Taymour Rekar K, Abir Mahshid, Chamberlin Margaret, Dunne Robert B, Lowell Mark, Wahl Kathy, Scott Jacqueline
1RTI Health Solutions,Research Triangle Park,North CarolinaUSA.
2University of Michigan,Department of Emergency Medicine,Ann Arbor,MichiganUSA.
Prehosp Disaster Med. 2018 Feb;33(1):89-97. doi: 10.1017/S1049023X17007129. Epub 2018 Jan 2.
Introduction In a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care.
This systematic literature review and environmental scan addresses NAM's recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight?
To answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved.
A total of 58 peer-reviewed articles met inclusion criteria; 46 included process, 36 outcomes, and 18 structural measures. Most studies applied quality measures at the personnel level (40), followed by the agency (28) and system of care (28), and few at the oversight level (5). Numerous grey literature articles provided principles for high-quality EMS oversight.
Limited quality measurement at the oversight level is an important gap in the peer-reviewed literature. The grey literature is ahead in this realm and can guide the policy and research agenda for EMS oversight quality measurement. Taymour RK , Abir M , Chamberlin M , Dunne RB , Lowell M , Wahl K , Scott J . Policy, practice, and research agenda for Emergency Medical Services oversight: a systematic review and environmental scan. Prehosp Disaster Med. 2018;33(1):89-97.
引言 2015年，美国医学研究所（IOM；华盛顿特区），现更名为美国国家医学院（NAM；华盛顿特区），发布报告指出，紧急医疗服务（EMS）领域呈现出碎片化迹象；缺乏全系统的协调与规划；联邦、州和地方层面的问责制缺失。NAM建议明确联邦政府、州政府和地方社区在EMS系统绩效监督与评估中所扮演的角色，以及它们如何能更好地协同工作以改善医疗服务。
本系统文献综述和环境扫描通过回答两个研究问题来回应NAM的建议：（1）在同行评审文献和灰色文献中，EMS系统的哪些方面得到了最多的衡量？（2）这些衡量指标和研究对高质量的EMS监督有何启示？
为回答这些问题，在PubMed（美国国立卫生研究院国家生物技术信息中心；马里兰州贝塞斯达）、Web of Science（汤森路透；美国纽约）、SCOPUS（爱思唯尔；荷兰阿姆斯特丹）和EMBASE（爱思唯尔；荷兰阿姆斯特丹）数据库中进行了系统文献综述，以查找同行评审文献和灰色文献；对10个与EMS相关的政府机构和专业组织进行了有针对性的网络搜索。纳入标准要求同行评审文献发表于1966 - 2016年之间，灰色文献发表于1996 - 2016年之间。共审查了1476篇同行评审文献标题，检索了76篇进行全文评审，58篇被保留并使用主题编码本在美国加利福尼亚州曼哈顿海滩的定性软件Dedoose中进行编码。将测量类型和应用水平的分类分配给提取的数据。对有针对性的网站进行了系统审查，并检索了115份相关灰色文献文件。
共有58篇同行评审文章符合纳入标准；46篇包含过程指标，36篇包含结果指标，18篇包含结构指标。大多数研究在人员层面应用质量指标（40项），其次是机构层面（28项）和护理系统层面（28项），而在监督层面应用较少（5项）。众多灰色文献文章提供了高质量EMS监督的原则。
同行评审文献中监督层面的质量测量有限是一个重要差距。灰色文献在这一领域领先，可为EMS监督质量测量的政策和研究议程提供指导。Taymour RK、Abir M、Chamberlin M、Dunne RB、Lowell M、Wahl K、Scott J。紧急医疗服务监督的政策、实践和研究议程：系统综述和环境扫描。《院前与灾难医学》。2018；33(1):89 - 97。
Zotero 插件