most often on-scene flights (59.9%), were most often for adult patients (92.9%; median age 56.9 years; 25-75% interquartile range 42-75 years), and most often represented medical diagnoses (57.8%).
Based on established criteria, only 1.3% of total flights were determined to be inappropriate. This large national cohort demonstrated compliance with current industry standards.
在过去十年中，直升机紧急医疗服务（HEMS）的医疗转运迅速普及。由于成本和安全问题，其合理使用受到越来越多的关注。
本研究旨在使用既定标准，描述大型全国患者队列中 HEMS 转运的医学适宜性。
对一家大型空中医疗公司（Air Evac EMS Inc.，运营 Air Evac Lifeteam [AEL]）在 2009 年 1 月 1 日至 2009 年 12 月 31 日期间指定为不适当的所有航班进行了回顾。每一次飞行都通过资源利用过程和利用审查过程进行了初步审查。医疗适宜性审查标准源自医疗保险福利政策手册和由医疗运输系统认证委员会（CAMTS）、航空医疗医师协会（AMPA）立场文件、疾病控制和预防中心（CDC）发病率和死亡率周报（MMWR）指南制定的行业指南，以及发表的临床同行评议文章，以及与医疗保险承包商的先前互动和报销上诉决定。对距离 <30 或 >100 英里的航班进行了更严格的审查。记录表明可能存在不适当的航班（即，审查标准未得到满足，但存在特殊情况），由高级质量保证/质量改进（QA/QI）护士和/或高级医疗主任进行了进一步审查，并进行了分类。
在研究期间，完成并审查了 27697 次飞行，有 582 次（2.1%）飞行由高级 QA/QI 护士和/或高级医疗主任进一步审查。其中，367 次（1.3%）被确定为医学上不适当的航班。不适当的航班主要是现场航班（59.9%），主要是成人患者（92.9%；中位数年龄 56.9 岁；25-75%四分位间距 42-75 岁），主要代表医学诊断（57.8%）。
根据既定标准，只有 1.3%的总航班被确定为不适当。这个大型全国队列符合当前行业标准。
