An article on a statewide MIH program in Florida is making the rounds within EMS trade journals.  EMS World and JEMS have both already covered it.  I was asked by EMS1‘s Editor-in-Chief to cover it, but given a variety of misgivings that I had about the integrity of the article it was decided to let sleeping dogs lie.

But that’s why I started my own website.

Article vs. Program Disclaimer
Any concerns I have exist around the study and subsequent paper.  I have not seen the data, nor the program in question.  I don’t doubt that the program is doing great things, I just worry that the level of its impact may be overstated in terms of how it was presented in the article.

I also have never met any of the authors.  I’m sure they are great men, doing great things.  But that doesn’t mean I can’t have issue with their attempt at publicizing the success of their business model via a peer-reviewed guise.

What I Loved
I should start by commending the authors for a couple of reasons:

1. Doing the intervention – As a huge fan and advocate for EMS in the public health and preventative medicine realms, I applaud their efforts to expand the MIH model.
2. Doing a study – EMS is poorly researched, so sometimes anything is better than nothing (more on that later).
3. Doing this study – Actuarial data within EMS is almost never researched. The authors are putting it in front of an EMS audience, which is exciting.
4. Publishing outside of EMS – I don’t know why they chose the journal that they did, but I have my suspicions.  Regardless of any misgivings, every time something relating to EMS is broadcast to a non-EMS audience, it has the potential to move the industry forward.

Langauge
In an effort to start with a clean slate, I try to read articles without paying attention to author name or background.  It sounds harder than it is, but since I’m more likely to remember useless details like your kid’s favorite sport than I am your name, it tends to work out in my favor.

Immediately I noticed verbose sentence and paragraph structures.  The level of detail around nonessential facts made this article read more like a book report than a peer-reviewed study.  But this is an online journal, so page limits may not apply.

What finally made me stop reading and start digging was the decision to name drop the team that calculated the results.  I’m not sure why that was pertinent.  I actually come from the tradition where, even if every author is from the same institution, the reader is never explicitly told where the research was conducted in an effort to maintain some semblance of anonymity.

Maybe I’m just old school.

Author Allegiance
All four authors work for the same parent company or one of its business units.  Envision Healthcare houses Evolution Health, EmCare, and AMR.

Three of the four authors are physicians, the fourth the senior director of actuarial services at Evolution Health.  Their names are well known within EMS, and tied to a number of other peer reviewed publications and successful EMS programs.

Evolution Health manages the organization which administers the MIH care coordination program that is being evaluated in this study.

Journal Choice
As an academic I pay attention to journal choice.  Most that will read this post have heard of NEJM, or Prehospital Emergency Care, and perhaps even Health Affairs.  But how many in EMS have heard of the Journal of Health Economics and Outcomes Research (JHEOR).

I hadn’t.  My department’s resident Health Economist hadn’t.

So I did some digging.  JHEOR is an open access journal,  which means anyone can read it without paying for a subscription.

But sometimes, you get what you pay for.

It promises that “manuscripts submitted to JHEOR are reviewed within 1 week. Accepted manuscripts are published as early as 24 hours after acceptance.”  As someone that has worked with more than a few qualified academics I can attest that evaluating a manuscript doesn’t take a week.  It takes an hour to two depending on length and complexity.

But getting two to four qualified reviewers to make that kind of time in their schedules means that more often than not you have to wait.  So with a seven day turnaround, I question how many reviewers evaluated this manuscript, and subsequently, how critically they did so.

 

The Paradox
EMS is a growing industry.  In the US it only recently gained subspecialty status under ABEM.  It’s still caught between trade and professional status.  There are only a handful of peer-reviewed journals that cover EMS, meaning that operational studies such as this are rarely given priority when competing with the 15th article from the latest cardiac arrest randomized control trial.  So, as I said earlier, sometimes any publication is a good publication.

But that’s not without its costs.

As such, both EMS as a whole, and individual researchers, must balance the desire to spread the gospel without inadvertently becoming snake oil salesmen.