In addition, statewide trauma and EMS systems are evaluated by ACS, NHTSA’s Office of EMS, and (in the past) HRSA’s Division of Trauma and EMS. There are also various components of the system with independent accrediting bodies. Hospitals, for example, are accredited by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO); ambulance services are accredited by the Commission on Accreditation of Ambulance Services (CAAS); and air medical services are voluntarily accredited by the Commission on Accreditation of Medical Transport Systems (CAMTS). Each of these organizations collects performance information.

What is missing is a standard set of measures that can be used to assess the performance of the full emergency and trauma care system within each community, as well as the ability to benchmark that performance against statewide and national performance metrics. A credible entity to develop such measures would not be strongly tied to any one component of the emergency care continuum.

One approach would be to form a collaborative entity that would include representation from all of the system components, including hospitals, trauma centers, EMS agencies, physicians, nurses, and others. Another approach would be to work with an existing organization, such as the National Quality Forum (NQF), to develop a set of emergency care–specific measures. NQF grew out of the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. It operates as a not-for-profit membership organization made up of national, state, regional, and local groups representing consumers, public and private purchasers, employers, health care professionals, provider organizations, health plans, accrediting bodies, labor unions, supporting industries, and organizations involved in health care research or quality improvement. NQF has reviewed and endorsed measure sets applicable to several health care settings and clinical areas and services, including hospital care, home health care, nursing-sensitive care, nursing home care, cardiac surgery, and diabetes care (NQF, 2002, 2003, 2004a,b, 2005).

The committee recommends that the Department of Health and Human Services convene a panel of individuals with emergency and trauma care expertise to develop evidence-based indicators of emergency and trauma care system performance (3.3). Because of the need for an independent, national process that involves the broad participation of every component of emergency and trauma care, the federal government should play a lead role in promoting and funding the process. The development of the initial set of performance indicators should be completed within 18 months of the release of this report.

The measures developed should include structure and process measures, but evolve toward outcome measures over time. They should be nationally standardized so that statewide and national comparisons can be made.

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