Center for Data Solutions, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida.
Department of Emergency Medicine, University of Florida College of Medicine - Jacksonville, Jacksonville, Florida.
Prehosp Emerg Care. 2024;28(2):381-389. doi: 10.1080/10903127.2023.2177365. Epub 2023 Mar 1.
Prehospital research and evidence-based guidelines (EBGs) have grown in recent decades, yet there is still a paucity of prehospital implementation research. While recent studies have revealed EMS agency leadership perspectives on implementation, the important perspectives and opinions of frontline EMS clinicians regarding implementation have yet to be explored in a systematic approach. The objective of this study was to measure the preferences of EMS clinicians for the process of EBG implementation and whether current agency practices align with those preferences.
This study was a cross-sectional survey of National Registry of Emergency Medical Technicians registrants. Eligible participants were certified paramedics who were actively practicing EMS clinicians. The survey contained discrete choice experiments (DCEs) for three EBG implementation scenarios and questions about rank order preferences for various aspects of the implementation process. For the DCEs, we used multinomial logistic regression to analyze the implementation preference choices of EMS clinicians, and latent class analysis to classify respondents into groups by their preferences.
A total of 183 respondents completed the survey. Respondents had a median age of 39 years, were 74.9% male, 89.6% White, and 93.4% of non-Hispanic ethnicity. For all three DCE scenarios, respondents were significantly more likely to choose options with hospital feedback and individual-level feedback from EMS agencies. Respondents were significantly less likely to choose options with email/online only education, no feedback from hospitals, and no EMS agency feedback to clinicians. In general, respondents' preferences favored classroom-based training over in-person simulation. For all DCE questions, most respondents (66.2%-77.1%) preferred their survey DCE choice to their agency's current implementation practices. In the rank order preferences, most participants selected "knowledge of the underlying evidence behind the change" as the most important component of the process of implementation.
In this study of EMS clinicians' implementation preferences using DCEs, respondents preferred in-person education, feedback on hospital outcomes, and feedback on their individual performance. However, current practice at EMS agencies rarely matched those expressed EMS clinician preferences. Collectively, these results present opportunities for improving EMS implementation from the EMS clinician perspective.
在最近几十年中，院前研究和循证指南（EBG）有了长足的发展，但仍缺乏院前实施研究。尽管最近的研究揭示了 EMS 机构领导层对实施的看法，但尚未以系统的方法探讨一线 EMS 临床医生对实施的重要看法和意见。本研究的目的是衡量 EMS 临床医生对 EBG 实施过程的偏好，以及当前机构实践是否符合这些偏好。
这是一项针对国家紧急医疗技术员注册处注册人员的横断面调查。合格的参与者是正在积极从事 EMS 临床工作的认证护理人员。该调查包含了三个 EBG 实施场景的离散选择实验（DCE）和关于实施过程各个方面的优先排序偏好的问题。对于 DCE，我们使用多项逻辑回归来分析 EMS 临床医生的实施偏好选择，并使用潜在类别分析根据他们的偏好对受访者进行分类。
共有 183 名受访者完成了调查。受访者的中位年龄为 39 岁，74.9%为男性，89.6%为白人，93.4%为非西班牙裔。对于所有三个 DCE 场景，受访者更有可能选择有医院反馈和 EMS 机构提供个人反馈的选项。受访者不太可能选择仅通过电子邮件/在线进行教育、没有来自医院的反馈以及没有 EMS 机构反馈给临床医生的选项。总的来说，受访者的偏好倾向于课堂培训而不是面对面模拟。对于所有 DCE 问题，大多数受访者（66.2%-77.1%）更喜欢他们的调查 DCE 选择而不是他们机构目前的实施实践。在优先排序偏好中，大多数参与者选择“了解变革背后的基本证据”作为实施过程中最重要的组成部分。
在这项使用 DCE 研究 EMS 临床医生实施偏好的研究中，受访者更喜欢面对面教育、医院结果反馈和个人绩效反馈。然而，EMS 机构的当前实践很少符合 EMS 临床医生表达的偏好。总的来说，这些结果为从 EMS 临床医生的角度改进 EMS 实施提供了机会。
