Measuring the Implementation Preferences of Emergency Medical Services Clinicians Using Discrete Choice Experiments

Abstract

Introduction

Prehospital research and evidence-based guidelines (EBGs) have grown in recent decades, yet there is still a paucity of prehospital implementation research. While recent studies have revealed EMS agency leadership perspectives on implementation, the important perspectives and opinions of frontline EMS clinicians regarding implementation have yet to be explored in a systematic approach. The objective of this study was to measure the preferences of EMS clinicians for the process of EBG implementation and whether current agency practices align with those preferences.

Methods

This study was a cross-sectional survey of National Registry of Emergency Medical Technicians registrants. Eligible participants were certified paramedics who were actively practicing EMS clinicians. The survey contained discrete choice experiments (DCEs) for three EBG implementation scenarios and questions about rank order preferences for various aspects of the implementation process. For the DCEs, we used multinomial logistic regression to analyze the implementation preference choices of EMS clinicians, and latent class analysis to classify respondents into groups by their preferences.

Results

A total of 183 respondents completed the survey. Respondents had a median age of 39 years, were 74.9% male, 89.6% White, and 93.4% of non-Hispanic ethnicity. For all three DCE scenarios, respondents were significantly more likely to choose options with hospital feedback and individual-level feedback from EMS agencies. Respondents were significantly less likely to choose options with email/online only education, no feedback from hospitals, and no EMS agency feedback to clinicians. In general, respondents’ preferences favored classroom-based training over in-person simulation. For all DCE questions, most respondents (66.2%–77.1%) preferred their survey DCE choice to their agency’s current implementation practices. In the rank order preferences, most participants selected “knowledge of the underlying evidence behind the change” as the most important component of the process of implementation.

Conclusions

In this study of EMS clinicians’ implementation preferences using DCEs, respondents preferred in-person education, feedback on hospital outcomes, and feedback on their individual performance. However, current practice at EMS agencies rarely matched those expressed EMS clinician preferences. Collectively, these results present opportunities for improving EMS implementation from the EMS clinician perspective.

Author contributions

JNF: study design and conceptualization, acquisition of funding, data collection, data analysis and interpretation, primary drafting of manuscript and revisions; CS: data analysis and interpretation, manuscript editing; SB: data collection, data interpretation, manuscript editing; CMG: study design, data interpretation, manuscript editing; CTR: study design, data interpretation, manuscript editing; JRP: study design, data collection, manuscript editing; ARP: study design, data collection, data interpretation, manuscript editing; RGS: study design and conceptualization, data interpretation, manuscript editing.

Acknowledgments

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors alone are responsible for the content and writing of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Research reported in this publication was supported by the University of Florida Clinical and Translational Sciences Institute, which is supported in part by the NIH National Center for Advancing Translational Sciences under award number UL1TR001427. Dr. Fishe’s activity on this study was supported in part by a career development award from NIH/NHLBI NHLBI (K23HL149991).