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Development of prehospital care quality indicators for the Australian setting: a modified RAND/UCLA appropriateness method
  1. Robin Pap1,2,
  2. Craig Lockwood2,
  3. Matthew Stephenson2,
  4. Paul Simpson1
  1. 1 School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia
  2. 2 JBI, The University of Adelaide, Adelaide, South Australia, Australia
  1. Correspondence to Robin Pap, School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith NSW 2751, Australia; r.pap{at}


Background Globally, the measurement of quality is an important process that supports the provision of high-quality and safe healthcare services. The requirement for valid quality measurement to gauge improvements and monitor performance is echoed in the Australian prehospital care setting. The aim of this study was to use an evidence-informed expert consensus process to identify valid quality indicators (QIs) for Australian prehospital care provided by ambulance services.

Methods A modified RAND/UCLA appropriateness method was conducted with a panel of Australian prehospital care experts from February to May 2019. The proposed QIs stemmed from a scoping review and were systematically prepared within a clinical and non-clinical classification system, and a structure/process/outcome and access/safety/effectiveness taxonomy. Rapid reviews were performed for each QI to produce evidence summaries for consideration by the panellists. QIs were deemed valid if the median score by the panel was 7–9 without disagreement.

Results Of 117 QIs, the expert panel rated 84 (72%) as valid. This included 26 organisational/system QIs across 7 subdomains and 58 clinical QIs within 10 subdomains.

Most QIs were process indicators (n=62; 74%) while QIs describing structural elements and desired outcomes were less common (n=13; 15% and n=9; 11%, respectively). Non-exclusively, 18 (21%) QIs addressed access to healthcare, 21 (25%) described safety aspects and 64 (76%) specified elements contributing to effective services and care. QIs on general time intervals, such as response time, were not considered valid by the panel.

Conclusion This study demonstrates that with consideration of best available evidence a substantial proportion of QIs scoped and synthesised from the international literature are valid for use in the Australian prehospital care context.

  • prehospital care
  • quality improvement
  • emergency ambulance systems

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Evidence summaries are available on reasonable request.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Evidence summaries are available on reasonable request.

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  • Handling editor Caroline Leech

  • Twitter @robin_pap

  • Contributors RP conceived the project, designed the study and obtained ethics approval and research funding. CL, MS and PS supervised the conduct of the study. RP, PS and CL prepared the quality indicators. RP conducted the rapid reviews. RP and PS undertook recruitment of panellists and all authors were involved in the selection. RP moderated the consensus process, analysed the data and drafted the manuscript. All authors contributed to its revision. RP took responsibility for the paper as a whole.

  • Funding The project that this study forms part of is supported by an Australian Government Research Training Programme Scholarship and partially by a research grant from the Australasian College of Paramedicine (ACP).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.