Annual EMSC Grantee Meeting

State Partnership Grant Representatives

Jumpstarting Your Performance Measure Activities

June 20 – 22, 2006

JENNIFER KUO: Good morning, everyone and I’m Jennifer Kou of the Lewin Group. As Diana said, the Lewin Group has been working for the past three years with the National Resource Center, NEDARC, and HRSA in developing the performance measures. So we are actually very excited and hopefully, you guys are, as well, because after three years, we are now ready to implement the measures and begin reporting data.

We know that a lot of you probably have a lot of questions about the measures and so the purpose of today’s session is to review performance measure 66. We’re actually going to review measures 67 and 68 in tomorrow’s breakout session in the afternoon. We’re also going to review the data collection tools that NEDARC has developed for this measure, and then have an interactive discussion with you all about any implementation strategies, challenges, and other questions or issues that you may have for this measure.

Before launching in to measure 66, we wanted to take a little bit of time and just review with you the timeline for submitting data for year one. We know that most of you have been in the electronic handbook and completing all the required forms so this should kind of be more of a reminder or a refresher as to the reporting requirements for this year. By July 3rd 2006, all states and territories must register their grants in the electronic handbook and also complete all the required forms. There will be no extensions to this deadline and it is a condition of your grant.

Also by July 3rd, you are required to submit target objectives for each of the measures. What this represents is your projected outcomes of which measures you feel like you’re going to be able to meet during the three years of your EMSC grant, keeping in mind this is not provisional performance measure data. It’s only projected outcomes of what you feel like or think you’re going to be able to meet. During the continuation application process of November of 2006, you’ll be asked to submit provisional performance measure data in the electronic handbook. This will represent where your program currently is at that point in time in November of 2006. Many of you will probably be in the process of collecting data and so it will just represent where you currently are in that point in time.

And then finally, by July 3rd of 2007, you’ll be required no later than that date to submit your final year one data and what this data will represent is where your program is as of February 28, 2007, which is the last day of the year one of your grant. Any questions about the timeline before moving on? Yes, Patricia.

PATRICIA: How long does it take to register when you said to July 3rd? Do you need days before to register or?

JENNIFER KUO: I’m going to kind of ask the audience. I know most of you have already done this so how long has it taken people to do?

UNKNOWN SPEAKER: It’s less than twenty.

UNKNOWN SPEAKER: Once you got it going, it could be about two hours.

PATRICIA: To do the whole thing?

UNKNOWN SPEAKER: Yeah.

JENNIFER KUO: So two hours?

UNKNOWN SPEAKER: Four hours.

UNKNOWN SPEAKER: Yeah. Four hours.

JENNIFER KUO: Four?

UNKNOWN SPEAKERS: (Inaudible)

JENNIFER KUO: So the question was how long it takes to register your grant in the electronic handbook and we’ve gotten answers that are between two and four hours. Okay. So moving on to performance measure number 66. This is A Gepre measure. The measure reads the degree to which the state or territory has insured the operational capacity to provide pediatric emergency care. The goal for this measure is that by 2011, each of the states and territories will have insured operational capacity to provide pediatric care.

There are a few definitions or important definitions for this measure that we like to review. The first is for the term pediatric. The EMSC program defines pediatric as persons up to 18 years old. We do know that there are some states out there that define pediatric differently. Some define it as up to 15 and some up to 16. Even though states may define it differently, we do ask you to try to submit data for all persons up to 18. If you’re unable to, then we’re asking you to submit a justification and explanation for how care for persons up to 18 is currently being provided in your state with respect to the measure. And so, report what you do have and then provide an explanation for any of the remaining ages that you are unable to provide that on.

Operational capacity is another important term in this measure. And for year one, it’s defined by four elements. And these four elements correspond to the four sub measures for this measure. So I’ll just quickly review them now and then we’ll go into each of the four sub measures in more detail in a little bit. The first element is that pre-hospital provider agencies have on-line and off-line pediatric medical direction at the scene of an emergency for both Basic Life Support and Advance Life Support providers.

The second element of the operational capacity is that pre-hospital provider agencies have the essential pediatric equipment and supplies as outlined in the AAP/ACEP Joint Guidelines for both BLS and ALS providers. The third element is the existence of a statewide, territorial or regional standardized system that recognizes hospitals that are able to stabilize and/or manage pediatric emergencies. And then, the fourth element is that hospitals have written inter-facility transfer agreements and guidelines.

I’m going to now talk more specifically about the first sub measure for this measure, 66A. I have just mentioned this measure reads the percentage of pre-hospital provider agencies that have on-line and off-line pediatric medical direction for both BLS and ALS providers. The goal for this measure is that states have until 2011 so that 90 percent of the pre-hospital provider agencies in their state or territory have on-line and off-line pediatric medical direction for BLS and ALS providers. You’ll notice in your implementation manual that there are targets listed for years 2006 through 2010 as well. Those are actually supposed to be used as a guide for each of the grantees in guiding their progress in meeting this measure through 2011 and so states will not be held accountable for those targets from 2006 to 2010. Those targets are actually for the EMSC Program as a whole so the total number of states as opposed to a goal for individual states to meet.

And then, an important definition for this term is for pre-hospital provider agencies. And those are defined as licensed, certified or designated agencies with the primary responsibility of delivering care to pediatric patients during an emergency and transporting them to the hospital. There’ve been some questions from grantees as to whether unlicensed agencies and air ambulances are included as pre-hospital provider agency and has been decided that they will be excluded from the definition. Yes?

UNKNOWN SPEAKER: What if your state doesn’t license agencies?

JENNIFER KUO: Based on this definition, if they are unlicensed, then they would not be included. Because I know if you don’t licensed them, then you’re not going to have any type of authority or be able to track them.

UNKNOWN SPEAKER: (Inaudible) what you talked about—you don’t apply—your office does—?

UNKNOWN SPEAKER: Ohio does licensing on those agencies.

UNKNOWN SPEAKER: (Inaudible) does anybody—?

UNKNOWN SPEAKER: (Inaudible) do they follow any rules or (inaudible)?

UNKNOWN SPEAKER: We certify the individual practitioners.

UNKNOWN SPEAKER: The agencies themselves are required to meet the standards.

UNKNOWN SPEAKER: They are not required to meet standards set by the state. We have voluntary standards that are set up for them but there is no requirement or anything those seems (inaudible).

JENNIFER KUO: The question is what happens if your state does not license pre-hospital agencies.

DIANE FENDI: We’re going to need to have a discussion on that one, Jen. That’s an excellent question but I’m not sure how many states serves--that’s not come to us as on PS so we’ll have to talk about that more specifically. You can pick up a couple more questions like if you want to but they were going to ask that the questions be on hold to the end of the discussion. Okay?

JENNIFER KUO: I’m actually going to turn it over right now to Mike, who’s going to review the data collection tools that they have developed for this measure.

UNKNOWN SPEAKER: Did you say air ambulances whether they’re licensed or not, they’re excluded?

JENNIFER KUO: Excluded. Yes.

UNKNOWN SPEAKER: Whether they’re licensed or not.

JENNIFER KUO: Yes. Excluded.

UNKNOWN SPEAKER: You don’t just mean transport ambulance (inaudible) you are not transport.

DIANE FENDI: Are you talking about stretcher transport? What are you talking about?

UNKNOWN SPEAKER: An ambulance to transport the patient to a hospital.

DIANE: From a nursing home to the hospital or—

UNKNOWN SPEAKER: No. Just anywhere.

UNKNOWN SPEAKER: We have (inaudible) but maybe not. Something called a class five ambulance that might just be paramedics needing a transfer ambulance provide a good care.

UNKNOWN SPEAKER: I’ve got rapid response.

UNKNOWN SPEAKER: What?

UNKNOWN SPEAKER: Rapid response.

UNKNOWN SPEAKER: Rapid Response. Don’t have any answer for you. We’re going to need to get back with you on that one, Janet. Okay.

MIKE: Okay. All right. Let me take you through the survey template for performance measure 66-A that we have developed. I am the thorn between the sides of these two folks. If you all have your manual, the templates were inadvertently put in a section right in the middle, right after--it’s called the NEDARC update but it should’ve been in the previous section. But the templates are in there, about halfway through in the speaker handout section. So you have hardcopies of what I’m going to show you real quickly here. But NEDARC has developed some survey templates for three of the measures that are all on 66 here that we’ll show you where a survey could be utilized or might be very helpful. So this one is for 66-A and these are on our website at NEDARC.org. Well, let’s just go through this really quickly and I’ll show you. These survey templates have been designed to--can you hear me?

UNKNOWN SPEAKER: No.

MIKE: The survey templates have been designed to help all of you at a general level with each of these measures but they’ll probably all need to be adapted a little bit for your state’s particular needs. As you go through these, you need to look at that. And as you can read through the directions on here what we have on our website, it says that each of these templates has been developed for generic use but it will probably need to be adapted for you state. And specifically, there are parts in red on each of the survey templates that you need to look at and decide whether or not you need to modify that because we figured those are the areas that may need to be modified by the states. Let’s see if I can talk into this and also see at the same time. How many of you have actually begun the process of serving your providers on any of these areas? And did you send out some sort of a cover letter or a notification that went to these folks in advance or just sent the survey to them right off the bat?

UNKNOWN SPEAKER: We sent the survey (inaudible)

MIKE: Okay, so you sent a cover letter. Well, anyway, this is one of the things that we definitely recommend. You send some sort of a cover letter that explains the purpose of the survey. Keep it brief as you can but explain the purpose of the survey and the importance of the survey and the value of receiving all of the comments back from folks. There’s a bunch of additional information on our website specifically about survey development and tips and things that you might want to consider when sending a survey such as if you have any kind of an incentive or anything like that which will help to increase your response rates. These are all the things that we presented at our NEDARC workshop in April about survey development. Those are also on our website. So if you go, you’ll be able to look at these templates plus a bunch of information on surveys and tips for deploying surveys on our website. So we can get through this, let me just show you this template again for 66-A which has to do with on and offline medical direction. These are fairly, fairly basic surveys. They follow pretty much the wording that’s in the manual but with some clarifications that hopefully will be helpful for your providers.

But obviously you’re going to need to find out names of the people you are surveying and phone numbers and all that sort of a thing and the date of the survey completion.