title: Emergency Medical Services Outcomes Project (EMSOP) II: developing the foundation and conceptual models for out-of-hospital outcomes research.
abstract: Development of methodologically acceptable outcomes models for emergency medical services (EMS) is long overdue. In this article, the Emergency Medical Services Outcomes Project proposes a conceptual framework that will provide a foundation for future EMS outcomes research. The "Episode of Care Model" and the "Out-of-Hospital Unit of Service Model" are presented. The Episode of Care Model is useful in conditions in which interventions and outcomes, especially survival and major physiologic dysfunction, are linked in a time-dependent manner. Conditions such as severe trauma, anaphylaxis, airway obstruction, respiratory arrest, and nontraumatic cardiac arrest are amenable to this methodology. The Out-of-Hospital Unit of Service Model is essentially a subunit of the Episode of Care Model. It is valuable for evaluating conditions that have minimal-to-moderate therapeutic time dependency. This model should be used when studying outcomes limited to the out-of-hospital interval. An example of this is pain management for injuries sustained in motor vehicle crashes. These models can be applied to a wide spectrum of conditions and interventions. With the scrutiny of health care expenditures ever increasing, the identification of clinical interventions that objectively improve patient outcome takes on growing importance. Therefore, the development, dissemination, and use of meaningful methodologies for EMS outcomes research is key to the future of EMS system development and maintenance.
authors.affiliation: Arizona Emergency Medicine Research Center, Division of Emergency Medicine, The University of Arizona College of Medicine, Tucson, AZ, USA.
authors.forename: D W
authors.initials: DW
authors.lastname: Spaite
authors.forename: R
authors.initials: R
authors.lastname: Maio
authors.forename: H G
authors.initials: HG
authors.lastname: Garrison
authors.forename: J S
authors.initials: JS
authors.lastname: Desmond
authors.forename: M A
authors.initials: MA
authors.lastname: Gregor
authors.forename: I G
authors.initials: IG
authors.lastname: Stiell
authors.forename: C G
authors.initials: CG
authors.lastname: Cayten
authors.forename: J L
authors.initials: JL
authors.lastname: Chew
authors.forename: E J
authors.initials: EJ
authors.lastname: Mackenzie
authors.forename: D R
authors.initials: DR
authors.lastname: Miller
authors.forename: P J
authors.initials: PJ
authors.lastname: O'Malley
mesh_terms: D000359:Aftercare / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D017050:Episode of Care; D006292:Health Priorities; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D017146:Models, Organizational; D009017:Morbidity; D017063:Outcome Assessment, Health Care / Q000458:organization & administration*; D016730:Program Development / Q000379:methods*; D012107:Research Design / Q000592:standards*; D020379:Risk Adjustment / Q000458:organization & administration; D016019:Survival Analysis; D013997:Time Factors; D014481:United States / Q000453:epidemiology