Objective: Nonemergency ambulance transports (NETs) represent a substantial proportion of all ambulance transports. Recently, the medical necessity of a substantial number of NETs has been questioned. The purpose of the study was threefold: 1) to formulate criteria for NET using a multidisciplinary panel; 2) to develop a structured implicit review instrument (SIRI) for the evaluation of NET from the criteria formulated; and 3) to evaluate the reliability and validity of the SIRI. Previously, a validated instrument has not been available to assess NET appropriateness.
Methods: Using a modified Delphi process and scale development techniques, a panel of ten multidisciplinary health care professionals determined criteria for NET and developed a SIRI consisting of two dimensions: 1) ambulation status and 2) medical care requirements. A convenience sample of 50 cases (occurring January through May 1996) were retrospectively reviewed by individual panel members and two panels, and categorized as either: 1) definitely appropriate NET; 2) possibly appropriate NET; 3) patient did not require ambulance transport; 4) patient required emergency transport; and 5) indeterminate. Reliability of the SIRI was assessed using percent agreement among individual panels and weighted kappa for the two panels. Interitem consistency of the SIRI was measured by Cronbach's alpha. Criterion validity was assessed by comparing percent agreements between the SIRI and Medicare reimbursement guidelines.
Results: Percent agreement among individual panel members was 62%. Percent agreement among the two panels was 74%, with a kappa of 0.43. Cronbach's alpha for individual panel member item response ranged from 0.647 to 0.960. Percent agreement with Medicare reimbursement guidelines was 92%.
Conclusion: Consensus criteria and an associated SIRI were developed for determining the appropriateness of NETs. Further research is needed to build on the validity and reliability of this instrument.