Association for Public Policy Analysis & Management

Cardiac arrest is an important public health issue that contributes to avoidable death and disability^.[i] Approximately one in ten persons experiencing out of hospital cardiac arrest (OHCA) survive to hospital discharge.i^{, [ii],[iii]} The application of cardiopulmonary resuscitation and use of an automated external defibrillator (AED) within minutes of cardiac arrest can save lives. However, the bystander public access defibrillation (PAD) rate in the United States is low (estimated at 11%).^[iv][v] PAD programs and policies aim to increase survival rates by making AEDs immediately available for bystanders use when and where they are needed.

To better understand the role of state law in lay bystander AED use, we assessed the association between evidence-informed state PAD laws and state-level outcome data captured via the Cardiac Arrest Registry to Enhance Survival (CARES). The initial step, involving concurrent early evidence review and state law assessment, provided the context and content of diverse state-level PAD laws and served to identify laws that were evidence-informed. The intent of CARES, a voluntary participant owned dataset with a catchment area of more than 105 million people across 42 states, is to assist communities in using standard outcome measures for Emergency Medical Services OHCA benchmarking and quality improvement efforts.[^vi] Linking CARES data to the evidence-informed state PAD laws presented both facilitators and challenges; some unique to PAD, others common across the breadth of public health practice.

This poster provides practical discussion of the methodological and contextual issues faced when linking CARES data to evidence-informed state PAD laws. From concerns about data de-identification in a voluntary participant owned dataset, to approximating CARES coverage within and across states, to considering how best to aggregate data over time while considering the complexities of changing state laws, we examine important, recurrent measurement issues that influence public health policy evaluation. Conclusions highlight the ongoing need for measurement systems that can capture critical public health outcomes in a timely way at multiple levels to support rigorous public health policy evaluation.