North Dakota Emergency Medical Services Association

Medicare Rural Hospital Flexibility Program – EMS Supplement

HRSA Funding Opportunity Number: HRSA-19-095

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What is this funding received by the University of North Dakota, Center for Rural Health?

The Center for Rural Health (CRH) at UND administers the Flex grant program. On September 1, 2019 CRH UND was awarded the Flex EMS Supplement to address Focus Area 2: To implement a demonstration project on data collection and reporting for a set of rural-relevant EMS quality measures. North Dakota received one of only four funding opportunities nationwide. The overall concept involves seeking stakeholder consensus during the measure selection process, testing the processes for collection, training and mentoring, and reporting the measures. This three year supplement grant period will end on August 31, 2022.

Who are the partners in this data collection project?

The ND EMS Association will be the official sub award recipient of this EMS supplement. The CRH will work with the ND EMS Association and the ND Department of Health, Division of EMS to implement the proposed work plan. In addition, ESO of Austin, Texas will provide a number of services to aid in the success of this project. ESO is a rapidly growing technology company providing software applications, interoperability and data management solutions to EMS, fire departments and hospitals. Finally, identified subject matter experts (SME’s) who specialize in data collection and quality measures are also contracted partners in the project. These parties and other EMS stakeholders will comprise the ND EMS Quality Improvement Steering Committee. The committee’s purpose is to oversee the project; serve as a resource; and, to promote and disseminate the findings from the project. This committee will also select a Project Manager to work with the steering committee.

What is the role of the Project Manager?

This is a full-time salary and benefited position for the entire length of this project. The Project Manager will be the direct liaison between the steering committee, the ND EMS Association, and the subcontractors. This individual will also assist the Principal Investigator with budgets, contractual requirements and submission of quarterly and year-end progress reports to the steering committee and UND Center for Rural Health. The Project Manager will be responsible for activities such as;

  • Steering committee meetings, logistics, and minutes,
  • Outreach coordination to the EMS agencies,
  • Be a first-line troubleshoot for EMS agencies prior to elevation of the issue to SME’s or ESO staff,
  • All aspects related to the coordination of and hosting the train-the-trainer sessions,
  • All aspects related to the coordination of and hosting the EMS agency training sessions,
  • Scheduling, agenda planning, and facilitate the quarterly webinar sessions,
  • Coordinate a data training session for the state EMS annual conference.

What is the role of the Subject Matter Experts (SME’s)?

Recognizing that many rural EMS agency leaders do not have a strong knowledge of process improvement, each agency that is participating in this project will be assigned a SME and partnered with other EMS agencies of a similar call volume. This mentorship relationship will reduce the perceived difficulties of data collection and analysis by answering questions and problem solving at each agency’s level of comfort. The SME’s will be sub contracted and paid on an hourly basis of support and training that is provided.

Work of the SME’s will include, but not necessarily limited to the following;

  • Participation in the EMS supplement steering committee,
  • Gathering for a one day session to rank and prioritize existing measures,
  • Assist in identifying rural ND EMS agencies that will participate in this project (between 20-40 agencies),
  • Aid the Project Manager in development of the train-the-trainer QI curriculum for EMS agencies,
  • Lead or assist the education component of the QI training sessions for EMS agencies (2-3 sessions per year),
  • Act as a mentor to EMS agencies that are chosen to participate in this project (maximum of 4 agencies to 1 mentor) (average of 10 hours or less per month),
  • Participate in quarterly training sessions using the Project ECHO platform (as needed basis),
  • Support use of quality measures in rural EMS agencies (minimum of 5 measures selected).

What is the breakdown of the work plan of this EMS supplement QI project?

Activity 2.1: Coordinate Project Organizational Structure

a. Establish ND EMS Quality Improvement Program steering committee

b. Select a project manager to coordinate project activities

Activity 2.2: Identify Rural EMS Agencies for Participation

a. Identify subject matter experts to participate in this project

b. Select ND-based EMS agencies operating in rural settings to participate in evaluation of selected measures

Activity 2.3: Measure Selection

a. Extract data from both rural communities in ND and the ESO Solutions national dataset

b. Identify currently available clinical and performance measures and rank available measures

c. Host one day focus group sessions

Activity 2.4: Training

a. Train the trainer and statewide training sessions for SME’s and EMS agencies

b. Mentorship of EMS agency leaders

Activity 2.5: Data Collection and Analysis

a. Use ND EMS data repository to evaluate the feasibility of implementing identified clinical and performance measures using existing data collection practices and standard elements

b. Conduct virtual quarterly training sessions using Project ECHO platform

Activity 2.6: Support Use of Quality Measures in Rural EMS Agencies

a. Benchmark comparison of ND quality measure reports to ESO national dataset for rural EMS agencies

b. Disseminate measures locally and nationally to promote widespread use and tracking of improvement trends

What are the anticipated challenges for a project of this scope and nature?

  • Finding an appropriate number of Subject Matter Experts in ND,
  • Providing an adequate number of training sessions for unprepared EMS leaders,
  • Low volume or small subset of patient encounters in specific areas,
  • Identification of a Project Manager in a low unemployment state and competitive job market,
  • Large geographical state to travel for training and mentorship opportunities.

North Dakota EMS Association

1622 East Interstate Avenue, Bismarck, ND 58503


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