Long-Term Outcomes Study
One important innovation we are completing for RACE-CARS is to measure the longer-term (up to 1 year) health status and QOL outcomes for the cardiac arrest survivors in the trial.
We are conducting quality of life (QOL) follow-up interviews for patients that survive a cardiac arrest to hospital discharge and evaluating the health care resources and costs required to institute and maintain the intervention strategy.
We have partnered with EMS agencies in each of the 62 participating counties to approach survivors and their caregivers and get permission for DCRI to conduct telephone-based structured interviews that will define more comprehensively their outcomes and extent of recovery/impairment.
The long-term outcomes study includes the following elements:
- Assessment of QOL and functional status (modified Rankin score, telephone version) at 3 and 12 months using validated scales
- Approximately 2,100 survivors
- Data collection through DCRI call center
- EMS agencies will send letter to survivors making them aware of the long-term follow-up study and providing contact information to opt out
- Survivors who do not opt out of the study will be contacted by DCRI call center at 3-month follow-up interval to explain the study, obtain verbal informed consent, and then conduct quality of life and functional status surveys.
Our primary goal of achieving more survivors to hospital discharge with good neurological function is important, but its health policy implications are strongly dependent on how well those survivors do long term and how much producing these incremental health benefits will cost counties.
Implementation Study
We will conduct a systematic assessment of the interventions, implementation, and impact using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework.
Quantitative and/or qualitative assessments of each intervention will be evaluated in accordance with the dimensions of the RE-AIM framework. Using the results of the mixed methods analysis, we will refine a proposed set of implementation strategies and dissemination methods to scale the RACE-CARS findings and successes in changing community care of cardiac arrest nationally.
The Implementation study includes the following elements:
- Both implementation staff and RACE-CARS staff will work to carry out analyses
- Identify early adopters of the implementation strategies used to improve bystander CPR and early defibrillation to improve survival
- Plan for both quantitative surveys and qualitative interviews at select time points throughout trial and intervention period to determine which strategies were most widely used and which of strategies are most effective across a range of barriers
- Develop a practical guide focused on adoption of evidence and supported practices of change on a national scale
Key Questions:
- What county and community-based characteristics (EMS resources, culture, and context) are associated with adoption of interventions to improve CPR and early defibrillation?
- What interventions are associated with increased reach, adoption, implementation, and maintenance of higher rates of CPR and early defibrillation?
- Which approaches were more or less successful in key subgroups, for example, racial/ethnic minorities or women?