PORTAL: Patient Outcome Reporting Tool for emergency medicAL services

摘要 每年为患者提供近2800万次院前紧急医疗服务（EMS）救护车 心血管急症美国心脏协会承认EMS在供应链中的价值 然而，包括EMS需要在多个 组织的通常，院前提供者不知道他们自己的实践模式和病人的结果 浪费了从经验中学习的宝贵机会，同时无意中加强了次优护理。 提供临床实践和患者结局的反馈是一种简单有效的干预措施， 在规模上是很有挑战性的。我们将使用人因工程原理（以用户为中心的设计）来开发， 完善并实现一个可扩展的反馈系统，我们称之为“门户”。PORTAL使用自动审计， 反馈、非财务激励和当地支持者，通过以下方式研究对供应商行为的影响： 在心血管急症中遵循指南的护理表现。 本申请描述了一种混合方法提案，该提案解决了NHLBI的主要优先事项，以改善患者 通过开发和完善门户反馈系统，为EMS供应商提供 急性心血管胸痛患者的急救护理。具体目标是：（1）检查 环境管理系统供应商和利益相关者遵守准则的决定因素; 2）完善视觉界面 通过以用户为中心的设计进行自动化EMS反馈;以及3）研究可行性并改进 实施门户干预，以支持随后的试验， 反馈干预 该团队具有独特的资格来实现这些目标，拥有护理过渡、医疗保健方面的专业知识 运筹学，生物医学信息学，人因工程，实施科学，实用主义 试验设计、定性方法和急性护理药物。范德比尔特的制度环境 大学医学中心是杰出的，包括临床质量和实施中心 研究（CCQIR），在研究的相关领域的国家排名研究生课程;和国家CTSA 协调中心。 该应用程序将开发一个自动反馈系统，用于院前提供者治疗以下患者： 疑似心血管急症采取以用户为中心的方法，将EMS供应商置于 设计过程的中心将大大提高通过以下方式增强供应商活动的能力： 利用提供者和利益相关者的投入提供可扩展的反馈。推进院前急救 提供者反馈创建了一种机制，通过以下方式提高院前护理的质量和安全性： 加强对符合准则的护理的接受。我们提出这项工作的准备集群随机 评估对提供者行为和患者结果的影响的试验。

ABSTRACT Nearly 28 million prehospital emergency medical services (EMS) ambulances runs occur annually for patients with cardiovascular emergencies. The American Heart Association recognizes the value of EMS in the Chain of Survival yet the inclusion of EMS necessitates logistically challenging communication amongst multiple organizations. Often, prehospital providers are unaware of their own practice patterns and patient outcomes wasting valuable opportunities to learn from experience while inadvertently reinforcing suboptimal care. Providing feedback on clinical practice and patient outcomes is a simple and effective intervention that has been challenging to scale. We will use human factors engineering principles (user-centered design) to develop, refine, and implement a scalable feedback system we call “PORTAL.” PORTAL uses automated audit and feedback, non-financial incentives, and local champions to examine the impact on provider behavior through the performance of guideline compliant care in the setting of cardiovascular emergencies. This application describes a mixed-methods proposal that addresses major NHLBI priorities to improve patient health through the development and refinement of the PORTAL feedback system for EMS providers delivering acute cardiovascular emergency care to patients with chest pain. The Specific Aims are: 1) Examine the determinants of guideline compliance amongst EMS providers and stakeholders; 2) Refine the visual interface for automated EMS feedback through user-centered design; and 3) Examine the feasibility and refine the implementation of the PORTAL intervention to support a subsequent trial testing the effectiveness of the feedback intervention. The team is uniquely qualified to accomplish these Aims, with expertise in care transitions, healthcare operations research, biomedical informatics, human factors engineering, implementation science, pragmatic trial design, qualitative methods, and acute care medicine. The institutional environment at Vanderbilt University Medical Center is outstanding, including the Center for Clinical Quality and Implementation Research (CCQIR), nationally ranked graduate programs in the relevant fields of study; and the national CTSA coordinating center. This application will develop an automated feedback system for prehospital providers treating patients with suspected cardiovascular emergencies. Taking a user-centered approach by placing the EMS provider at the center of the design process will substantially advance the ability to enhance provider activities through the delivery of scalable feedback using provider and stakeholder input. Advancing the delivery of prehospital provider feedback creates a mechanism to improve the quality and safety of prehospital care through the enhanced uptake of guideline compliant care. We propose this work in preparation for a cluster randomized trial evaluating the impact on provider behavior and patient outcomes.