The Rising Tide Lifts All Boats: Using the Ground and Air Medical qUality in Transport (GAMUT) Database as a Tool for Quality Improvement

Abstract

Introduction The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality database to track critical care transport (CCT) performance for a discrete set of quality metrics on a monthly basis. Benchmark performance feedback reports are available for programs to allow comparison. We sought to describe the impact of GAMUT participation as determined by quality metric measurement over time. Methods To provide an estimate of the impact of GAMUT reporting feedback over the entire reporting period (Jan 2014 - Dec 2017), data from each institution that provided complete data for the study period were aggregated. Evaluations focused on 4 exemplar quality metrics: blood glucose measurement in patients with altered mental status, first attempt intubation success, confirmation of tracheal tube placement, and mechanical ventilation utilization. The slopes of the yearly metric values were determined by linear regression modeling to estimate the annual rate of improvement. To better isolate the effects of GAMUT feedback from the learning associated with evolving processes, a before-and-after approach was employed. The initial metric values were determined prior to GAMUT reporting feedback and then again one year later after GAMUT feedback. The one year period with +/- 3 month window was chosen to minimize any potential seasonality in the data. A two factor ANOVA model was then employed with fixed effects for year, to take into account natural process evolution, and an indicator of whether the data was before or after GAMUT feedback. Estimated marginal means with 95% confidence intervals were displayed for each metric for the before and after GAMUT feedback study groups. Results The annual growth rates as determined by the cohort (N=23 institutions) reporting over the entire GAMUT reporting period for blood glucose measurement increased by 1.8%; first attempt intubation rates increased by 4.8% annually; tracheal tube place checks increased by 0.1% annually; mechanical ventilation of advanced airways increased by 2.5% annually. The 1-year impact of GAMUT measurement and reporting feedback is reported in Figure 1, demonstrating improvement in each of the 4 exemplar metrics (p Conclusion GAMUT quality metric reporting and benchmarked feedback is associated with improvement over the entire reporting period for a variety of CCT quality improvement metrics. GAMUT QI collaborative is an effective tool for supporting quality improvement.