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Galárraga O, Quijano-Ruiz A, Faytong-Haro M. The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador. WORLD DEVELOPMENT 2024; 181:106659. [PMID: 38911668 PMCID: PMC11192489 DOI: 10.1016/j.worlddev.2024.106659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.
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Affiliation(s)
| | - Alonso Quijano-Ruiz
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- The Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, China
| | - Marco Faytong-Haro
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- Pennsylvania State University, State College, PA, USA
- Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
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Ernecoff NC, Anhang Price R, Klein DJ, Haviland AM, Saliba D, Orr N, Gildner J, Gaillot S, Elliott MN. Which medicare advantage enrollees are at highest one-year mortality risk? Arch Gerontol Geriatr 2024; 124:105454. [PMID: 38703702 DOI: 10.1016/j.archger.2024.105454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/05/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND While a number of tools exist to predict mortality among older adults, less research has described the characteristics of Medicare Advantage (MA) enrollees at higher risk for 1 year mortality. OBJECTIVES To describe the characteristics of MA enrollees at higher mortality risk using patient survey data. RESEARCH DESIGN Retrospective cohort. SUBJECTS MA enrollees completing the 2019 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey. MEASURES Linked demographic, health, and mortality data from a sample of MA enrollees were used to predict 1-year mortality risk and describe enrollee characteristics across levels of predicted mortality risk. RESULTS The mortality model had a 0.80 c-statistic. Mortality risks were skewed: 6 % of enrollees had a ≥ 10 % 1-year mortality risk, while 45 % of enrollees had 1 % to < 5 % 1-year mortality risk. Among the high-risk (≥10 %) group, 47 % were age 85+ versus 12 % among those with mortality risk <5 %. 79 % were in fair or poor self-rated health versus 29 % among those with mortality risk of <5 %. 71 % reported needing urgent care in the prior 6 months versus 40 % among those with a mortality risk of 1 to<5 %. CONCLUSIONS Relatively few older adults enrolled in MA are at high 1-year mortality risk. Nonetheless, MA enrollees over age 85, in fair or poor health, or with recent urgent care needs are far more likely to be in a high mortality risk group.
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Affiliation(s)
- Natalie C Ernecoff
- RAND Corporation, 4570 Fifth Avenue Suite 600, Pittsburgh, PA 15213, United States
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Amelia M Haviland
- RAND Corporation and Carnegie Mellon University, 4800 Forbes Avenue, Hamburg Hall 2214, Pittsburgh, PA 15213, United States
| | - Debra Saliba
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States; University of California Los Angeles Borun Center, 10945 Le Conte Ave, Suite 2339, Los Angeles, CA 90095, United States; Los Angeles Veterans Administration GRECC, Los Angeles, CA, United States
| | - Nate Orr
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Jennifer Gildner
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Sarah Gaillot
- Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244, United States
| | - Marc N Elliott
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States.
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O'Connor L, Behar S, Refuerzo J, Mele X, Sundling E, Johnson SA, Faro JM, Lindenauer PK, Mattocks KM. Factors Impacting the Implementation of Mobile Integrated Health Programs for the Acute Care of Older Adults. PREHOSP EMERG CARE 2024:1-16. [PMID: 38498782 DOI: 10.1080/10903127.2024.2333034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/12/2024] [Indexed: 03/20/2024]
Abstract
Objective: Emergency services utilization is increasing in older adult populations. Many such encounters may be preventable with better access to acute care in the community. Mobile integrated health (MIH) programs leverage mobile resources to deliver care and services to patients in the out-of-hospital environment and have the potential to improve clinical outcomes and decrease health care costs; however, they have not been widely implemented. We assessed barriers, potential facilitators, and other factors critical to the implementation of MIH programs with key vested partners.Methods: Professional and community-member partners were purposefully recruited to participate in recorded structured interviews. The study team used the Practical Robust Implementation and Sustainability Model (PRISM) framework to develop an interview guide and codebook. Coders employed a combination of deductive and inductive coding strategies to identify common themes across partner groups.Results: The study team interviewed 22 participants (mean age 56, 68% female). A cohort of professional subject matter experts included physicians, paramedics, public health personnel, and hospital administrators. A cohort of lay community partners included patients and caregivers. Coders identified three prominent themes that impact MIH implementation. First, MIH is disruptive to existing clinical workflows. Second, using MIH to improve patients' experience during acute care encounters is key to intervention adoption. Finally, legislative action is needed to augment central financial and regulatory policies to ensure the adoption of MIH programs.Conclusions: Common themes impacting the implementation of MIH programs were identified across vested partner groups. Multilevel strategies are needed to address patient adoption, clinical partners' workflow, and legislative policies to ensure the success of MIH programs.
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Affiliation(s)
- Laurel O'Connor
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester Massachusetts, United States
| | - Stephanie Behar
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester Massachusetts, United States
| | - Jade Refuerzo
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester Massachusetts, United States
| | - Xhenifer Mele
- Department of Emergency Medicine, University of Massachusetts Chan Medical School, Worcester Massachusetts, United States
| | - Elsa Sundling
- Department of Industrial Management, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sharon A Johnson
- Robert A. Foisie School of Business, Worcester Polytechnic Institute, Worcester Massachusetts, United States
| | - Jamie M Faro
- Department of Population Health and Quantitative Sciences, University of Massachusetts Chan Medical School Worcester Massachusetts, United States
| | - Peter K Lindenauer
- Department of Healthcare Delivery and Population Sciences and Department of Medicine, University of Massachusetts Chan Medical School-Baystate, Springfield, MA
| | - Kristin M Mattocks
- Department of Population Health and Quantitative Sciences, University of Massachusetts Chan Medical School Worcester Massachusetts, United States
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Ulintz AJ, Gage CB, Powell JR, Wang HE, Panchal AR. Mobile Integrated Health Care Roles of US EMS Clinicians: A Descriptive Cross-Sectional Study. PREHOSP EMERG CARE 2023; 28:179-185. [PMID: 37141533 DOI: 10.1080/10903127.2023.2210219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/27/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Mobile integrated health care (MIH) leverages emergency medical services (EMS) clinicians to perform local health care functions. Little is known about the individual EMS clinicians working in this role. We sought to describe the prevalence, demographics, and training of EMS clinicians providing MIH in the United States (US). METHODS This is a cross-sectional study of US-based, nationally certified civilian EMS clinicians who completed the National Registry of Emergency Medical Technicians (NREMT) recertification application during the 2021-2022 cycle and completed the voluntary workforce survey. Workforce survey respondents self-identified their job roles within EMS, including MIH. If an MIH role was selected, additional questions clarified the primary role in EMS, type of MIH provided, and hours of MIH training received. We merged the workforce survey responses with the individual's NREMT recertification demographic profile. The prevalence of EMS clinicians with MIH roles and data on demographics, clinical care provided, and MIH training were calculated using descriptive statistics, including proportions with associated binomial 95% confidence intervals (CI). RESULTS Of 38,960 survey responses, 33,335 met inclusion criteria and 490 (1.5%; 95%CI 1.3-1.6%) EMS clinicians indicated MIH roles. Of these, 62.0% (95%CI 57.7-66.3%) provided MIH as their primary EMS role. EMS clinicians with MIH roles were present in all 50 states and certification levels included emergency medical technician (EMT) (42.8%; 95%CI 38.5-47.2%), advanced emergency medical technician (AEMT) (3.5%; 95%CI 1.9-5.1%), and paramedic (53.7%; 95%CI 49.3-58.1%). Over one-third (38.6%; 95%CI 34.3-42.9%) of EMS clinicians with MIH roles received bachelor's degrees or above, and 48.4% (95%CI 43.9%-52.8%) had been in their MIH roles for less than 3 years. Nearly half (45.6%; 95%CI 39.8-51.6%) of all EMS clinicians with primary MIH roles received less than 50 hours (h) of MIH training; only one-third (30.0%; 95%CI 24.7-35.6%) received more than 100 h of training. CONCLUSION Few nationally certified US EMS clinicians perform MIH roles. Only half of MIH roles were performed by paramedics; EMT and AEMT clinicians performed a substantial proportion of MIH roles. The observed variability in certification and training suggest heterogeneity in preparation and performance of MIH roles among US EMS clinicians.
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Affiliation(s)
- Alexander J Ulintz
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Christopher B Gage
- National Registry of Emergency Medical Technicians, Columbus, USA
- Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Jonathan R Powell
- National Registry of Emergency Medical Technicians, Columbus, USA
- Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Henry E Wang
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, USA
| | - Ashish R Panchal
- Department of Emergency Medicine, The Ohio State University College of Medicine, Columbus, USA
- National Registry of Emergency Medical Technicians, Columbus, USA
- Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
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Lurie T, Adibhatla S, Betz G, Palmer J, Raffman A, Andhavarapu S, Harris A, Tran QK, Gingold DB. Mobile integrated health-community paramedicine programs' effect on emergency department visits: An exploratory meta-analysis. Am J Emerg Med 2023; 66:1-10. [PMID: 36640693 DOI: 10.1016/j.ajem.2022.12.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Mobile Integrated Health Community Paramedicine (MIH-CP) programs are designed to increase access to care and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. Previous MIH-CP systematic reviews reported varied interventions, effect sizes, and a high prevalence of biased methods. We aimed to perform a meta-analysis on MIH-CP effect on ED visits, and to evaluate study designs' effect on reported effect sizes. We hypothesized biased methods would produce larger reported effect sizes. METHODS We searched Pubmed, Embase, CINAHL, and Scopus databases for peer-reviewed MIH-CP literature from January 1, 2000, to July 24, 2021. We included all full-text English studies whose program met the National Associations of Emergency Medical Technicians definition, reported ED visits, and had an MIH-CP related intervention and outcome. We established risk ratios for each included study through interpreting the reported data. We performed a random-effects and cumulative meta-analysis of ED visit data, tests of heterogeneity, and a moderator analysis to assess for factors influencing the magnitude of observed effect. RESULTS We identified 16 studies that reported ED visit data and included 12 in our meta-analysis. All studies were observational; 3 used matched controls, 6 pre-post controls, and 3 without controls. 7 studies' intervention were diversion/triage while 5 studies intervened with health education/home primary care services. Pooled risk ratio for our data set was 0.56 (95% confidence interval 0.42-0.74). Cumulative meta-analysis revealed that as of 2018 MIH-CP programs began to show consistent reductions in ED visits. Significant heterogeneity was seen among studies, with I-squared >90%. Moderator analysis showed reduced heterogeneity for matched-control studies. CONCLUSION Our data revealed MIH-CP programs were associated with a reduced risk of ED visits. Study design did not have a statistically significant influence on effect size, though it did influence heterogeneity. We would recommend future studies continue to use high levels of control to produce reliable data with lower heterogeneity.
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Affiliation(s)
- Tucker Lurie
- Wellspan York Hospital, Department of Emergency Medicine, 1001 South George Street, York, PA 17403, USA.
| | - Srikar Adibhatla
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Gail Betz
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Jamie Palmer
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Alison Raffman
- Hennepin County Medical Center, Department of Emergency Medicine, 730 S 8th St, Minneapolis, MN 55415, United States of America.
| | - Sanketh Andhavarapu
- University of Maryland at College Park, College Park, MD 20742, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA.
| | - Andrea Harris
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA.
| | - Quincy K Tran
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street; 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, Baltimore, MD 21201, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA.
| | - Daniel B Gingold
- University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street; 6th Floor, Suite 200, Baltimore, MD 21201, USA.
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Louras N, Reading Turchioe M, Shafran Topaz L, Demetres MR, Ellison M, Abudu-Solo J, Blutinger E, Munjal KG, Daniels B, Masterson Creber RM. Mobile Integrated Health Interventions for Older Adults: A Systematic Review. Innov Aging 2023; 7:igad017. [PMID: 37090165 PMCID: PMC10114527 DOI: 10.1093/geroni/igad017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Indexed: 03/04/2023] Open
Abstract
Background and Objectives Mobile integrated health (MIH) interventions have not been well described in older adult populations. The objective of this systematic review was to evaluate the characteristics and effectiveness of MIH programs on health-related outcomes among older adults. Research Design and Methods We searched Ovid MEDLINE, Ovid EMBASE, CINAHL, AgeLine, Social Work Abstracts, and The Cochrane Library through June 2021 for randomized controlled trials or cohort studies evaluating MIH among adults aged 65 and older in the general community. Studies were screened for eligibility against predefined inclusion/exclusion criteria. Using at least 2 independent reviewers, quality was appraised using the Downs and Black checklist and study characteristics and findings were synthesized and evaluated for potential bias. Results Screening of 2,160 records identified 15 studies. The mean age of participants was 67 years. The MIH interventions varied in their focus, community paramedic training, types of assessments and interventions delivered, physician oversight, use of telemedicine, and post-visit follow-up. Studies reported significant reductions in emergency call volume (5 studies) and immediate emergency department (ED) transports (3 studies). The 3 studies examining subsequent ED visits and 4 studies examining readmission rates reported mixed results. Studies reported low adverse event rates (5 studies), high patient and provider satisfaction (5 studies), and costs equivalent to or less than usual paramedic care (3 studies). Discussion and Implications There is wide variability in MIH provider training, program coordination, and quality-based metrics, creating heterogeneity that make definitive conclusions challenging. Nonetheless, studies suggest MIH reduces emergency call volume and ED transport rates while improving patient experience and reducing overall health care costs.
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Affiliation(s)
- Nathan Louras
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Leah Shafran Topaz
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Michelle R Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, New York, USA
| | - Melani Ellison
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Jamie Abudu-Solo
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, USA
| | - Erik Blutinger
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Kevin G Munjal
- Department of Emergency Medicine, Mount Sinai Icahn School of Medicine, New York, New York, USA
| | - Brock Daniels
- Department of Emergency Medicine, Weill Cornell Medicine, New York, New York, USA
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Adibhatla S, Lurie T, Betz G, Palmer J, Raffman A, Andhavarapu S, Harris A, Tran QK, Gingold DB. A Systematic Review of Methodologies and Outcome Measures of Mobile Integrated Health-Community Paramedicine Programs. PREHOSP EMERG CARE 2022; 28:168-178. [PMID: 36260780 DOI: 10.1080/10903127.2022.2138654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/10/2022] [Accepted: 10/16/2022] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Mobile integrated health-community paramedicine (MIH-CP) uses patient-centered, mobile resources in the out-of-hospital environment to increase access to care and reduce unnecessary emergency department (ED) usage. The objective of this systematic review is to characterize the outcomes and methodologies used by MIH-CP programs around the world and assess the validity of the ways programs evaluate their effectiveness. METHODS The PubMed, Embase, CINAHL, and Scopus databases were searched for peer-reviewed literature related to MIH-CP programs. We included all full-length studies whose programs met the National Association of Emergency Medical Technicians definition, had MIH-CP-related interventions, and measured outcomes. We excluded all non-English papers, abstract-only, and incomplete studies. RESULTS Our initial literature review identified 6434 titles. We screened 178 full-text studies to assess for eligibility and identified 33 studies to include in this review. These 33 include four randomized controlled trials, 17 cohort studies, eight 8 case series, and four 4 cross-sectional studies. Of the 29 non-randomized trials, five used matched controls, 13 used pre-post, and 11 used no controls. Outcomes measured were hospital usage (24 studies), ED visits (15), EMS usage (23), patient satisfaction (8), health-related outcomes (8), and cost (9). Studies that evaluated hospital usage reported one of several outcome measures: hospital admissions (11), ED length of stay (3), and hospital readmission rate (2). EMS usage was measured by ambulance transports (12) and EMS calls (10). Cost outcomes observed were ambulance transport savings (7), ED visit savings (4), hospital admission savings (3), and cost per quality-adjusted life year (2). CONCLUSION Most studies assessing MIH-CP programs reported success of their interventions. However, significant heterogeneity of outcome measures and varying quality of study methodologies exist among studies. Future studies designed with adequately matched controls and applying uniform core metrics for cost savings and health care usage are needed to better evaluate the effectiveness of MIH-CP programs.
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Affiliation(s)
| | - Tucker Lurie
- Department of Emergency Medicine, Wellspan York Hospital, York, Pennsylvania
| | - Gail Betz
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Jamie Palmer
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Alison Raffman
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Sanketh Andhavarapu
- University of Maryland at College Park, College Park, Maryland
- The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, Maryland
| | - Andrea Harris
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Quincy K Tran
- University of Maryland School of Medicine, Baltimore, Maryland
- University of Maryland at College Park, College Park, Maryland
- The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, Maryland
- Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, Maryland
| | - Daniel B Gingold
- University of Maryland School of Medicine, Baltimore, Maryland
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland
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Noel L, Chen Q, Petruzzi LJ, Phillips F, Garay R, Valdez C, Aranda MP, Jones B. Interprofessional collaboration between social workers and community health workers to address health and mental health in the United States: A systematised review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6240-e6254. [PMID: 36269094 PMCID: PMC10675993 DOI: 10.1111/hsc.14061] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/14/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Collaboration between social workers (SW) and community health workers (CHW) plays an essential role in addressing health inequities in the United States (US). However, little is known about the current state of CHW/SW collaboration. The objectives of this review were to identify (a) the nature, goals and setting of CHWs and SW collaboration; (b) the patient outcomes utilised to measure intervention efficacy. The literature search was conducted in December 2020 using six databases. The inclusion criteria were (1) interventions that included CHWs and SWs; (2) US-based; (3) published between 2000-2020; (4) peer-reviewed journal articles; (5) examining health or mental health outcomes. Search results identified 281 articles, and 15 were included in the final analysis. Settings that utilised SW/CHW collaboration included outpatient clinics (n = 10); community organisations (n = 4) or hospital (n = 1). CHW and SW interventions focused on disease prevention (n = 8), chronic care (n = 4) and mental health (n = 3). Health outcomes were the most evaluated (n = 13), and significant improvement of at least one health outcome was reported in those studies. Mental health outcomes (n = 3) were also significantly improved, while social determinants of health (n = 2) were least common and descriptive only. This is the first review of SW and CHW collaboration. Clarity regarding SW and CHW roles and scopes of practice are needed to understand better SW/CHW collaboration and its impacts on community health outcomes and improve the process of collaboration. SW and CHW collaboration may increase clients' access to preventive care, mental health and address health inequities.
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Affiliation(s)
- Lailea Noel
- Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas, USA
| | - Qi Chen
- Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas, USA
| | - Liana J. Petruzzi
- Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas, USA
| | - Farya Phillips
- Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas, USA
- Dell Medical School, Health Social Work, Austin, Texas, USA
| | - Ricardo Garay
- Dell Medical School, Population Health, Austin, Texas, USA
| | - Carmen Valdez
- Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas, USA
- Dell Medical School, Population Health, Austin, Texas, USA
| | - María P. Aranda
- University of Southern California Susanne Dworak-Peck School of Social Work, Los Angeles, California, USA
| | - Barbara Jones
- Steve Hicks School of Social Work at the University of Texas at Austin, Austin, Texas, USA
- Dell Medical School, Health Social Work, Austin, Texas, USA
- Dell Medical School, LIVESTRONG Cancer Institutes, Austin, Texas, USA
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Munjal KG, Yeturu SK, Chapin HH, Tan N, Gregoriou D, Garcia D, Grudzen C, Hwang U, Morano B, Neher H, Gorbenko K, Youngblood G, Misra A, Dietrich S, Gonzalez C, Appel G, Jacobs E, Siu A, Richardson LD. Feasibility of the Transport PLUS intervention to improve the transitions of care for patients transported home by ambulance: a non-randomized pilot study. Pilot Feasibility Stud 2022; 8:169. [PMID: 35932067 PMCID: PMC9354351 DOI: 10.1186/s40814-022-01138-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/28/2022] [Indexed: 12/03/2022] Open
Abstract
Background The growing population of patients over the age of 65 faces particular vulnerability following discharge after hospitalization or an emergency room visit. Specific areas of concern include a high risk for falls and poor comprehension of discharge instructions. Emergency medical technicians (EMTs), who frequently transport these patients home from the hospital, are uniquely positioned to aid in mitigating transition of care risks and are both trained and utilized to do so using the Transport PLUS intervention. Methods Existing literature and focus groups of various stakeholders were utilized to develop two checklists: the fall safety assessment (FSA) and the discharge comprehension assessment (DCA). EMTs were trained to administer the intervention to eligible patients in the geriatric population. Using data from the checklists, follow-up phone calls, and electronic health records, we measured the presence of hazards, removal of hazards, the presence of discharge comprehension issues, and correction or reinforcement of comprehension. These results were validated during home visits by community health workers (CHWs). Feasibility outcomes included patient acceptance of the Transport PLUS intervention and accuracy of the EMT assessment. Qualitative feedback via focus groups was also obtained. Clinical outcomes measured included 3-day and 30-day readmission or ED revisit. Results One-hundred three EMTs were trained to administer the intervention and participated in 439 patient encounters. The intervention was determined to be feasible, and patients were highly amenable to the intervention, as evidenced by a 92% and 74% acceptance rate of the DCA and FSA, respectively. The majority of patients also reported that they found the intervention helpful (90%) and self-reported removing 40% of fall hazards; 85% of such changes were validated by CHWs. Readmission/revisit rates are also reported. Conclusions The Transport PLUS intervention is a feasible, easily implemented tool in preventative community paramedicine with high levels of patient acceptance. Further study is merited to determine the effectiveness of the intervention in reducing rates of readmission or revisit. A randomized control trial has since begun utilizing the knowledge gained within this study.
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Affiliation(s)
- Kevin G Munjal
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Sai Kaushik Yeturu
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA.
| | - Hugh H Chapin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Nadir Tan
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Diana Gregoriou
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Daniela Garcia
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Corita Grudzen
- Department of Emergency Medicine, New York University School of Medicine, New York, NY, USA
| | - Ula Hwang
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Barbara Morano
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Hayley Neher
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Ksenia Gorbenko
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA.,Institute for Health Equity Research and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Glen Youngblood
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Anjali Misra
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Staley Dietrich
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Cyndi Gonzalez
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA
| | - Giselle Appel
- Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Erica Jacobs
- George Washington University School of Medicine, Washington D.C., USA
| | - Albert Siu
- Department of Geriatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lynne D Richardson
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1620, New York, NY, 10029, USA.,Institute for Health Equity Research and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Ciasullo MV, Lim WM, Manesh MF, Palumbo R. The patient as a prosumer of healthcare: insights from a bibliometric-interpretive review. J Health Organ Manag 2022; 36:133-157. [PMID: 35383429 DOI: 10.1108/jhom-11-2021-0401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Healthcare policies around the globe are aimed at achieving patient-centeredness. The patient is understood as a prosumer of healthcare, wherein healthcare service co-production and value co-creation take center stage. The article endeavors to unpack the state of the literature on the innovations promoting the transition toward patient-centeredness, informing policy and management interventions fostering the reconceptualization of the patient as a prosumer of healthcare services. DESIGN/METHODOLOGY/APPROACH A hybrid review methodology consisting of a bibliometric-interpretive review following the Scientific Procedures and Rationales for Systematic Literature Reviews (SPAR-4-SLR) protocol is used. The bibliometric component enabled us to objectively map the extant scientific knowledge into research streams, whereas the interpretive component facilitated the critical analysis of research streams. FINDINGS Patient-centeredness relies on a bundle of innovations that are enacted through a cycle of patients' activation, empowerment, involvement and engagement, wherein the omission of any steps arrests the transition toward service co-production and value co-creation. Institutional, organizational and cognitive barriers should be overcome to boost the transition of patients from consumers to prosumers in a patient-centered model of healthcare. ORIGINALITY/VALUE The article delivers the state of the art of the scientific literature in the field of innovations aimed at sustaining the transition toward patient-centeredness and provides some food for thoughts to scholars and practitioners who wish to push forward service co-production and value co-creation in healthcare.
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Affiliation(s)
- Maria Vincenza Ciasullo
- Department of Management and Innovation Systems, University of Salerno, Salerno, Italy.,Faculty of Business, Design and Arts, Swinburne University of Technology, Kuching, Malaysia.,Department of Management, University of Isfahan, Isfahan, Iran
| | - Weng Marc Lim
- School of Business, Law and Entrepreneurship, Swinburne University of Technology, Melbourne, Australia.,Faculty of Business, Design and Arts, Swinburne University of Technology, Kuching, Malaysia
| | | | - Rocco Palumbo
- Department of Management and Law, University of Rome Tor Vergata, Roma, Italy
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11
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Xie F, Yan J, Agarwal G, Ferron R. Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams. JAMA Netw Open 2021; 4:e210055. [PMID: 33625510 PMCID: PMC7905495 DOI: 10.1001/jamanetworkopen.2021.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
IMPORTANCE Mobile integrated health care (MIH) is a new model of community-based health care to provide on-site urgent or nonurgent care. Niagara emergency medical services (NEMS) started MIH in 2018 to serve the Niagara region of Ontario, Canada. However, its economic impact is unknown. OBJECTIVE To compare time on task and cost between MIH and ambulance delivered by NEMS from a public payer's perspective. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was an analysis of the NEMS databases regarding responses to emergency calls by the NEMS from 2016 to 2019. Emergency calls serviced by MIH in 2018 to 2019 were used as an intervention cohort. Propensity score matching was used to identify a 1:1 matched cohort of calls serviced by regular ambulance response for the same period and 2 years prior. Statistical analyses were performed from January to April 2020. EXPOSURES MIH compared with matched ambulance services. MAIN OUTCOMES AND MEASURES The main outcomes were the time on task (including time on scene and time at hospital) and costs. Costs were calculated in 2019 Canadian dollars using cost per minute and compared with the 3 ambulance cohorts. RESULTS In 2018 to 2019, there were 1740 calls serviced by MIH for which a matched ambulance cohort was identified for the same period and 2 years prior. The mean (SD) time on task was 72.7 (51.0) minutes for MIH, compared with 84.1 (52.0) minutes, 84.3 (54.1) minutes, and 79.4 (42.0) minutes for matched ambulance in 2018 to 2019, 2017 to 2018, and 2016 to 2017, respectively. Of calls serviced by MIH, 498 (28.6%) required ED transport (ie, after MIH team assessment, transport to ED was deemed to be necessary or demanded by the patient), compared with 1300 (74.7%) calls serviced by ambulance in 2018 to 2019, 1294 (74.4%) in 2017 to 2018, and 1359 (78.1%) in 2016 to 2017. The mean (SD) total cost per 1000 calls was $122 760 ($78 635) for MIH compared with $294 336 ($97 245), $299 797 ($104 456), and $297 269 ($81 144) for regular ambulance responses in the 3 matched cohorts, respectively. CONCLUSIONS AND RELEVANCE Compared with regular ambulance response, MIH was associated with a substantial reduction in the proportion of patients transported to the ED, leading to a substantial saving in total costs. This finding suggests that the MIH model is a promising and viable solution to meeting urgent health care needs in the community, while substantially improving the use of scarce health care resources.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Ontario, Canada
| | - Jiajun Yan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Gina Agarwal
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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12
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Ho V, Chen C, Ho S, Hooi B, Chin LS, Merchant RA. Healthcare utilisation in the last year of life in internal medicine, young-old versus old-old. BMC Geriatr 2020; 20:495. [PMID: 33228566 PMCID: PMC7685638 DOI: 10.1186/s12877-020-01894-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background With increasing cost of healthcare in our aging society, a consistent pain point is that of end-of-life care. It is particularly difficult to prognosticate in non-cancer patients, leading to more healthcare utilisation without improving quality of life. Additionally, older adults do not age homogenously. Hence, we seek to characterise healthcare utilisation in young-old and old-old at the end-of-life. Methods We conducted a single-site retrospective review of decedents under department of Advanced Internal Medicine (AIM) over a year. Young-old is defined as 65–79 years; old-old as 80 years and above. Data collected was demographic characteristics; clinical data including Charlson Comorbidity Index (CCI), FRAIL-NH and advance care planning (ACP); healthcare utilisation including days spent in hospital, hospital admissions, length of stay of terminal admission and clinic visits; and quality of end-of-life care including investigations and symptomatic control. Documentation was individually reviewed for quality of communication. Results One hundred eighty-nine older adult decedents. Old-old decedents were mostly females (63% vs. 42%, p = 0.004), higher CCI scores (7.7 vs 6.6, p = 0.007), similarly frail with lower polypharmacy (62.9% vs 71.9%, p = 0.01). ACP uptake was low in both, old-old 15.9% vs. young-old 17.5%. Poor prognosis was conveyed to family, though conversation did not result in moderating extent of care. Old-old had less healthcare utilisation. Adjusting for sex, multimorbidity and frailty, old-old decedents had 7.3 ± 3.5 less hospital days in their final year. Further adjusting for cognition and residence, old-old had 0.5 ± 0.3 less hospital admissions. When accounted for home care services, old-old spent 2.7 ± 0.8 less hospital days in their last admission. Conclusion There was high healthcare utilisation in older adults, but especially young-old. Enhanced education and goal-setting are needed in the acute care setting. ACP needs to be reinforced in acute care with further research to evaluate if it reduces unnecessary utilisation at end-of-life.
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Affiliation(s)
- Vanda Ho
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.
| | - Cynthia Chen
- Saw Swee Hock School of Public Health, National University Singapore, Singapore, Singapore
| | - Sara Ho
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Hooi
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Loo Swee Chin
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Reshma Aziz Merchant
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore
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13
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Senderovich H, McFadyen K. Palliative Care: Too Good to Be True? Rambam Maimonides Med J 2020; 11:RMMJ.10394. [PMID: 32213278 PMCID: PMC7571433 DOI: 10.5041/rmmj.10394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Many patients and their families are hesitant to consult a palliative care (PC) team. In 2014, approximately 6,000,000 people in the United States could benefit from PC, and this number is expected to increase over the next 25 years. OBJECTIVES The purpose of this review is to shed light on the significance of PC and provide a holistic view outlining both the benefits and existing barriers. METHODS A literature search was conducted using MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, and Web of Science to identify articles published in journals from 1948 to 2019. A narrative approach was used to search the grey literature. DISCUSSION Traditionally, the philosophy behind PC was based on alleviating suffering associated with terminal illnesses; PC was recommended only after other treatment options had been exhausted. However, the tenets of PC are applicable to anyone with a life-threatening illness as it is beneficial in conjunction with traditional treatments. It is now recognized that PC services are valuable when initiated alongside disease-modifying therapy early in the disease course. Studies have shown that PC decreased total symptom burden, reduced hospitalizations, and enabled patients to remain safely at home. CONCLUSION As the population ages and chronic illnesses become more widespread, there continues to be a growing need for PC programs. The importance of PC should not be overlooked despite existing barriers such as the lack of professional training and the cost of implementation. Education and open discussion play essential roles in the successful early integration of PC.
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Affiliation(s)
- Helen Senderovich
- Geriatrics & Palliative Care & Pain Medicine, Baycrest Health Sciences, Toronto, Ontario, Canada
- Assistant Professor of the University of Toronto, Department of Family and Community Medicine, Division of Palliative Care, Toronto, Ontario, Canada
- To whom correspondence should be addressed. E-mail:
| | - Kristen McFadyen
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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14
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Kearns R, Harris-Roxas B, McDonald J, Song HJ, Dennis S, Harris M. Implementing the Patient Activation Measure (PAM) in clinical settings for patients with chronic conditions: a scoping review. INTEGRATED HEALTHCARE JOURNAL 2020. [DOI: 10.1136/ihj-2019-000032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
ObjectiveThe Patient Activation Measure (PAM) assesses the knowledge, skills and confidence of patients to manage their health, and has been consistently used as an outcome measure of health interventions. Using the PAM to tailor interventions to a patient’s activation level is less understood. This literature review aimed to examine evidence for interventions using the PAM to tailor care for patients with chronic conditions, including enablers and barriers to implementation, and the impact on quality of care.Methods and analysisA scoping review methodology was used to identify literature reporting on PAM-tailored interventions. The Insignia Health website and Medline database were searched. Included papers were published in English from 2004 to 2017, from Organisation for Economic Cooperation and Development countries, included adult patients with chronic conditions, and a PAM-tailored intervention. Eligible full-text papers were assessed against the inclusion criteria. Data were extracted into tables and summarised to assess the key findings, recurring themes and differences across papers.ResultsTwenty-one papers describing the use of PAM-tailored interventions (n=21) were identified. Interventions included motivational interviewing, health coaching, self-management planning and risk profile assessment. The perceived value and function of the PAM held by organisations, clinicians and patients influenced implementation and use. Evidence for the impact of PAM-tailored interventions on quality of care was limited.ConclusionThe PAM is being used to tailor a range of interventions for patients with chronic conditions. Clinician perceptions and understanding about the PAM’s value and purpose influenced implementation. Further research is needed about how PAM-tailored interventions can be integrated into clinical practice, and guide the patient-clinician interaction, in ways that improve the quality of patient care.
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15
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Thurman WA, Moczygemba LR, Tormey K, Hudzik A, Welton-Arndt L, Okoh C. A scoping review of community paramedicine: evidence and implications for interprofessional practice. J Interprof Care 2020; 35:229-239. [PMID: 32233898 DOI: 10.1080/13561820.2020.1732312] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Community paramedicine (CP) is an evolving method of providing community-based health care in which paramedics function outside of their traditional emergency response roles in order to improve access to primary and preventive health care and to basic social services. Early evidence indicates that CP programs have contributed to reducing health care utilization and improving patient outcomes leading some to call for a transformation of EMS into value-based mobile healthcare fully integrated within an interprofessional care team. The purpose of this scoping review was to understand the evidence base of CP in order to inform the further evolution of this model of care. Following the PRISMA extension for Scoping Reviews, 1,163 titles were screened by our research team. Eligibility criteria were publication in English after January 1, 2000; description of a CP program located in a Western nation; and inclusion of a discussion of outcomes. Twenty-nine publications met the criteria for inclusion. The literature was varied in terms of study design, program purpose, and target audience. The lack of rigorous, longitudinal studies with control groups makes rendering conclusions as to the value and effectiveness of CP programs difficult. Further, the extent to which community paramedics operate within interprofessional teams remains unclear. However, some programs demonstrated improvement in both health services and patient outcomes. As stakeholders continue to explore the potential of CP, results of this review highlight the importance of further investigation of outcomes, the professional identity of the community paramedic, and the role of the community paramedic on interprofessional teams.
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16
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Hosseinzadeh H, Verma I, Gopaldasani V. Patient activation and Type 2 diabetes mellitus self-management: a systematic review and meta-analysis. Aust J Prim Health 2020; 26:431-442. [DOI: 10.1071/py19204] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
Patient activation has been recognised as a reliable driver of self-management decision-making. This systematic review and meta-analysis examines existing evidence on whether embedding patient activation within Type 2 diabetes mellitus (T2DM) self-management programs can improve patient outcomes. This review has included 10 randomised controlled trials (RCTs) conducted between 2004 and 2019 retrieved from well-known databases such as MEDLINE, PubMed, CINAHL Plus, Scopus, ProQuest and ScienceDirect. The eligible RCTs were excluded if they scored low according to Cochrane Collaboration’s ‘risk of bias’ criteria. Random-effects meta-analyses showed that there were no significance changes in haemoglobin A1C (HbA1c), body mass index (BMI) and patient activation measure (PAM) between intervention and control groups after the intervention; however, the systematic review findings indicated that an improved patient activation level led to significant improvements in T2DM self-management and clinical outcomes including HbA1c level. Studies with a longer follow-up period conducted in community settings and delivered by peer coaches were more likely to lead to significant improvement in both patient activation levels and T2DM self-management and clinical outcomes. This review concludes that patient activation can be used as a reliable tool for improving T2DM self-management and clinical outcomes.
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17
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Geskey JM, Grile C, Jennings N, Good H, Crawford A, Kaminski M. Use of Postdischarge Emergency Medical Services to Reduce Hospital Readmissions: Does It Work and Is It Economically Feasible? Popul Health Manag 2019; 23:220-225. [PMID: 31589089 DOI: 10.1089/pop.2019.0125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A new model of community health delivery has utilized emergency medical services (EMS) to manage care transitions and provide chronic care services in patients' homes. The authors performed a retrospective, case-controlled analysis of a quality improvement project that examined whether an EMS home visit to recently discharged inpatients from the zip code where EMS provides services can reduce 30-day unscheduled ED visits and hospital readmissions. Additionally, the financial impact from the perspective of the community-based EMS provider and the community hospital from which patients were discharged was examined. A total of 53 patients and 53 controls were matched on the following variables: readmission risk score, age, sex, insurance status, and case management intervention. Patients who received the intervention had a 44% relative reduction of 30-day ED visits (17% vs 24.5%, P = 0.3381) and a 28.4% relative reduction in 30-day readmissions (18.9% vs 26.4%, P = 0.3532) but neither achieved statistical significance. The intervention cost to EMS was $1937; the intervention led to a $3626 profit for the hospital compared to a loss of $9915 for the control group. Use of local EMS providers may lead to enhanced health care and financial outcomes for community hospitals but the study was underpowered to make a definitive conclusion. However, the results may allow health systems to assess whether collaboration with local EMS providers can improve outcomes at a lower cost.
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Affiliation(s)
- Joseph M Geskey
- OhioHealth Doctors Hospital, Columbus, Ohio, USA.,Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Chris Grile
- Norwich Township Emergency Medical Services, Hilliard, Ohio, USA
| | - Nathan Jennings
- Norwich Township Emergency Medical Services, Hilliard, Ohio, USA
| | - Heith Good
- Norwich Township Emergency Medical Services, Hilliard, Ohio, USA
| | - Albert Crawford
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Mitchell Kaminski
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
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18
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Community paramedicine: A systematic review of program descriptions and training. CAN J EMERG MED 2019; 21:749-761. [DOI: 10.1017/cem.2019.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTObjectivesThe aim of this study is to identify the types of community paramedicine programs and the training for each.MethodsA systematic review of MEDLINE, Embase, grey literature, and bibliographies followed a search strategy using common community paramedicine terms. All studies published in English up to January 22, 2018, were captured. Screening and extraction were completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality (full methodology on PROSPERO: CRD42017051774).ResultsFrom 3,004 papers, there were 64 papers identified (58 unique community paramedicine programs). Of the papers with an appraisable study design (40.6%), the median MMAT score was 3 of 4 criteria met, suggesting moderate quality. Programs most often served frequent 911 callers (48.3%) and individuals at risk for emergency department admission, readmission, or hospitalization (41.4%); and 70.7% of programs were preventive home visits. Common services provided were home assessment (29.5%), medication management (39.7%), and referral and/or transport to community services (37.9%); and 77.6% of programs involved interprofessional collaboration. Community paramedicine training was described by 57% of programs and expanded upon traditional paramedicine training and emphasized technical skills. Study heterogeneity prevented meta-analysis.ConclusionCommunity paramedicine programs and training were diverse and allowed community paramedics to address a spectrum of population health and social needs. Training was poorly described. Enabling more programs to assess and report on program and training outcomes would support community paramedicine growth and the development of formalized training or education frameworks.
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Gregg A, Tutek J, Leatherwood MD, Crawford W, Friend R, Crowther M, McKinney R. Systematic Review of Community Paramedicine and EMS Mobile Integrated Health Care Interventions in the United States. Popul Health Manag 2019; 22:213-222. [PMID: 30614761 DOI: 10.1089/pop.2018.0114] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Emergency medical services (EMS) in the United States are frequently used for nonurgent medical needs. Use of 911 and the emergency department (ED) for primary care-treatable conditions is expensive, inefficient, and undesirable for patients and providers. The objective is to describe the outcomes from community paramedicine (CP) and mobile integrated health care (MIH) interventions related to the Quadruple Aim. Three electronic databases were searched for peer-review literature on CP-MIH interventions in the United States. Eight articles reporting data from 7 interventions were included. Four studies reported high levels of patient satisfaction, and only 3 measured health outcomes. No study reported provider satisfaction measures. Reducing ED and inpatient utilization were the most common study outcomes, and programs generally were successful at reducing utilization. With reduced utilization, costs should be reduced; however, most studies did not quantify savings. Future studies should conduct economic analyses that not only compare the intervention to traditional EMS services, but also measure potential cost savings to the EMS agencies running the intervention. Most cost savings from reduced utilization will be to insurance companies and patients, but more efficient use of EMS agencies' resources could lead to cost savings that could offset intervention implementation costs. The other 3 aims (health, patient satisfaction, and provider satisfaction) were reported inconsistently in these studies and need to be addressed further. Given the small number of heterogeneous studies reviewed, the potential for CP-MIH interventions to comprehensively address the Quadruple Aim is still unclear, and more research on these programs is needed.
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Affiliation(s)
- Abbey Gregg
- 1 Institute for Rural Health Research, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Joshua Tutek
- 2 Department of Psychology, College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Matthew D Leatherwood
- 3 Department of Kinesiology, College of Education, The University of Alabama, Moore Hall, Tuscaloosa, Alabama
| | - William Crawford
- 1 Institute for Rural Health Research, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
- 4 Office of EMS, Alabama Department of Public Health, Montgomery, Alabama
| | - Richard Friend
- 5 Department of Family, Internal, and Rural Medicine and College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Martha Crowther
- 1 Institute for Rural Health Research, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
- 5 Department of Family, Internal, and Rural Medicine and College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
| | - Robert McKinney
- 6 Department of Psychiatry and Behavioral Health, College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama
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