Voll Nicole, Gettel Cameron, Li Shu-Xia, Qin Li, Li Yixin, Attanasio Sarah, Epshtein Isabella, Nichols Marvin, Lilly Alexis, Quinton Jacob, Bernheim Susannah, Stiles Hannah, Murugiah Karthik, Mann N Clay, Venkatesh Arjun
Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation, (YNHHSC/CORE), New Haven, Connecticut.
Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut.
Prehosp Emerg Care. 2025 Jul 31:1-8. doi: 10.1080/10903127.2025.2535574.
In general, Medicare pays for emergency ground ambulance services when a patient is transported to the nearest emergency department (ED) or other select facilities. As state and local agencies strive to provide high quality person-centered emergency care in locations outside the ED, there is a need for a reliable and valid prehospital quality measure to ensure patient safety. The Centers for Medicare and Medicaid Innovation Center's Emergency Triage, Treat and Transport (ET3) Model created a unique opportunity to develop a quality measure for ambulance organizations to measure safe and effective prehospital care. Our objective was to develop and validate the Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure.
The measure was developed using 2021-2023 Medicare Part B fee-for-service administrative and claims data from 67 ambulance organizations that participated in the ET3 Model, triaging patients using predetermined clinical protocols. The measure cohort included patients that were either transported to an alternative destination (TAD), such as urgent care, or provided treatment in place (TIP). The measure outcome was met if the patient subsequently had an ED visit or died within three days of a TAD/TIP encounter, as an inverse measure, lower is better. We calculated a risk-adjusted measure score using a hierarchical generalized linear model approach, adjusting for patient-level variables and calculating model and measure performance. Finally, we assessed measure face validity and construct validity. To ensure measure reliability, some results were examined using a minimum case threshold of 20 TAD/TIP encounters by each ambulance organization.
Among the 22 ambulance organizations that met the minimum case volume threshold, the mean, SD measure score was 20.3 (5.3), ranging from 11.6 to 35.4. The mean (SD) reliability signal-to-noise ratio was 0.791 (0.124). Nine of 11 (82%) members of an interested party consensus group provided a positive vote of face validity. Construct validity was demonstrated by identifying an anticipated negative correlation with three relevant prehospital measures.
The Risk Adjusted Post-Ambulance Provider Triage ED Visit Rate Measure is a reliable and valid measure that fills a critical gap in assessing patient safety in prehospital care in the United States.
一般来说，当患者被转运至最近的急诊科（ED）或其他特定医疗机构时，医疗保险会支付地面急救救护车服务费用。随着州和地方机构努力在急诊科以外的地点提供高质量的以患者为中心的急救护理，需要一种可靠且有效的院前质量指标来确保患者安全。医疗保险和医疗补助服务中心创新中心的紧急分诊、治疗和转运（ET3）模式创造了一个独特的机会，可为救护车组织制定一项质量指标，以衡量安全有效的院前护理。我们的目标是开发并验证风险调整后的救护车提供者分诊后急诊就诊率指标。
该指标是利用2021 - 2023年医疗保险B部分按服务收费的行政和索赔数据开发的，这些数据来自67个参与ET3模式的救护车组织，这些组织使用预定的临床方案对患者进行分诊。该指标队列包括被转运至替代目的地（TAD）（如紧急护理机构）或就地接受治疗（TIP）的患者。如果患者在TAD/TIP接触后的三天内随后前往急诊科就诊或死亡，则该指标达标，作为一项反向指标，数值越低越好。我们使用分层广义线性模型方法计算了风险调整后的指标得分，对患者层面的变量进行了调整，并计算了模型和指标的性能。最后，我们评估了指标的表面效度和结构效度。为确保指标的可靠性，我们使用每个救护车组织20次TAD/TIP接触的最低病例阈值对一些结果进行了检验。
在达到最低病例量阈值的22个救护车组织中，指标得分的均值、标准差为20.3（5.3），范围为11.6至35.4。可靠性信噪比的均值（标准差）为0.791（0.124）。利益相关方共识小组的11名成员中有9名（82%）对表面效度投了赞成票。通过确定与三项相关院前指标的预期负相关关系，证明了结构效度。
风险调整后的救护车提供者分诊后急诊就诊率指标是一项可靠且有效的指标，填补了美国院前护理中评估患者安全的关键空白。
