PORTAL: Patient Outcome Reporting Tool for emergency medicAL services

摘要 每年有近2800万辆院前紧急医疗服务(EMS)救护车为患者提供服务 有心血管急症。美国心脏协会认识到EMS在产业链中的价值 然而，包括EMS在内的EMS需要在多个 组织。通常，院前提供者不知道他们自己的实践模式和患者结果 在不经意间加强次优护理的同时，浪费了宝贵的经验学习机会。 提供对临床实践和患者结果的反馈是一种简单而有效的干预措施，它具有 在规模方面一直具有挑战性。我们将运用人因工程原则(以用户为中心的设计)来开发， 改进并实现一个可伸缩的反馈系统，我们称之为“门户”。门户使用自动审核和 反馈、非财务激励和当地冠军企业通过以下方式检查对提供商行为的影响 符合指南的护理在心血管急诊环境中的表现。 此应用程序描述了一种混合方法提案，解决了NHLBI的主要优先事项，以改善患者 通过为EMS提供者开发和完善门户反馈系统来实现健康 胸痛患者的急性心血管急救护理。具体目标是：1)考查 EMS供应商和利益相关方遵守指南的决定因素；2)改进视觉界面 通过以用户为中心的设计提供自动化的EMS反馈；以及3)研究可行性并完善 实施门户干预，以支持随后的试验，测试 反馈干预。 该团队是唯一有资格实现这些目标的团队，拥有护理过渡、医疗保健等方面的专业知识 运筹学、生物医学信息学、人因工程学、实施学、实用学 试验设计、定性方法和急性护理医学。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)，相关研究领域的国家排名的研究生课程；以及国家CTSA 协调中心。 这个应用程序将为院前提供者开发一个自动反馈系统，用于治疗患有 疑似心血管急症。采取以用户为中心的方法，将EMS提供商放在 设计流程的中心将大大提高通过以下方式增强提供商活动的能力 使用提供商和利益相关者的意见提供可扩展的反馈。积极推进院前接生 提供者反馈创建了一种机制，通过 加强了对指南合规护理的接受。我们提出这项工作是为了准备一个随机化的集群 试验评估对提供者行为和患者结果的影响。

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.