EMS/Trauma

Rural Health Plan Goals

1. Improve the recruitment and retention of the rural health workforce
2. Improve the reputation of and quality of care provided by CAHs and local EMS
3. Increase access to health services in rural communities
4. Improve the financial status of CAHs and local EMS
5. Establish a rural health voice in California
6. Improve the effectiveness and outcomes of rural programs through increased collaboration and coordination between rural health stakeholders

EMS Objective

Develop and implement a coordinated EMS performance improvement system that takes into consideration and includes:

• Title 22, Division 9, Chapter 12 – “EMS System Quality Improvement” and the EMSA #166 – “Quality Improvement Program Model Guidelines
• State EMS goals and objectives, state trauma system development goals and objectives, LEMSA QI goals and objectives, and local providers’ QI goals and objectives
• The unique training needs of regional and local EMS
• Statewide e-data collection system and regional data collection efforts/systems
• Measures that can be collected by all rural EMS providers

Needs

• Identification of statewide measures with a small sub-set that will be collected by all providers. Sub-set must include measures that can be collected by rural providers.
• Training for LEMSA QI coordinators. Some LEMSA QI staff are highly trained in PI/QI while others have limited knowledge/experience.
• Training for local providers’ directors (including medical directors as feasible)
• Practical and demonstrated tools in order to implement PI at the local level

Approach 2009 – 2010

1. Statewide LEMSA PI training and QI Measure Identification Meeting
   1. 1-day training/meeting to review and discuss current measures to work towards statewide implementation
2. Local EMS provider training opportunities – 2 courses
   1. 2-Day training – PI/QI Course that includes the identified measures.
   2. Courses set for Riverside (June 25 & 26, 2010) and Kern Counties (May 24 & 25, 2010).
   3. Course costs will be paid for by Flex. Participating providers will receive a stipend based on distance from the training site. Priority will go to providers located in CAH service areas.
   4. Pending outcomes and funding, additional regions will receive training as part of 2010-2011 Flex Program.

Contracts

Three contracts will be in place annually to make the courses available:

1. Trainers – SafeTech Solutions, CA
2. Regional Course Organizers (2) – LEMSAs

Next Steps

• On-going planning with state, regional, and local EMS
• Follow-up for statewide EMS QI data collection, reporting, and QI process improvement implementation
• On-going regional course implementation

Regional PI/QI Course Content

Local EMS Quality Manager Academy

Day One

• Introductions
• Begin with the end in mind….importance of QI, Title 22, and components of a Quality Program QA, CQI, TQM…defining terms
  • Exercise – small group activity, placing EQIP measures into buckets
  • Exercise – moving buckets
• Data
  • Forms and methods
  • Pay for performance
  • Reports, benchmark, statistics

• Exercise – small group activity, EQIP measure data collection
• Exercise – making improvements, increasing performance on the measures
  • Training, education, skill review
    -Exercise – Good to Great, Mock improvement counseling
    -Exercise – Lessons from the Trenches: Identifying California’s Best Practices
  • Role of the medical director
    -Prevention

Day Two

• PDA models
• Science based decisions – Equipment & Medical Guidelines
  • Exercise: Using the Statapult
• Bring it all together…EMS Balanced Score Card
  • Exercise – small group activity to translate EQIP into BSC
• Local, regional, state QA requirements
  • Publication 166 (discussed by LEMSA staff)
• Appreciative feedback
  • Developing a feedback system using the Academy’s tools
• Building our ideal Quality Program
  Sacramento Course/Measures Meeting

LEMSA Course

Day One – QI/PI 101

• Introductions
• Begin with the end in mind…. Why QI, components of a Quality Program
  • QA, CQI, TQM…defining terms
  • Data
    • Forms and methods
    • Pay for performance
    • Reports, benchmark, statistics
  • Training, education, skill review
  • Role of the medical director
  • PDA models
  • Science based decisions – Equipment & Medical Guidelines
    • Exercise: Using the Statapult
  • Bring it all together…EMS Balanced Score Card
• Building our ideal Quality Program

Day Two – Facilitated Discussion

• Goal of Day Two – to agree on measures to be tracked by all LEMSAs
• Introduction – overview of facilitated, participatory process
• Review of State EMS QI rules and regulations
• Discussion on matching measurement with mission
  • Beyond measurement for measurement sake
  • Clarifying the “end” we have in mind
  • Measuring what matters (best and worst practices)
  • Opportunities and Limitations of statewide measurements
  • Creating rural friendly measurements
• Facilitated discussion
  • Group mind-mapping
  • Categorizing and prioritizing (create a working list)
  • Focus on nuts and bolts of specific measurements
  • Refine list
  • Complete final list