Understanding Why Frequent Users of EMS Call 9-1-1: A Grounded Theory Study.

INTRODUCTION: Frequent users of emergency medical services (EMS) have disproportionately high 9-1-1 call frequency. Evidence suggests that this small group burdens the health care system, leading to misallocation of already-limited health resources. AIM: To understand frequent users' perceptions and experiences regarding EMS, as well as the driving factors underlying their frequent use. METHOD: A grounded theory approach guided our qualitative research process. Participants older than 17 years who called EMS five or more times in the past year were consecutively sampled where each participant was contacted in the order they appeared on our list of potential participants for interviews until data saturation was achieved. Transcripts were analyzed to derive common themes among frequent EMS callers. RESULTS: Frequent EMS calls often resulted from chronic medical conditions creating recurrent crisis situations, mental health issues as well as mobility issues, frequent noninjurious falls, and social isolation. Combined with these factors, perceptions of the purpose of EMS and social circumstances also contributed to the creation of complex health issues that influenced frequent EMS use. These findings can advise the development of future paramedicine programs and health promotion interventions.

Evaluation of the McMaster Family Health Team: results and practical implications for quality improvement.

PURPOSE: To evaluate the McMaster Family Health Team (MFHT) as part of a Continuous Quality Improvement initiative using a set of provincial performance metrics to demonstrate which measures of assessment are actually clinically meaningful in context and where system-level changes might be implemented to improve operational practice. METHODS: Measures were selected from the Primary Care Performance Measurement Framework based on data availability for the MFHT and provincial comparators. The measures explored in this paper are those that were deemed to have actionable properties. Data were extracted from billing reports, electronic medical records and information collated for the Association of Family Health Teams of Ontario Data to Decisions database. Metrics were then examined to demonstrate the importance of interpretation in clinical context. CONCLUSIONS: Quantitative assessment of performance based on standardised measures is a suitable starting point when evaluating a practice, however it is not appropriate as a stand-alone report card of practice performance. Rather, quantitative measures must be of clinical relevance and applicable to the patient populations of interest in order to create conversation and impact change. Thus, the focus of quality improvement should not be to improve numbers relating to efficiency, patient satisfaction and continuity of care, but rather to determine what drives those numbers and how changes might be made at a system or practice level that will optimise clinician buy-in.