Risk factors related to unnecessary emergency medical services transport for pediatric patients

Using Natural Language Processing to Examine Social Determinants of Health in Prehospital Pediatric Encounters and Associations with EMS Transport Decisions

BACKGROUND

Social determinants of health (SDOH) influence access to health care and are associated with inequities in patient outcomes, yet few studies have explored SDOH among pediatric EMS patients. The objective of this study was to examine the presence of SDOH in EMS clinician free text notes and quantify the association of SDOH with EMS pediatric transport decisions.

METHODS

This was a retrospective analysis of primary 9-1-1 responses for patients ages 0-17 years from the 2019 ESO Data Collaborative research dataset. We excluded cardiac arrests and patients in law enforcement custody. Using natural language processing (NLP) we extracted the following SDOH categories: income insecurity, food insecurity, housing insecurity, insurance insecurity, poor social support, and child protective services. Univariate and multivariable associations between the presence of SDOH in EMS records and EMS transport decisions were assessed using logistic regression.

RESULTS

We analyzed 325,847 pediatric EMS encounters, of which 35% resulted in non-transport. The median age was 10 years and 52% were male. Slightly over half (53%) were White, 31% were Black, and 11% were Hispanic. Child protective services (n = 2,620) and housing insecurity (n = 1,136) were the most common SDOH categories found in the EMS free text narratives. In the multivariable model, child protective services involvement (odds ratio (OR)=2.04 [95% confidence interval (CI) 1.84-2.05]), housing insecurity (OR = 1.46 [95% CI 1.26-1.70]), insurance security (OR = 2.44 [95% CI 1.93-3.09]), and poor social support (OR = 10.48 [95% CI 1.42-77.29]) were associated with greater odds of EMS transport.

CONCLUSIONS

SDOH documentation in the EMS narrative was rare among pediatric encounters; however, children with documented SDOH were more likely to be transported. Additional exploration of the root causes and outcomes associated with SDOH among children encountered by EMS are warranted.

EMS utilization predictors in a Mobile Integrated Health (MIH) program

BACKGROUND

The provision of unnecessary Emergency Medical Services care remains a challenge throughout the US and contributes to Emergency Department overcrowding, delayed services and lower quality of care. New EMS models of care have shown promise in improving access to health services for patients who do not need urgent care. The goals of this study were (1) to identify factors associated with EMS utilization (911) and (2) their effects on total EMS calls and transports in an MIH program.

METHODS

The study sample included 110 MIH patients referred to the program or considered high-users of EMS services between November 2016 and September 2018. The study employed descriptive statistics and Poisson regressions to estimate the effects of covariates on total EMS calls and transports.

RESULTS

The typical enrollee is a 60-year-old single Black male living with two other individuals. He has a PCP, takes 12 medications and is compliant with his treatment. The likelihood of calling and/or being transported by EMS was higher for males, patients at high risk for falls, patients with asthma/COPD, psychiatric or behavioral illnesses, and longer travel times to a PCP. Each prescribed medication increased the risk for EMS calls or transports by 4%. The program achieved clear reductions in 911 calls and transports and savings of more than 140,000 USD in the first month.

CONCLUSIONS

This study shows that age, marital status, high fall risk scores, the number of medications, psychiatric/behavioral illness, asthma/COPD, CHF, CVA/stroke and medication compliance may be good predictors of EMS use in an MIH setting. MIH programs can help control utilization of EMS care and reduce both EMS calls and transports.