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Creating an infrastructure for comparative effectiveness research in emergency medical services
Christopher W Seymour1, Jeremy M Kahn, Christian Martin-Gill
1The Department of Critical Care and Emergency Medicine, University of Pittsburgh School of Medicine (CWS), Pittsburgh, PA; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, PA.
Summary
A new infrastructure linked emergency medical services (EMS) records with hospital data, enabling research into long-term patient outcomes. This approach improves prehospital care by overcoming data silos and engaging stakeholders.
Area of Science:
- Prehospital Care Research
- Health Services Research
- Comparative Effectiveness
Background:
- Emergency medical services (EMS) providers offer critical initial care, yet research to improve prehospital care is limited by data silos, lack of long-term outcomes, and insufficient stakeholder involvement.
- The Institute of Medicine highlighted these deficits as major barriers to advancing prehospital medical care.
Purpose of the Study:
- To describe a regional initiative in southwestern Pennsylvania to establish a high-performing research infrastructure for prehospital care.
- To address identified barriers including data silos, lack of long-term patient outcomes, and limited stakeholder engagement in research.
Main Methods:
- Linked regional EMS records from 33 agencies with hospital-based electronic health records (EHRs) from a nine-hospital system.
- Incorporated community stakeholder engagement to guide research questions and included a 2-year follow-up for patient-centered outcomes.
- Manually reviewed record matches for accuracy.
Main Results:
- Over 95% of EMS records were successfully linked to hospital EHRs.
- More than 80% of records were linked to 2-year mortality data.
- Prehospital hypotension and respiratory distress were associated with higher 2-year mortality rates compared to chest pain or nonspecific complaints.
Conclusions:
- A feasible prehospital comparative effectiveness research infrastructure integrating EMS data, EHRs, long-term outcomes, and stakeholder perspectives can be established.
- This model is potentially scalable to larger regions and networks, offering a roadmap for future prehospital care research.
- Lessons learned and identified barriers provide valuable insights for addressing community and policy-relevant research questions in prehospital settings.