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Activity Number: 308
Type: Contributed
Date/Time: Tuesday, August 2, 2016 : 8:30 AM to 10:20 AM
Sponsor: Health Policy Statistics Section
Abstract #318994
Title: Basic Versus Advanced Life Support Ambulances for Out-of-Hospital Medical Emergencies
Author(s): Prachi Sanghavi* and Anupam B. Jena and Joseph P. Newhouse and Alan M. Zaslavsky
Companies: The University of Chicago and Harvard Medical School and Harvard and Harvard Medical School
Keywords: Multilevel modeling ; Propensity scores ; Instrumental variables ; Comparative effectiveness analysis ; Health policy ; Medicare

Most Medicare patients seeking emergency medical transport are treated by ambulance providers trained in Advanced Life Support (ALS). Evidence supporting the superiority of ALS over Basic Life Support (BLS) is limited. We compared effects of ALS and BLS on health outcomes after out-of-hospital medical emergencies. We analyzed claims from a 20% sample of Medicare beneficiaries from non-rural counties between 2006-2011 with cardiac arrest, major trauma, stroke, acute myocardial infarction (AMI), or respiratory failure. To address unmeasured confounding, we exploited variation in geographic penetration in ALS rates across counties, using an instrumental variables approach. In particular, we predicted the probability of ALS use for each patient as a function of ALS rates in each county for patients with other diagnoses, using a multivariate multilevel logistic regression model. Survival to 90 days among trauma, stroke, cardiac arrest, and AMI patients was higher with BLS than ALS; respiratory failure patients did not exhibit differences in survival. ALS is associated with substantially higher mortality than BLS, and may harm patients through delayed hospital care and iatrogenic injury.

Authors who are presenting talks have a * after their name.

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