Emergency Medicine International

Research Article

Payment Reforms for Prehospital Care Services in a Middle Income Country: Assessing Implementation and Patient Outcomes Using a Mixed-Methods Approach

Table 6

Comparison of quality of care processes and patient outcomes between participating EMS units and nonparticipating EMS units under the direct-pay system and the E-claim system.
Quality indicatorDirect-pay systemsE-claim system
Non-participating unitParticipating unitNon-participating unitParticipating unit
n(%)n(%)n(%)n(%)
Response time < 10 minutes964344 2241117  374402 442976  
 Yes821646(85.2)1896709(84.6)<0.001333783(89.2)387860(87.6)<0.001
 No142698(14.8)344408(15.4) 40619(10.8)55116(12.4) 
Airway management320224 699907  89358 114152  
 Inappropriate1574(0.5)2217(0.3)<0.001314(0.4)394(0.3)<0.001
 Appropriate305193(95.3)665803(95.1) 83872(93.9)109306(95.8) 
 Did not do13457(4.2)31887(4.6) 5172(5.8)4452(3.9) 
Bleeding control196361 367564  181161 224923  
 Inappropriate569(0.3)1183(0.3)<0.001572(0.3)572(0.3)<0.001
 Appropriate186672(95.1)342220(93.1) 171955(94.9)216896(96.4) 
 Did not do9120(4.6)24161(6.6) 8634(4.8)7455(3.3) 
Fluid replacement62235 148658  21392 23348  
 Inappropriate200(0.3)480(0.3)<0.00158(0.3)62(0.3)0.500
 Appropriate59199(95.1)143634(96.6) 20392(95.3)22204(95.1) 
 Did not do2836(4.6)4544(3.1) 942(4.4)1082(4.6) 
Fracture stabilization134012 265740  123190 158050  
 Inappropriate834(0.6)1683(0.6)<0.001797(0.6)945(0.6)<0.001
 Appropriate123614(92.2)241438(90.9) 115010(93.4)149619(94.7) 
 Did not do9564(7.1)22619(8.5) 7383(6)7486(4.7) 
Outcome of treatment1212785 2556614  449156 508811  
 Death15779(1.3)24767(1)<0.0014410(1)5110(1)<0.001
 Referral or length of stay > 30 days103682(8.5)218784(8.6) 41751(9.3)51939(10.2) 
 Length of stay < 30 days642944(53)1351751(52.9) 216169(48.1)242023(47.6) 
 Unknown result17644(1.5)22457(0.9) 5268(1.2)5522(1.1) 
 N/A432736(35.7)938855(36.7) 181558(40.4)204217(40.1)