Emergency Medical Services Outcomes Project III (EMSOP III): The role of risk adjustment in out-of-hospital outcomes research

Herbert G. Garrison, Ronald F. Maio, Daniel W Spaite, Jeffrey S. Desmond, Mary Ann Gregor, Patricia J. O'Malley, Ian G. Stiell, C. Gene Cayten, John L. Chew, Ellen J. MacKenzie, David R. Miller

Research output: Contribution to journalArticle

34 Scopus citations


The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out-of-hospital outcomes research. Fundamental to that purpose is the identification of priority conditions, risk-adjustment measures (RAMs), and outcome measures. In this third EMSOP article, we examine the topic of risk adjustment, discuss the relevance of risk adjustment for out-of-hospital outcomes research, and recommend RAMs that should be evaluated for potential use in emergency medical services (EMS) research. Risk adjustment allows better judgment about the effectiveness and quality of alternative therapies; it fosters a better comparison of potentially dissimilar groups of patients. By measuring RAMs, researchers account for an important source of variation in their studies. Core RAMs are those measures that might be necessary for out-of-hospital outcomes research involving any EMS condition. Potential core RAMs that should be evaluated for their feasibility, validity, and utility in out-of-hospital research include patient age and sex, race and ethnicity, vital signs, level of responsiveness, Glasgow Coma Scale, standardized time intervals, and EMS provider impression of the presenting condition. Potential core RAMs that could be obtained through linkage to other data sources and that should be evaluated for their feasibility, validity, and utility include principal diagnosis and patient comorbidity. We recommend that these potential core RAMs be systematically evaluated for use in risk adjustment of out-of-hospital patient groups that might be used for outcomes research.

Original languageEnglish (US)
Pages (from-to)79-88
Number of pages10
JournalAnnals of Emergency Medicine
Issue number1
Publication statusPublished - Jul 2002


ASJC Scopus subject areas

  • Emergency Medicine

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