Pre-Hospital Outcomes for Evidence-Based Evaluation (PHOEBE)

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Project title Pre-hospital Outcomes for Evidence-Based Evaluation (PhOEBE)
Funding body  National Institute for Health Research – Programme Grant for Applied Health Research
Total funding £2,035,959
Team 
  • Professor Niroshan Siriwardena, Associate Clinical Director / Professor Primary and Pre-hospital Health Care, East Midlands Ambulance Service & School of Health & Social Care, University of Lincoln
  • Ms Janette Turner, Research Fellow, School of Health & Related Research (ScHARR)
  • Professor Jonathan Nicholl, Director, Medical Care Research Unit (MCRU), School of Health & Related Research (ScHARR), University of Sheffield
  • Professor Steve Goodacre, Professor of Emergency Medicine, School of Health & Related Research (ScHARR), University of Sheffield
  • Professor Ronan Lyons, Professor of Health Services Research, School of Medicine, Swansea University
  • Mr Andrew Booth, Reader in Evidence-Based Information Practice and Director of Information, School of Health & Related Research (ScHARR), University of Sheffield
  • Professor Helen Snooks, Professor of Health Services Research, School of Medicine, Swansea University
  • Professor John Bazier, Professor of Health Economics, School of Health & Related Research (ScHARR), University of Sheffield
  • Dr James Gray, Medical Director, East Midlands Ambulance Service NHS Trust
  • Dr Alison Walker, Medical Director, Yorkshire Ambulance Service NHS Trust
  • Professor Mike Campbell, Professor in Medical Statistics, School of Health & Related Research (ScHARR)
  • Mrs Joanne Coster, Research Associate, School of Health & Related Research (ScHARR), University of Sheffield
  • Professor Alicia O’Cathain, Professor of Health Services Research, School of Health and Related Research (ScHARR), University of Sheffield
  • Professor David Meechan, Director, East Midlands Public Health Observatory & Trent Cancer Registry
Overarching aim The aim of the programme is to develop new ways of measuring the impact of ambulance service care to support quality improvement through monitoring, auditing and service evaluation.
Objectives 
  1. To review and synthesise the research literature on pre-hospital care outcome measures and identify measures relevant to the NHS and patients for further development
  2. To create a dataset linking routinely collected pre-hospital data, hospital data and mortality data to provide outcome information
  3. To develop new ways of measuring process and outcome indicators including building the adjustment models that predict the outcomes using the linked data
  4. To explore the practical use of the linked dataset and the risk adjustment models to measure the effectiveness and quality of ambulance service care and assess how they can be best used to support quality improvement strategies. 
Methods
  1. Synthesis of evidence on outcome measures and identification of measures for further development – review and assessment of the evidence base on outcome measurement for pre-hospital care and a consensus study to identify measures relevant to patients and NHS staff
  2. Linking pre-hospital data with other patient data sources – creating a single dataset that links ambulance service electronic care records with routinely collected hospital episode statistics (HES) and national mortality data
  3. Development of risk adjustment models for outcomes in patients attended by the ambulance service – using the linked data to develop risk adjustment tools that will allow patient differences to be taken into account and differences between expected and actual outcomes to be detected
  4. Testing the risk adjustment models to assess if they can be used to measure effectiveness and quality – exploring the practical application of the measures by using them to assess if different ways of quality – exploring the practical application of the measures by using them to assess if different ways of providing ambulance service care result in different consequences for patients, and assessing the views of potential users about how they can best be implemented in the NHS.
Outcomes  Develop a method for linking healthcare information into a format that can be used to support quality improvement, is acceptable to patients and complies with information legislation. Develop population-based models for measuring the impact of pre-hospital care that can be used to monitor quality and safety, evaluate new service innovations and support quality improvement. Provide added value by using routine information and NHS infrastructure to operationalise the process and outcome models so they will be of use across the NHS.
Outputs

Publications:

Togher F, O’Cathain A, Phung VH, Turner J, Siriwardena AN. Reassurance as a key outcome valued by emergency ambulance service users: a qualitative interview study. Health Expectations 2014 (early view).

Presentations:

Impact  This project will change the way in which the quality of ambulance services is measured.  As such, it goes beyond just measuring performance in terms of response times.  This may impact on the operation of ambulance services from organisations that concentrate on meeting response time targets towards those that are geared to improving the quality of patient care.

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