The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand
Introduction: The aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. Method: Using 2017–2019 data from the Australasian Resuscita...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
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2023
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| Online Access: | http://purl.org/au-research/grants/nhmrc/1116453 http://hdl.handle.net/20.500.11937/93654 |
| _version_ | 1848765762936766464 |
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| author | Howell, S. Smith, K. Finn, Judith Cameron, P. Ball, Stephen Bosley, E. Doan, T. Dicker, B. Faddy, S. Nehme, Z. Swain, A. Thorrowgood, M. Thomas, A. Perillo, S. McDermott, M. Smith, T. Bray, Janet |
| author_facet | Howell, S. Smith, K. Finn, Judith Cameron, P. Ball, Stephen Bosley, E. Doan, T. Dicker, B. Faddy, S. Nehme, Z. Swain, A. Thorrowgood, M. Thomas, A. Perillo, S. McDermott, M. Smith, T. Bray, Janet |
| author_sort | Howell, S. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | Introduction: The aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. Method: Using 2017–2019 data from the Australasian Resuscitation Outcomes Consortium (Aus-ROC) OHCA Epistry, we included adults who received an EMS attempted resuscitation for a presumed medical OHCA. Logistic regression was applied to develop risk adjustment models for event survival (return of spontaneous circulation at hospital handover) and survival to hospital discharge/30 days. We examined potential effect modifiers, and assessed model discrimination and validity. Results: Both OHCA survival outcome models included EMS agency and the Utstein variables (age, sex, location of arrest, witnessed arrest, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation prior to EMS arrival, and EMS response time). The model for event survival had good discrimination according to the concordance statistic (0.77) and explained 28% of the variation in survival. The corresponding figures for survival to hospital discharge/30 days were 0.87 and 49%. The addition of effect modifiers did little to improve the performance of either model. Conclusion: The development of risk adjustment models with good discrimination is an important step in benchmarking EMS performance for OHCA. The Utstein variables are important in risk-adjustment, but only explain a small proportion of the variation in survival. Further research is required to understand what factors contribute to the variation in survival between EMS. |
| first_indexed | 2025-11-14T11:40:25Z |
| format | Journal Article |
| id | curtin-20.500.11937-93654 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | eng |
| last_indexed | 2025-11-14T11:40:25Z |
| publishDate | 2023 |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-936542023-11-15T07:41:16Z The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand Howell, S. Smith, K. Finn, Judith Cameron, P. Ball, Stephen Bosley, E. Doan, T. Dicker, B. Faddy, S. Nehme, Z. Swain, A. Thorrowgood, M. Thomas, A. Perillo, S. McDermott, M. Smith, T. Bray, Janet Emergency medical services Heart arrest Out of hospital cardiac arrest Registries Resuscitation Adult Humans Out-of-Hospital Cardiac Arrest Benchmarking Cohort Studies Risk Adjustment New Zealand Registries Emergency Medical Services Cardiopulmonary Resuscitation Australia Aus-ROC OHCA Epistry Management Committee Humans Cardiopulmonary Resuscitation Registries Cohort Studies Adult Emergency Medical Services Benchmarking Risk Adjustment Australia New Zealand Out-of-Hospital Cardiac Arrest Introduction: The aim of this study was to develop a risk adjustment strategy, including effect modifiers, for benchmarking emergency medical service (EMS) performance for out-of-hospital cardiac arrest (OHCA) in Australia and New Zealand. Method: Using 2017–2019 data from the Australasian Resuscitation Outcomes Consortium (Aus-ROC) OHCA Epistry, we included adults who received an EMS attempted resuscitation for a presumed medical OHCA. Logistic regression was applied to develop risk adjustment models for event survival (return of spontaneous circulation at hospital handover) and survival to hospital discharge/30 days. We examined potential effect modifiers, and assessed model discrimination and validity. Results: Both OHCA survival outcome models included EMS agency and the Utstein variables (age, sex, location of arrest, witnessed arrest, initial rhythm, bystander cardiopulmonary resuscitation, defibrillation prior to EMS arrival, and EMS response time). The model for event survival had good discrimination according to the concordance statistic (0.77) and explained 28% of the variation in survival. The corresponding figures for survival to hospital discharge/30 days were 0.87 and 49%. The addition of effect modifiers did little to improve the performance of either model. Conclusion: The development of risk adjustment models with good discrimination is an important step in benchmarking EMS performance for OHCA. The Utstein variables are important in risk-adjustment, but only explain a small proportion of the variation in survival. Further research is required to understand what factors contribute to the variation in survival between EMS. 2023 Journal Article http://hdl.handle.net/20.500.11937/93654 10.1016/j.resuscitation.2023.109847 eng http://purl.org/au-research/grants/nhmrc/1116453 http://purl.org/au-research/grants/nhmrc/1174838 http://purl.org/au-research/grants/nhmrc/1139686 http://creativecommons.org/licenses/by-nc-nd/4.0/ fulltext |
| spellingShingle | Emergency medical services Heart arrest Out of hospital cardiac arrest Registries Resuscitation Adult Humans Out-of-Hospital Cardiac Arrest Benchmarking Cohort Studies Risk Adjustment New Zealand Registries Emergency Medical Services Cardiopulmonary Resuscitation Australia Aus-ROC OHCA Epistry Management Committee Humans Cardiopulmonary Resuscitation Registries Cohort Studies Adult Emergency Medical Services Benchmarking Risk Adjustment Australia New Zealand Out-of-Hospital Cardiac Arrest Howell, S. Smith, K. Finn, Judith Cameron, P. Ball, Stephen Bosley, E. Doan, T. Dicker, B. Faddy, S. Nehme, Z. Swain, A. Thorrowgood, M. Thomas, A. Perillo, S. McDermott, M. Smith, T. Bray, Janet The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand |
| title | The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand |
| title_full | The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand |
| title_fullStr | The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand |
| title_full_unstemmed | The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand |
| title_short | The development of a risk-adjustment strategy to benchmark emergency medical service (EMS) performance in relation to out-of-hospital cardiac arrest in Australia and New Zealand |
| title_sort | development of a risk-adjustment strategy to benchmark emergency medical service (ems) performance in relation to out-of-hospital cardiac arrest in australia and new zealand |
| topic | Emergency medical services Heart arrest Out of hospital cardiac arrest Registries Resuscitation Adult Humans Out-of-Hospital Cardiac Arrest Benchmarking Cohort Studies Risk Adjustment New Zealand Registries Emergency Medical Services Cardiopulmonary Resuscitation Australia Aus-ROC OHCA Epistry Management Committee Humans Cardiopulmonary Resuscitation Registries Cohort Studies Adult Emergency Medical Services Benchmarking Risk Adjustment Australia New Zealand Out-of-Hospital Cardiac Arrest |
| url | http://purl.org/au-research/grants/nhmrc/1116453 http://purl.org/au-research/grants/nhmrc/1116453 http://purl.org/au-research/grants/nhmrc/1116453 http://hdl.handle.net/20.500.11937/93654 |