Quality measurement in physician-staffed emergency medical services: a systematic literature review.

PURPOSE: Quality measurement of physician-staffed emergency medical services (P-EMS) is necessary to improve service quality. Knowledge and consensus on this topic are scarce, making quality measurement of P-EMS a high-priority research area. The aim of this review was to identify, describe and evaluate studies of quality measurement in P-EMS. DATA SOURCES: The databases of MEDLINE and Embase were searched initially, followed by a search for included article citations in Scopus. STUDY SELECTION: The study eligibility criteria were: (1) articles describing the use of one quality indicator (QI) or more in P-EMS, (2) original manuscripts, (3) articles published from 1 January 1968 until 5 October 2016. The literature search identified 4699 records. 4543 were excluded after reviewing title and abstract. An additional 129 were excluded based on a full-text review. The remaining 27 papers were included in the analysis. Methodological quality was assessed using an adapted critical appraisal tool. DATA EXTRACTION: The description of used QIs and methods of quality measurement was extracted. Variables describing the involved P-EMSs were extracted as well. RESULTS OF DATA SYNTHESIS: In the included papers, a common understanding of which QIs to use in P-EMS did not exist. Fifteen papers used only a single QI. The most widely used QIs were 'Adherence to medical protocols', 'Provision of advanced interventions', 'Response time' and 'Adverse events'. CONCLUSION: The review demonstrated a lack of shared understanding of which QIs to use in P-EMS. Moreover, papers using only one QI dominated the literature, thus increasing the risk of a narrow perspective in quality measurement. Future quality measurement in P-EMS should rely on a set of consensus-based QIs, ensuring a comprehensive approach to quality measurement.

Community paramedicine: cost-benefit analysis and safety evaluation in paramedical emergency services in rural areas - a scoping review.

OBJECTIVE: To examine the current knowledge and possibly identify gaps in the knowledge base for cost-benefit analysis and safety concerning community paramedicine in rural areas. DESIGN: Scoping review. DATA SOURCES: MEDLINE via PubMed, CINAHL, Cochrane and Embase up to December 2020. STUDY SELECTION: All English studies involving community paramedicine in rural areas, which include cost-benefit analysis or safety evaluation. DATA EXTRACTION: This scoping review follows the methodology developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We systematically searched for all types of studies in the databases and the reference lists of key studies to identify studies for inclusion. The selection process was in two steps. First, two reviewers independently screened 2309 identified articles for title and abstracts and second performed a full-text review of 24 eligible studies for inclusion. RESULTS: Three articles met the inclusion criteria concerning cost-benefit analysis, two from Canada and one from USA. No articles met the inclusion criteria for safety evaluation. CONCLUSION: There are knowledge gaps concerning safety evaluation of community paramedicine in rural areas. Three articles were included in this scoping review concerning cost-benefit analysis, two of them showing positive cost-effectiveness with community paramedicine in rural areas.