The Development of a Risk-Adjustment Strategy to Benchmark Emergency Medical Service (EMS) Performance in Relation to Out-of-Hospital Cardiac Arrest in Australia and New Zealand

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aut.relation.articlenumber109847
aut.relation.journalResuscitation
aut.relation.startpage109847
aut.relation.volume188
dc.contributor.authorHowell, Stuart
dc.contributor.authorSmith, Karen
dc.contributor.authorFinn, Judith
dc.contributor.authorCameron, Peter
dc.contributor.authorBall, Stephen
dc.contributor.authorBosley, Emma
dc.contributor.authorDoan, Tan
dc.contributor.authorDicker, Bridget
dc.contributor.authorFaddy, Steven
dc.contributor.authorNehme, Ziad
dc.contributor.authorSwain, Andy
dc.contributor.authorThorrowgood, Melanie
dc.contributor.authorThomas, Andrew
dc.contributor.authorPerillo, Samuel
dc.contributor.authorMcDermott, Mike
dc.contributor.authorSmith, Tony
dc.contributor.authorBray, Janet
dc.contributor.authorAus-ROC OHCA Epistry Management Committee
dc.date.accessioned2023-06-26T00:58:56Z
dc.date.available2023-06-26T00:58:56Z
dc.date.issued2023-05-19
dc.description.abstractINTRODUCTION: The aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. METHOD: Using 2017-2019 data from the Australasian Resuscitation Outcomes Consortium (Aus-ROC) OHCA Epistry, we included adults who received an EMS attempted resuscitation for a presumed medical OHCA. Logistic regression was applied to develop risk adjustment models for event survival (return of spontaneous circulation at hospital handover) and survival to hospital discharge/30 days. We examined potential effect modifiers, and assessed model discrimination and validity. RESULTS: Both OHCA survival outcome models included EMS agency and the Utstein variables (age, sex, location of arrest, witnessed arrest, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation prior to EMS arrival, and EMS response time). The model for event survival had good discrimination according to the concordance statistic (0.77) and explained 28% of the variation in survival. The corresponding figures for survival to hospital discharge/30 days were 0.87 and 49%. The addition of effect modifiers did little to improve the performance of either model. CONCLUSION: The development of risk adjustment models with good discrimination is an important step in benchmarking EMS performance for OHCA. The Utstein variables are important in risk-adjustment, but only explain a small proportion of the variation in survival. Further research is required to understand what factors contribute to the variation in survival between EMS.
dc.identifier.citationResuscitation, ISSN: 0300-9572 (Print); 1873-1570 (Online), Elsevier, 188, 109847-. doi: 10.1016/j.resuscitation.2023.109847
dc.identifier.doi10.1016/j.resuscitation.2023.109847
dc.identifier.issn0300-9572
dc.identifier.issn1873-1570
dc.identifier.urihttp://hdl.handle.net/10292/16319
dc.languageeng
dc.publisherElsevier
dc.relation.urihttps://www.sciencedirect.com/science/article/pii/S0300957223001600
dc.rights.accessrightsOpenAccess
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectEmergency medical services
dc.subjectHeart arrest
dc.subjectOut of hospital cardiac arrest
dc.subjectRegistries
dc.subjectResuscitation
dc.subjectAus-ROC OHCA Epistry Management Committee
dc.subject4203 Health Services and Systems
dc.subject32 Biomedical and Clinical Sciences
dc.subject3202 Clinical Sciences
dc.subject42 Health Sciences
dc.subjectHeart Disease
dc.subjectEmergency Care
dc.subjectCardiovascular
dc.subjectCardiovascular
dc.subject1103 Clinical Sciences
dc.subject1110 Nursing
dc.subject1117 Public Health and Health Services
dc.subjectEmergency & Critical Care Medicine
dc.subject3202 Clinical sciences
dc.subject4205 Nursing
dc.subject4206 Public health
dc.titleThe Development of a Risk-Adjustment Strategy to Benchmark Emergency Medical Service (EMS) Performance in Relation to Out-of-Hospital Cardiac Arrest in Australia and New Zealand
dc.typeJournal Article
pubs.elements-id507014
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