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Improving risk prediction for children seeking emergency medical services (EMS) care with non-emergent complaints

Award Number: K08HS029515
ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY
OPDIV: AHRQ
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP
PERIOD OF PERFORMANCE START DATE: 08/01/2024
PERIOD OF PERFORMANCE END DATE: 07/31/2029

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Improving risk prediction for children seeking emergency medical services (EMS) care with non-emergent complaints - ABSTRACT: Approximately 1.6 million children access the healthcare system through Emergency Medical Services (EMS) each year in the U.S. Despite an absence of validated EMS triage tools, 30% of all children are left at the scene, while many low acuity children are transported to an emergency department (ED) unnecessarily. This non-standardized EMS approach results in both under-triage and over-triage of children. The use of EMS for non-emergent complaints is unsafe because it causes delays in EMS response times for other patients and exacerbates ED overcrowding. Current EMS triage tools were not designed to identify children who can be safely managed without emergent transport to the ED. There is an urgent need for a pediatric EMS risk assessment tool (similar to the Emergency Severity Index [ESI] ED triage score developed with support from the Agency for Healthcare Research and Quality [AHRQ]). The Pediatric Observation Priority Score (POPS) was developed to identify children at low risk of deterioration in emergency settings. POPS has been validated in EDs with moderate/excellent inter-rater reliability between different healthcare professionals and is used in some EMS agencies in the United Kingdom. The acceptability and accuracy of the POPS tool in EMS is unknown. The overall goal of this proposal is to refine and pilot-test the POPS tool for use by EMS clinicians. This will be achieved through the following specific aims: (1) identify factors associated with under- triage for children not transported by EMS; (2) optimize the acceptability, appropriateness, and feasibility of the POPS tool with clinical end-users; and (3) assess the refined POPS tool through simulation and field pilot studies. Aim 1 will be conducted in a multisite retrospective analysis linking EMS records and Medicaid Claims data (a high-risk population). The POPS tool will be refined by incorporating factors found to be associated with under-triage. Aim 2 will be addressed using a mixed-methods approach with EMS clinicians. The POPS tool will be refined and iteratively assessed before pilot testing. Aim 3 will involve assessing the refined POPS tool in simulations with EMS clinicians and a feasibility field pilot test linking POPS scores with patient outcomes. These studies will generate preliminary data on tool accuracy and under and over-triage rates, leading to a national effectiveness trial of the refined POPS tool. A validated pediatric screening tool would enable urgently needed studies of EMS innovations (including treatment in place, telemedicine, and integration of primary care) for children, an AHRQ priority population. The Principal Investigator, Dr. Caleb Ward, is an early career physician-scientist with a strong clinical background in pediatrics, emergency medicine, and EMS. This award will foster his development as a researcher with content expertise in large database analytics, multisite EMS research, and implementation science. A mentorship team with expertise in these content areas will support Dr. Ward as he completes these research aims and related career development activities to ensure his transition to research independence.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $142,170 )
2026	2026	CHILDREN'S RESEARCH INSTITUTE	111 MICHIGAN AVE NW	WASHINGTON	DC	20010	DISTRICT OF COLUMBIA	USA	Research on Healthcare Costs, Quality and Outcomes	000	3	8/20/2026	NON-COMPETING CONTINUATION	$142,170
														Subtotal = $142,170

Issue Date FY: 2025 ( Subtotal = $142,476 )
2025	2025	CHILDREN'S RESEARCH INSTITUTE	111 MICHIGAN AVE NW	WASHINGTON	DC	20010	DISTRICT OF COLUMBIA	USA	Research on Healthcare Costs, Quality and Outcomes	001	2	9/12/2025	NON-COMPETING CONTINUATION	$142,476
2025	2024	CHILDREN'S RESEARCH INSTITUTE	111 MICHIGAN AVE NW	WASHINGTON	DC	20010	DISTRICT OF COLUMBIA	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	12/23/2024	NEW	$0
														Subtotal = $142,476

Issue Date FY: 2024 ( Subtotal = $141,998 )
2024	2024	CHILDREN'S RESEARCH INSTITUTE	111 MICHIGAN AVE NW	WASHINGTON	DC	20010	DISTRICT OF COLUMBIA	USA	Research on Healthcare Costs, Quality and Outcomes	000	1	7/25/2024	NEW	$141,998
														Subtotal = $141,998

Grand Total All Awards = $426,644

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Improving risk prediction for children seeking emergency medical services (EMS) care with non-emergent complaints

Award Number: K08HS029515

ORGANIZATION: AGENCY FOR HEALTH CARE RESEARCH AND QUALITY

OPDIV: AHRQ

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: TRAINING/TRAINEESHIP

PERIOD OF PERFORMANCE START DATE: 08/01/2024

PERIOD OF PERFORMANCE END DATE: 07/31/2029

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