The California EMS System Core Quality Measures (EMSA #166 – Appendix E) for 2012 and 2013 data years can be found here.  (This is the most recent version: Updated Dec. 2013)

Objectives

During the 1 year period, from July 31, 2013 to June 30, 2014, The California EMS Authority (EMSA) is performing the following activities to deliver a set of publicly available data reports:

1. Create a formal data system profile and written analysis to identify areas for data quality improvement and inform an action plan to address the issues.

2. Work to reveal opportunities for both short-term and long-term data improvement plans.

3. Focus on achieving reliable measures that are high value and feasible within a short-term time frame.

4. Refine and publish core measure sets that describe the coordination and effectiveness of EMS utilizing regional and local information for California.  This project focuses upon the following core measure sets:

• Trauma
• Acute Coronary Syndrome/Heart Attack
• Cardiac Arrest
• Stroke
• Respiratory
• Pain Intervention
• Pediatric
• Skill Performance by EMS Providers
• EMS Response and Transport
• Public Education Bystander CPR

5. Conduct data workshops for local EMS agencies across the state to implement improved data collection and reporting practices with those Local Emergency Medical Services Agencies who participate in California Emergency Medical Services Information System.

CEMSIS Evaluation (Objective 1 and 2)

Last year’s review of CEMSIS by Health Services Advisory Group showed that the system capabilities were problematic.  These weaknesses prompted EMSA to sub-contract through Inland Counties EMS Agency (ICEMA), with ImageTrend, through an established nationwide software vendor capable of capturing data using the NEMSIS 2.x data standards and dictionary as well as the new NEMSIS 3.x data standards and dictionary.  This shift has staged California for national changes in standards as well as providing EMSA with more robust software that, in time, will be capable of providing core measures reports.  Currently the system does not contain sufficient data to generate these reports; however, the reports will be built into the system in the near future.  EMSA will continue to review and assess the core measure submissions and provide feedback to each LEMSA that can help to improve both their system and the core measures methodology.  EMSA provided technical support to the LEMSAs that facilitated an increase in participation. This year, 32 of 33 LEMSAs submitted core measures reports for at least 1 measure generated from 2013 data, a vast improvement from the first year of data collection (2009-2011 data).

EMS Data Planning (Objective 3)

Through this project, EMSA has revealed opportunities for both short-term and long-term data improvement.  EMSA, with the help of the task force, has utilized feedback from LEMSA data and quality improvement experts to refine the measures for 2014 data collection, and we are already looking forward to 2015.  In addition, EMSA is preparing for the shift to NEMSIS 3.x and urging all LEMSAs to make sure they are implementing compliant software before the change occurs.  EMSA continues to work with our Core Measures Task Force to improve the collection methods, educate both LEMSAs and providers, and reinforce the importance of documentation.

EMS Core Measures Task Force (Objective 4)

In collaboration with the Core Measures Task Force, EMSA made changes to the reporting instructions allowing for more reliable and accurate information to be reported.  The changes included asking LEMSAs to report the measures exactly as written.  If they were unable to do so, they were asked to provide their specific methodology.  This allows EMSA to better assess the measures by looking at alternative ways to obtain the same result among the 33 diverse EMS systems in California.  The changes made from the previous year of data collection yielded a higher level of participation with significantly larger numbers of cases in the denominator and numerator of the results.  In addition, there was an increase in both the averages as well as the medians for each of the measures.

EMS Core Quality Measures Workshops (Objective 5)

EMSA conducted three, 2-day workshops throughout the state in June 2014.  Two new locations were selected from the similar workshops done last year to gain a wider audience and increase statewide education on California’s EMS Core Measures.  The workshops were held in San Diego (June 11-12), Rancho Cordova (June 16-17), and San Francisco (June 25-26).  In addition, the updated curriculum provided new materials to attendees who participated last year.  During day 1 of each session, attendees received instruction and participated in exercises related to quality improvement, developing indicators, and the importance of data quality.  The second day featured an in depth review of the EMS Core Measures for California, national data trends, and the results from the second year of the project.  Between all three workshops, over 100 individuals registered for the 2-day event. Attendees consisted of representatives from hospitals, EMS providers and local EMS agencies throughout California.

• Day 1 Presentation – Quality Improvement in EMS (click to view PDF)
• Day 2 Presentation – EMS Core Measures: National Trends and California, CEMSIS Transformation, and Review of Core Measures for 2012 and 2013 Data (click to view PDF)

EMS Core Measure Project Results (Project Goal)

Through the development of Core Measures, EMSA achieved reliable measures that are of high value and were relatively feasible to collect within a short period of time. However, there were limitations and barriers to collecting retrospective information pertaining to the measures.  Many of the challenges from year one of the project carried over into the second year of the project.  EMSA was very encouraged by the increased participation in year two (32 of 33 LEMSAs submitted at least 1 core measures) and looks to have full participation (33 of 33 LEMSAs) in the third year of the project.

Information was collected from local EMS agencies, by April 1, 2014, using retrospective data from 2012 and 2013. EMSA examined 20 Core Measures (17 clinical measures and 3 measures related to response and transport) covering 8 Core measure sets. The available information is noted below.

• CHCF Grant Report Narrative – (click here to view PDF)
• Reporting Capability of EMSA and LEMSA Data Systems and Results from Clinical Measure Reports – (click here to view PDF)

Resources

National Quality Forum Report

NEMSIS Performance Measures

EMS Core Measures Suggestions to NHTSA (2004)

For Further Information

Daniel Smiley, Chief Deputy Director, EMSA

Tom McGinnis, Chief, EMS Systems Division

Adam Davis, Quality Improvement Coordinator