nemsqar

Streamlines NEMSQA Metric Calculations

https://github.com/bemts-hhs/nemsqar

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Streamlines NEMSQA Metric Calculations

README.Rmd

---
output: github_document
---



```{r, include = FALSE}
knitr::opts_chunk$set(
  collapse = TRUE,
  comment = "#>",
  fig.path = "man/figures/README-",
  out.width = "100%"
)
```

# nemsqar 


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`nemsqar` is an R package designed to automate the calculation of EMS quality metrics as defined by the National EMS Quality Alliance (NEMSQA). With a focus on enhancing EMS service performance through reliable, evidence-based quality measures, `nemsqar` aims to streamline metric calculation for healthcare providers, EMS agencies, and researchers dedicated to improving patient outcomes.

## Installation

You can install the development version of `nemsqar` with:

``` r
# install.packages("remotes")
remotes::install_github("bemts-hhs/nemsqar")
```

Additionally, you may install the current version of `nemsqar` on CRAN via:

```r
install.packages("nemsqar")
```

## Functionality

`nemsqar` has functions that will always automate the calculation of a service's performance (or even a system's) against the currently approved list of NEMSQA Measures (see below).  Given the large number of these functions, please check the full package documentation resource [here](https://bemts-hhs.github.io/nemsqar/).

## About NEMSQA

The National EMS Quality Alliance (NEMSQA) is committed to developing and endorsing quality measures that improve patient and provider experiences within EMS and healthcare systems. Originating from the EMS Compass Project (2014), NEMSQA has evolved as an independent organization, tasked with completing and sustaining the development of impactful, evidence-based EMS quality measures.

### History of EMS Quality Measure Development

The structured development of EMS quality measures began with the EMS Compass Project, an initiative funded by the National Highway Traffic Safety Administration (NHTSA) and led by the National Association of State EMS Officials (NASEMSO) to establish relevant performance measures for EMS agencies. Since then, the field has advanced under the guidance of NEMSQA, which works to create sustainable, practical, and high-impact EMS quality measures through a collaborative, scientifically driven process.

For more about NEMSQA, please visit their official website: [nemsqa.org](https://www.nemsqa.org/).

---

## NEMSQA Measure Set

The National EMS Quality Alliance (NEMSQA) Measure Set includes a comprehensive list of EMS quality measures that have been developed and approved for national use. These measures are intended to guide EMS agencies in collecting data to assess and improve patient care. Below are the measures approved by the NEMSQA Measure Development Committee and Board of Trustees as of August 2019. Access to the full technical specifications for these measures is available on the NEMSQA website after creating a user profile. 

### Key for **`Developed in Package?`** Column
* Developed and in package: ✔️
* Slated for future development: 🔧

```{r seqic-table, echo = FALSE, message = FALSE}

# Define the checkmark symbol programmatically
checkmark <- intToUtf8(0x2714)  # Unicode for heavy check mark

ems_table <- tibble::tibble(
  `Measure ID` = c("Airway-01", "Airway-05", "Airway-18", "Asthma-01", "Hypoglycemia-01",
                   "Respiratory-01", "Respiratory-02", "Pediatrics-03b", "Safety-01", "Safety-02",
                   "Safety-04", "Seizure-02", "Stroke-01", "Syncope-01", "TBI-01", "Trauma-01",
                   "Trauma-03", "Trauma-04", "Trauma-08", "Trauma-14", "TTR-01"),
  Description = c(
    "Percentage of EMS responses from a 911 request with successful advanced airway placement on first attempt without hypotension or hypoxia in peri-intubation period.",
    "Percentage of intubation procedures from a 911 request in which adequate patient oxygen levels were achieved prior to intubation.",
    "Percentage of successful advanced airway procedures from a 911 request in which waveform capnography is used for confirmation and monitoring.",
    "Percentage of EMS responses from a 911 request for asthma patients receiving an aerosolized beta agonist.",
    "Percentage of EMS responses from a 911 request for symptomatic hypoglycemia patients who receive treatment to correct hypoglycemia.",
    "Percentage of EMS responses from a 911 request for respiratory distress patients with a respiratory assessment.",
    "Percentage of EMS responses from a 911 request for patients with hypoxia receiving oxygen.",
    "Percentage of EMS responses from a 911 request for patients <18 years receiving a weight-based medication with documented weight in kg or length-based estimate.",
    "Percentage of EMS responses from a 911 request without lights and sirens.",
    "Percentage of EMS transports from a 911 request without lights and sirens during patient transport.",
    "Percentage of EMS transports from a 911 or interfacility request for patients <8 years transported with a pediatric restraint device.",
    "Percentage of EMS responses from a 911 request for patients with status epilepticus who received benzodiazepine.",
    "Percentage of EMS responses from a 911 request for suspected stroke patients who had a stroke assessment.",
    "Percentage of EMS responses from a 911 request for syncope patients with a 12-lead (or greater) ECG performed.",
    "Percentage of EMS transports from a 911 request for suspected TBI patients with documented oxygen level, ETCO2, and systolic BP.",
    "Percentage of EMS responses from a 911 request for injury patients assessed for pain.",
    "Percentage of EMS transports from a 911 request for patients whose pain score decreased during EMS encounter.",
    "Percentage of EMS responses from a 911 request for patients meeting CDC trauma criteria transported to a trauma center.",
    "Percentage of EMS transports from a 911 request for trauma patients with documented GCS, systolic BP, and respiratory rate.",
    "Percentage of EMS transports from a 911 request for patients meeting Step 1 or Step 2 field triage criteria with a pre-arrival trauma alert.",
    "Percentage of EMS responses from a 911 request for non-transported patients with documented vital signs."
  ),
  Type = c("Outcome", "Process", "Process", "Process", "Process", "Process", "Process", "Process",
           "Process", "Process", "Process", "Process", "Process", "Process", "Process", "Process",
           "Outcome", "Process", "Process", "Process", "Process"),
  `National Quality Strategy Domain` = c("Clinical Process – Effectiveness", "Patient Safety",
                                         "Clinical Process – Effectiveness", "Clinical Process – Effectiveness",
                                         "Clinical Process – Effectiveness", "Clinical Process – Effectiveness",
                                         "Clinical Process – Effectiveness", "Patient Safety",
                                         "Patient Safety", "Patient Safety", "Patient Safety",
                                         "Clinical Process – Effectiveness", "Clinical Process – Effectiveness",
                                         "Clinical Process – Effectiveness", "Clinical Process – Effectiveness",
                                         "Patient Experience", "Patient Experience",
                                         "Clinical Process – Effectiveness", "Clinical Process – Effectiveness",
                                         "Clinical Process – Effectiveness", "Clinical Process – Effectiveness"),
  `Developed in Package?` = rep(checkmark, 21)
)

knitr::kable(ems_table)

```

# Resources

Interested persons may reference the following links and resources via NEMSQA's website.  Note - some materials may require a free membership to access.

* [Measure Specification Table (NEMSQA)_2021](https://www.nemsqa.org/assets/docs/Measure-Specification-Table-NEMSQA_2021.pdf): A quick-reference table that includes broad-view measure specifications (i.e., numerator and denominator criteria) for each measure.
* [Project Summary with Measure Narratives](https://www.nemsqa.org/assets/docs/Project-Summary-with-Measure-Narrative-NEMSQA.pdf): An overview of the EMS Compass 2.0 project and narratives for each measure, which include systems implications.
* [Frequently Asked Questions](https://www.nemsqa.org/nemsqa-measure-faq): Answers to commonly asked questions.
* [NEMSQA Measure Technical Release Notes_2021](https://www.nemsqa.org/assets/docs/NEMSQA-Measure-Technical-Release-Notes_2021.pdf): A reference table that documents changes made to the NEMSQA measures during the 2021 annual review.
* [Fact Sheet](https://www.nemsqa.org/assets/docs/Fact-Sheet-NEMSQA.pdf): An info page explaining why agencies and systems should migrate from EMS Compass legacy/candidate measures to the National EMS Quality Alliance Measure Set.

# Thanks!

A big loud thanks to Sheree Murphy from NEMSQA, Peter Geissert from Oregon EMS & Trauma Systems, Jeffrey Jarvis medical director for the Metropolitan Area EMS Authority (Fort Worth, Texas), and Marshall Washick (Washington D.C. Fire) for all their input and consultation!

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