James Cook University, Townsville, QLD, Australia.
Queensland University of Technology, Brisbane, Australia.
Australas Emerg Care. 2021 Jun;24(2):147-159. doi: 10.1016/j.auec.2020.10.002. Epub 2020 Nov 25.
Measuring the performance of air ambulance services are complex and dynamic due to the variability and interconnectedness of emergency systems. The aim of this study is to review the range and nature of air ambulance outcome measures published in peer review articles and construct a quality framework based on the results. A scoping review of the literature was conducted to identify outcome measures that evaluate the quality of air ambulance services. Combined frameworks from the Institutes of Medicine (IOM) and Dr. Avedia Donabedian were used to create a dashboard structure for a framework of air ambulance outcome measures.
A literature search strategy was undertaken, following PRISMA-ScR guidelines and included eight databases over the period 2001-2019. Qualitative content analysis was conducted in 4-phases: 1) table summary of selected article outcome measures, 2) content analysis themes, codes of outcome measures and independent variables 3) narrative description of main themes 4) visual dashboard diagram of service priorities and quality strategies, based on the findings.
Thirty-four articles were screened by full text and eighteen met the selection criteria. Twenty codes emerged and were grouped to form eight consistent outcome themes; asset/ team type, access to definitive interventions, prehospital factors, mortality, morbidity, responsiveness of service, accessibility of service and patient disposition.
A quality framework consisting of eight outcome measures was created, it also identified seven gaps which ordinarily require performance evaluation; patient comfort and satisfaction reporting, cultural awareness training, safety alarms in place to identify volume stress, optimal coordination of resources, cost of service analysis, comprehensive patient journey time and an adaptive referral system analysis. The measures in the framework provide a broad perspective of air ambulance performance we believe will help decision-making and planning to improve patients experience and outcomes.
由于应急系统的可变性和相互关联性，空中救护服务的绩效衡量非常复杂且具有动态性。本研究旨在回顾发表在同行评审文章中的空中救护结果衡量标准的范围和性质，并根据研究结果构建一个质量框架。对文献进行了范围审查，以确定评估空中救护服务质量的结果衡量标准。综合使用了美国医学研究所（IOM）和 Avedia Donabedian 博士的框架，为空中救护结果衡量标准构建了一个仪表板结构框架。
按照 PRISMA-ScR 指南进行了文献检索策略，包括在 2001 年至 2019 年期间对八个数据库进行了搜索。采用四阶段进行定性内容分析：1）选定文章结果衡量标准的表格摘要，2）内容分析主题、结果衡量标准和独立变量的代码，3）主要主题的叙述性描述，4）基于研究结果的服务优先级和质量策略的可视化仪表板图。
对 34 篇全文文章进行了筛选，18 篇符合选择标准。出现了 20 个代码，并被分组为 8 个一致的结果主题；资产/团队类型、获得明确干预措施的机会、院前因素、死亡率、发病率、服务响应能力、服务可及性和患者处置。
创建了一个由 8 项结果衡量标准组成的质量框架，还确定了通常需要绩效评估的七个差距；患者舒适度和满意度报告、文化意识培训、识别容量压力的安全警报、资源的最佳协调、服务成本分析、全面的患者旅程时间和适应性转诊系统分析。该框架中的措施提供了一个广泛的空中救护绩效视角，我们相信这将有助于决策和规划，以改善患者体验和结果。
