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Long-term air medical services system performance using APACHE-II and mortality benchmarking.
Robert Silbergleit1, Richard E Burney, Kris Nelson
1University of Michigan Department of Emergency Medicine, UMMC TC, Ann Arbor 48109-0303, USA. robie@umich.edu
Prehospital Emergency Care
|April 25, 2003
Summary
Air medical transport services are seeing increased patient acuity and mortality over time. The APACHE-II scoring system effectively predicts mortality, offering a benchmark for evaluating air medical transport performance.
Area of Science:
- Emergency Medicine
- Healthcare Systems Analysis
- Transport Medicine
Background:
- Air medical transport programs have operated for two decades without established outcome measures.
- Characterizing the performance of these services is crucial for quality improvement.
Purpose of the Study:
- To examine severity scoring and mortality data from an air medical service over 15 years.
- To identify trends in patient acuity and mortality within air medical transport.
- To validate the use of severity scoring for benchmarking air medical services.
Main Methods:
- Analysis of APACHE-II scores and hospital mortality data from adult air transports (1986-2001).
- Examination of the correlation between APACHE-II scores at transport and subsequent hospital mortality.
- Statistical analysis of a 15-year dataset comprising 13,808 adult transports.
Main Results:
- Overall mortality was 22% across 10,845 analyzed transports.
- Both patient acuity (mean APACHE-II 11.6) and mortality showed an upward trend over the study period.
- A strong, linear correlation (R² = 0.97) was found between APACHE-II scores and mortality.
Conclusions:
- Patient severity and mortality in air medical transport are increasing, potentially due to healthcare system changes.
- APACHE-II scoring at transport is a validated method for benchmarking air medical service performance.
- The correlation slope serves as an outcome-based metric for monitoring and comparing air medical systems.