Abstract
ABSTRACTOBJECTIVE To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition.METHODS The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included.RESULTS The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: −0.0816 – −0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: −4.3293 – −1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of −0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: −0.1060 – −0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series.CONCLUSIONS Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.
Highlights
Prehospital emergency care has been increasingly relevant in our society, because of the need to structure emergency care, ensuring a shorter response time and better regulation of care flows
This study used interrupted time series to evaluate the effectiveness of the mobile emergency medical services on the hospital mortality rate by myocardial infarction in a region of Brazil. This is an ecological study with interrupted time series analysis, considered one of the most effective quasi-experimental designs to evaluate the longitudinal effect of interventions[10,11]
The statistical analysis empirically tested the hypothesis of significant reduction in the trend and level of the hospital mortality rate by myocardial infarction (MI) in adults older than 40 years after the implementation of prehospital emergency care that took place in 2004
Summary
Prehospital emergency care has been increasingly relevant in our society, because of the need to structure emergency care, ensuring a shorter response time and better regulation of care flows. Inspired by the French model, but with features of the American model, its main objectives are to reduce the number of deaths, length of hospitalization, and sequelae resulting from the lack of timely care. It is operated by the emergency regulation demanded by the user, and the conduct can take place by telephone or by dispatch of basic or advanced life support teams, for the severe cases that require a more complex intervention[2,3]. Some authors involved in this topic in Brazil emphasize that SAMU promotes, in addition to the prehospital start of treatment at the site of the event, the immediate removal of the patient to the tertiary center, when indicated by protocol based on the best evidence[7,8]
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