Systematic review of pre-hospital outcomes for evidence-based evaluation of ambulance service care

Abstract

Background: Ambulance service performance measurement has previously focused on response times and survival (particularly from out-of-hospital cardiac arrest). The PhOEBE (Pre-hospital Outcomes for Evidence Based Evaluation) project is a 5-year research programme which aims to develop new ways of measuring the performance, quality and impact of ambulance service care. As part of this programme we conducted a systematic review of the international literature on quality measures and outcomes relating to pre-hospital ambulance service care, aiming to identify a broad range of outcome measures to provide a more meaningful assessment of ambulance service care. Methods: We searched a number of electronic databases including CINAHL, the Cochrane Library, EMBASE, Medline, and Web of Science. For inclusion, studies had to report either research or evaluation conducted in a pre-hospital setting and published in the English language from 1982 to 2011, reporting either outcome measures or specific outcome instruments. Results: Overall, 181 full-text articles were included: 83 (46%) studies from North America, 50 (28%) from Europe and 21 (12%) from the United Kingdom. Initially, 176 articles were included after examining 257 full-text articles from 5,088 abstracts screened. A further five papers were subsequently identified from references of the articles examined and studies known to the authors. There were 140 articles (77%) which contained at least one survival-related measure, while 47 (26%) included information about length of stay and 87 (48%) identified at least one place of discharge as an outcome. Conclusion: In addition to measures relating to survival, length of stay and place of discharge, we identified over 100 additional outcome measures. Few studies included patient reported outcomes or economic outcomes. By identifying a range of outcome measures, this review will inform the use of a greater range of outcome measures and development of new outcome measures in pre-hospital research and quality improvement.