title: Emergency Medical Services Outcomes Project III (EMSOP III): the role of risk adjustment in out-of-hospital outcomes research.
abstract: The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. Fundamental to that purpose is the identification of priority conditions, risk-adjustment measures (RAMs), and outcome measures. In this third EMSOP article, we examine the topic of risk adjustment, discuss the relevance of risk adjustment for out-of-hospital outcomes research, and recommend RAMs that should be evaluated for potential use in emergency medical services (EMS) research. Risk adjustment allows better judgment about the effectiveness and quality of alternative therapies; it fosters a better comparison of potentially dissimilar groups of patients. By measuring RAMs, researchers account for an important source of variation in their studies. Core RAMs are those measures that might be necessary for out-of-hospital outcomes research involving any EMS condition. Potential core RAMs that should be evaluated for their feasibility, validity, and utility in out-of-hospital research include patient age and sex, race and ethnicity, vital signs, level of responsiveness, Glasgow Coma Scale, standardized time intervals, and EMS provider impression of the presenting condition. Potential core RAMs that could be obtained through linkage to other data sources and that should be evaluated for their feasibility, validity, and utility include principal diagnosis and patient comorbidity. We recommend that these potential core RAMs be systematically evaluated for use in risk adjustment of out-of-hospital patient groups that might be used for outcomes research
authors.affiliation: Department of Emergency Medicine, The Brody School of Medicine at East Carolina University, Greenville, NC 27858-4354, USA. hgarriso@pcmh.com
authors.forename: Herbert G
authors.initials: HG
authors.lastname: Garrison
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Maio
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Spaite
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Desmond
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Gregor
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: O'Malley
authors.forename: Ian G
authors.initials: IG
authors.lastname: Stiell
authors.forename: C Gene
authors.initials: CG
authors.lastname: Cayten
authors.forename: John L
authors.initials: JL
authors.lastname: Chew
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: Mackenzie
authors.forename: David R
authors.initials: DR
authors.lastname: Miller
mesh_terms: D000328:Adult; D002648:Child; D003625:Data Collection / Q000379:methods; D004282:Documentation / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D015203:Reproducibility of Results; D020379:Risk Adjustment / Q000379:methods*; D014481:United States