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Azizi S, Aygül Ö, Faber B, Johnson S, Konrad R, Trapp AC. Select, route and schedule: optimizing community paramedicine service delivery with mandatory visits and patient prioritization. Health Care Manag Sci 2023; 26:719-746. [PMID: 37462877 DOI: 10.1007/s10729-023-09646-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 05/25/2023] [Indexed: 09/07/2023]
Abstract
Healthcare delivery in the United States has been characterized as overly reactive and dependent on emergency department care for safety net coverage, with opportunity for improvement around discharge planning and high readmissions and emergency department bounce-back rates. Community paramedicine is a recent healthcare innovation that enables proactive visitation of patients at home, often shortly after emergency department and hospital discharge. We establish the first optimization-based framework to study efficiencies in the management and operation of a community paramedicine program. The collective innovations of our modeling include i) a novel hierarchical objective function with the goals of fairly increasing patient welfare, lowering hospital costs, and reducing readmissions and emergency department visits, ii) a new constraint set that ensures priority same-day visits for emergent patients, and iii) a further extension of our model to determine the minimum supplemental resources necessary to ensure feasibility in a single optimization formulation. Our medical-need based objective function prioritizes patients based on their clinical features and seeks to select and schedule patient visits and route healthcare providers to maximize overall patient welfare while favoring shorter tours. We use our methods to develop managerial insights via computational experiments on a variety of test instances based on real data from a hospital system in Upstate New York. We are able to identify optimal and nearly optimal tours that efficiently select, route, and schedule patients in reasonable timeframes. Our results lead to insights that can support managerial decisions about establishing (and improving existing) community paramedicine programs.
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Affiliation(s)
- Shima Azizi
- Business Analytics and Information Systems, Peter J. Tobin College of Business, St. John's University, Queens, NY, USA.
| | - Özge Aygül
- Data Science Program, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - Brenton Faber
- Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - Sharon Johnson
- The Business School, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - Renata Konrad
- The Business School, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
| | - Andrew C Trapp
- Data Science Program, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
- The Business School, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA, USA
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Leduc S, Wells G, Thiruganasambandamoorthy V, Cantor Z, Kelly P, Rietschlin M, Vaillancourt C. The hospital care and outcomes of long-term care patients treated by paramedics during an emergency call: exploring the potential impact of 'treat-and-refer' pathways and community paramedicine. CAN J EMERG MED 2023; 25:873-883. [PMID: 37715067 DOI: 10.1007/s43678-023-00590-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/22/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION Adults living in long-term care (LTC) are at increased risk of harm when transferred to the emergency department (ED), and programs targeting treatment on-site are increasing. We examined characteristics, clinical course, and disposition of LTC patients transported to the ED to examine the potential impact of alternative models of paramedic care for LTC patients. METHODS We conducted a health records review of paramedic and ED records between April 1, 2016, and March 31, 2017. We included emergency calls originating from LTC centers and patients transported to either ED campus of The Ottawa Hospital. We excluded scheduled or deferrable transfers, and patients with Canadian Triage and Acuity Scale of 1. We categorized patients into groups based on care they received in the ED. We calculated standardized differences to examine differences between groups. RESULTS We identified four groups: (1) patients requiring no treatment or diagnostics in the ED (7.9%); (2) patients receiving ED treatment within current paramedic directives and no diagnostics (3.2%); (3) patients requiring diagnostics or ED care outside current paramedic directives (54.9%); and (4) patients requiring admission (34.1%). CONCLUSION This study found 7.9% of LTC patients transported to the ED did not receive diagnostics, medications, or treatment, and overall 11.1% of patients could have been treated by paramedics within current medical directives using 'treat-and-refer' pathways. This group could potentially expand utilizing community paramedics with expanded scopes of practice.
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Affiliation(s)
- Shannon Leduc
- Ottawa Paramedic Service, Ottawa, ON, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - George Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Venkatesh Thiruganasambandamoorthy
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Zach Cantor
- Ottawa Paramedic Service, Ottawa, ON, Canada
| | - Peter Kelly
- Ottawa Paramedic Service, Ottawa, ON, Canada
| | | | - Christian Vaillancourt
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Plishka M, Angeles R, Pirrie M, Marzanek F, Agarwal G. Challenges in recruiting frequent users of ambulance services for a community paramedic home visit program. BMC Health Serv Res 2023; 23:1091. [PMID: 37821905 PMCID: PMC10568826 DOI: 10.1186/s12913-023-10075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND The Community Paramedicine at Home (CP@home) program is a health promotion program where community paramedics conduct risk assessments with frequent 9-1-1 callers in their homes, with a goal of reducing the frequency of 9-1-1 calls in this vulnerable population. The effectiveness of the CP@home program was investigated through a community-based RCT conducted in four regions in Ontario, Canada. The purpose of this current recruitment study is to examine the challenges met when recruiting for a community randomized control trial on high frequency 9-1-1 callers. METHODS Eligible participants were recruited from one of four regions participating in the CP@home program and were randomly assigned to an intervention group (n = 1142) or control group (n = 1142). Data were collected during the recruitment process from the administrative database of the four paramedic services. Whether they live alone, their parental ethnicity, age, reason for calling 9-1-1, reason for not participating, contact method, and whether they were successfully contacted were recorded. Statistical significance was calculated using the Chi-Squared Test and Fisher's Exact Test to evaluate the effectiveness of the recruitment methods used to enroll eligible participants in the CP@home Program. RESULTS Of the people who were contacted, 48.0% answered their phone when called and 53.9% answered their door when a home visit was attempted. In Total, 110 (33.1%) of people where a contact attempt was successful participated in the CP@home program. Most participants were over the age of 65, even though people as young as 18 were contacted. Older adults who called 9-1-1 for a lift assist were more likely to participate, compared to any other individual reason recorded, and were most often recruited through a home visit. CONCLUSIONS This recruitment analysis successfully describes the challenges experienced by researchers when recruiting frequent 9-1-1 callers, which are considered a hard-to-reach population. The differences in age, contact method, and reason for calling 9-1-1 amongst people contacted and participants should be considered when recruiting this population for future research.
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Affiliation(s)
- Mikayla Plishka
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, L8P 1H6, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, L8P 1H6, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, L8P 1H6, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, L8P 1H6, Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, 100 Main St W, Hamilton, L8P 1H6, Canada.
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Okoh CM, Moczygemba LR, Thurman W, Brown C, Hanson C, Baffoe JO. An examination of the emerging field of community paramedicine: a national cross-sectional survey of community paramedics. BMC Health Serv Res 2023; 23:516. [PMID: 37221608 DOI: 10.1186/s12913-023-09537-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/09/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Community Paramedicine is an evolving community-based model that expands paramedic roles from emergency and transport care to a focus on non-emergent and preventive health services tailored to local community needs. Though community paramedicine is a growing field and acceptance is gradually increasing, there is limited information on community paramedics (CPs) perceptions of their expanded roles. The study's aim is to assess CPs' perceptions about their training, roles, role clarity, role readiness, role satisfaction, professional identity, interprofessional collaboration, and the future of the community paramedicine care model. METHODS Using the National Association of Emergency Medical Technicians-mobile integrated health (NAEMT-MIH) listserv, a cross-sectional survey was conducted in July/August 2020 using a 43-item web-based questionnaire. Thirty-nine questions evaluated CPs' training, roles, role clarity, role readiness, role satisfaction, professional identity, interprofessional collaboration, and program/work characteristics. Four open-ended questions examined perceptions of the future of community paramedicine care models and challenges/opportunities encountered during the COVID-19 pandemic. Data was analyzed using Spearman's correlation, Wilcoxon Mann-Whitney U, and Kruskal-Wallis tests. Open-ended questions were analyzed using qualitative content analyses. RESULTS Responses from fifty-seven CPs were analyzed. Most (80%) completed didactic and/or clinical training. Nearly all respondents (96.5%) performed health assessments; only 38.6% administered vaccines. Overall, participants were neutral about their role readiness with a mean score of 3.3/5.0. The mean role clarity was 15.5 (range 4-29; higher scores = higher clarity), professional identity was 46.8 (range 30-55; higher scores = higher identity), role satisfaction was 4.4/5 with 5 = very satisfied, and interprofessional collaboration was 9.5/10 (10 = very important). Role clarity training (rho = 0.4, p = 0.0013) and higher interprofessional collaboration (rho = 0.4, p = 0.0015) were found to be significantly associated with the enhancement of professional identity. Respondents who completed training showed higher role satisfaction compared to those who did not (p = 0.0114). COVID-19 challenges included keeping up with emerging policies/procedures, CPs' well-being, and inadequate funding to meet service needs; opportunities identified included service delivery expansion and CPs meeting community needs in a flexible manner. Respondents reported that sustainable payment models, expanding services, and geographic reach were important to the future of community paramedicine. CONCLUSIONS Interprofessional collaboration is important to fulfill CPs roles. Role clarity and readiness could be improved, which aligns with the emerging nature of community paramedicine. The future of the community paramedicine care model is dependent on funding and expanding reach of services.
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Affiliation(s)
- Chinyere Mma Okoh
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, USA.
| | - Leticia R Moczygemba
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, USA
| | - Whitney Thurman
- The University of Texas at Austin School of Nursing, 1710 Red River St, Austin, TX, 78712, USA
| | - Carolyn Brown
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, USA
| | - Christopher Hanson
- TMF Health Quality Institute, 3107 Oak Creek Dr Ste. 200, Austin, TX, 78727, USA
| | - James O Baffoe
- Health Outcomes Division, The University of Texas at Austin College of Pharmacy, 2409 University Ave, #A1900, Austin, TX, 78712, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Leduc S, Wells G, Thiruganasambandamoorthy V, Kelly P, Vaillancourt C. Alternative care models for paramedic patients from long-term care centers: a national survey of Canadian paramedic services. CAN J EMERG MED 2023. [PMID: 36897539 DOI: 10.1007/s43678-023-00471-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 02/10/2023] [Indexed: 03/11/2023]
Abstract
INTRODUCTION Long-term care (LTC) patients do poorly when transported to emergency departments (ED). Community paramedic programs deliver enhanced care in their place of residence, yet few programs are reported in the literature. We conducted a national cross-sectional survey of land ambulance services to understand if such programs exist in Canada, and what the perceived needs and priorities are for future programs. METHODS We emailed a 46 question survey to paramedic services across Canada. We asked about service characteristics, current ED diversion programs, existing diversion programs specific to LTC patients, priorities for future programs, the potential impact of such programs, and what the feasibility and barriers are to implementing programs that treat LTC patients on-site, avoiding an ED visit. RESULTS We received responses from 50 sites across Canada, providing services to 73.5% of the total population. Almost a third (30.0%) had existing treat-and-refer programs, and 65.5% of services transported to destinations other than an ED. Almost all respondents (98.0%) felt the need for programs to treat LTC patients on-site, and 36.0% had existing programs. The top priorities for future programs were support for patients being discharged (30.6%), extended care paramedics (24.5%), and respiratory illness treat-in-place programs (20.4%). The highest potential impact was expected from support for patients being discharged (62.0%) and respiratory illness treat-in-place programs (54.0%). Required changes in legislation (36.0%) and required changes to the system of medical oversight (34.0%) were identified as top barriers to implementing such programs. CONCLUSION There is a significant mismatch between the perceived need for community paramedic programs treating LTC patients on-site, and the number of programs in place. Programs could benefit from standardized outcome measurement and the publication of peer-reviewed evidence to guide future programs. Changes in legislation and medical oversight are needed to address the identified barriers to program implementation.
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Ridgeway JL, Gerdes EOW, Dodge A, Liedl CP, Juntunen MB, Sundt WJS, Glasgow A, Lampman MA, Fink AL, Severson SB, Lin G, Sampson RR, Peterson RP, Murley BM, Klassen AB, Luke A, Friedman PA, Buechler TE, Newman JS, McCoy RG. Community paramedic hospital reduction and mitigation program: study protocol for a randomized pragmatic clinical trial. Trials 2023; 24:122. [PMID: 36805692 PMCID: PMC9940335 DOI: 10.1186/s13063-022-07034-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/16/2022] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND New patient-centered models of care are needed to individualize care and reduce high-cost care, including emergency department (ED) visits and hospitalizations for low- and intermediate-acuity conditions that could be managed outside the hospital setting. Community paramedics (CPs) have advanced training in low- and high-acuity care and are equipped to manage a wide range of health conditions, deliver patient education, and address social determinants of health in the home setting. The objective of this trial is to evaluate the effectiveness and implementation of the Care Anywhere with Community Paramedics (CACP) program with respect to shortening and preventing acute care utilization. METHODS This is a pragmatic, hybrid type 1, two-group, parallel-arm, 1:1 randomized clinical trial of CACP versus usual care that includes formative evaluation methods and assessment of implementation outcomes. It is being conducted in two sites in the US Midwest, which include small metropolitan areas and rural areas. Eligible patients are ≥ 18 years old; referred from an outpatient, ED, or hospital setting; clinically appropriate for ambulatory care with CP support; and residing within CP service areas of the referral sites. Aim 1 uses formative data collection with key clinical stakeholders and rapid qualitative analysis to identify potential facilitators/barriers to implementation and refine workflows in the 3-month period before trial enrollment commences (i.e., pre-implementation). Aim 2 uses mixed methods to evaluate CACP effectiveness, compared to usual care, by the number of days spent alive outside of the ED or hospital during the first 30 days following randomization (primary outcome), as well as self-reported quality of life and treatment burden, emergency medical services use, ED visits, hospitalizations, skilled nursing facility utilization, and adverse events (secondary outcomes). Implementation outcomes will be measured using the RE-AIM framework and include an assessment of perceived sustainability and metrics on equity in implementation. Aim 3 uses qualitative methods to understand patient, CP, and health care team perceptions of the intervention and recommendations for further refinement. In an effort to conduct a rigorous evaluation but also speed translation to practice, the planned duration of the trial is 15 months from the study launch to the end of enrollment. DISCUSSION This study will provide robust and timely evidence for the effectiveness of the CACP program, which may pave the way for large-scale implementation. Implementation outcomes will inform any needed refinements and best practices for scale-up and sustainability. TRIAL REGISTRATION ClinicalTrials.gov NCT05232799. Registered on 10 February 2022.
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Affiliation(s)
- Jennifer L. Ridgeway
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Erin O. Wissler Gerdes
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Andrew Dodge
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | | | | | - Wendy J. S. Sundt
- Research Services – Clinical Trials Office, Mayo Clinic, Rochester, MN USA
| | - Amy Glasgow
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Michelle A. Lampman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
| | - Angela L. Fink
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Sara B. Severson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | - Richard R. Sampson
- Department of Family Medicine, Mayo Clinic Health System - Northland, Barron, WI USA
| | - Robert P. Peterson
- Division of Hospital Internal Medicine, Mayo Clinic Health System - Northland, Barron, WI USA
| | | | - Aaron B. Klassen
- Department of Emergency Medicine, Mayo Clinic Ambulance, Rochester, MN USA
| | - Anuradha Luke
- Department of Emergency Medicine, Mayo Clinic Ambulance, Rochester, MN USA
| | - Paul A. Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN USA
| | | | - James S. Newman
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN USA
| | - Rozalina G. McCoy
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN USA
- Mayo Clinic Ambulance, Rochester, MN USA
- Department of Medicine, Division of Community Internal Medicine, Geriatrics, and Palliative Care, Rochester, MN USA
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Naimi S, Stryckman B, Liang Y, Seidl K, Harris E, Landi C, Thomas J, Marcozzi D, Gingold DB. Evaluating Social Determinants of Health in a Mobile Integrated Healthcare- Community Paramedicine Program. J Community Health 2023; 48:79-88. [PMID: 36269531 DOI: 10.1007/s10900-022-01148-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/26/2022]
Abstract
In 2018, the University of Maryland Medical Center and the Baltimore City Fire Department implemented a community paramedicine program to help medically or socially complex patients transition from hospital to home and avoid hospital utilization. This study describes how patients' social determinants of health (SDoH) needs were identified, and measures the association between needs and hospital utilization. SDoH needs were categorized into ten domains. Multinomial logistic regression was used to measure association between identified SDoH domains and predicted risk of readmission. Poisson regression was used to measure association between SDoH domains and actual 30-day hospital utilization. The most frequently identified SDoH needs were in the Coordination of Healthcare (37.7%), Durable Medical Equipment (18.8%), and Medication (16.3%) domains. Compared with low-risk patients, patients with an intermediate risk of readmission were more likely to have needs within the Coordination of Healthcare (RRR [95% CI] 1.12 [1.01, 1.24], p = 0.032) and Durable Medical Equipment (RRR = 1.13 [1.00, 1.27], p = 0.046) domains. Patients with the highest risk for readmission were more likely to have needs in the Utilities domain (RRR = 1.76 [0.97, 3.19], p = 0.063). Miscellaneous domain needs, such as requiring a social security card, were associated with increased 30-day hospital utilization (IRR = 1.23 [0.96, 1.57], p = 0.095). SDoH needs within the Coordination of Healthcare, Durable Medical Equipment, and Utilities domains were associated with higher predicted 30-day readmission, while identification documentation and social services needs were associated with actual readmission. These results suggest where to allocate resources to effectively diminish hospital utilization.
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Affiliation(s)
- Sean Naimi
- University of Maryland School of Medicine, 620 W Lexington St, Baltimore, MD, 21201, USA.
| | - Benoit Stryckman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Yuanyuan Liang
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Kristin Seidl
- Department of Quality and Safety, University of Maryland Medical Center, Baltimore, USA
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD, 21201, USA
| | - Erinn Harris
- Baltimore City Fire Department, Baltimore, MD, 21201, USA
| | - Colleen Landi
- Mobile Integrated Health Community Paramedicine, University of Maryland Medical Center, Baltimore, MD, 21201, USA
| | - Jessica Thomas
- Baltimore City Fire Department, Baltimore, MD, 21201, USA
| | - David Marcozzi
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
| | - Daniel B Gingold
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA
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Cantor Z. Code Angel: a reflection from the frontlines. CAN J EMERG MED 2023; 25:96-97. [PMID: 35972720 PMCID: PMC9380667 DOI: 10.1007/s43678-022-00357-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 06/27/2022] [Indexed: 02/08/2023]
Affiliation(s)
- Zach Cantor
- McNally Project for Paramedicine Research, Toronto, Canada
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Munene A, Alaazi D, Mathew J, McLane P, Cummings G, Holroyd-Leduc J. Impact of community paramedic interventions on transfers from long term care to emergency departments: results of a systematic review. CAN J EMERG MED 2022; 24:101-102. [PMID: 34648170 DOI: 10.1007/s43678-021-00214-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Abraham Munene
- Cumming School of Medicine, University of Calgary (Foothills Campus), South Tower, 1403-29 Street NW T2N 4N1, Calgary, AB, Canada.
| | - Dominic Alaazi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jane Mathew
- Cumming School of Medicine, University of Calgary (Foothills Campus), South Tower, 1403-29 Street NW T2N 4N1, Calgary, AB, Canada
| | | | - Greta Cummings
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jayna Holroyd-Leduc
- Cumming School of Medicine, University of Calgary (Foothills Campus), South Tower, 1403-29 Street NW T2N 4N1, Calgary, AB, Canada
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12
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Schwab-Reese LM, Renner LM, King H, Miller RP, Forman D, Krumenacker JS, DeMaria AL. "They're very passionate about making sure that women stay healthy": a qualitative examination of women's experiences participating in a community paramedicine program. BMC Health Serv Res 2021; 21:1167. [PMID: 34706727 PMCID: PMC8550812 DOI: 10.1186/s12913-021-07192-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women's experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. METHODS We completed 21 interviews with women living in Indiana (July 2019-February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. RESULTS Program enrollment was influenced by the community paramedics' experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. CONCLUSIONS Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.
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Affiliation(s)
- Laura M Schwab-Reese
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA.
| | - Lynette M Renner
- School of Social Work, College of Education and Human Development, University of Minnesota, St. Paul, MN, USA
| | - Hannah King
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - R Paul Miller
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | - Darren Forman
- City of Crawfordsville Fire Department, Crawfordsville, IN, USA
| | | | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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13
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Gingold DB, Stryckman B, Liang Y, Harris E, McCarren WL, Marcozzi D. Analysis of an Alternative Model of Definitive Care For Low-Acuity Emergency Calls: A Natural Experiment. J Emerg Med 2021; 62:38-50. [PMID: 34538675 DOI: 10.1016/j.jemermed.2021.07.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/20/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Emergency medical services (EMS) diversion strategies attempt to limit the impact of low-acuity care on emergency department (ED) crowding, but evidence supporting these strategies is scarce. OBJECTIVE This study aims to measure the effect of a treat-in-place and alternative destination program on ED transports and EMS utilization. METHODS We used a natural experiment study design to measure effects of a pilot prehospital diversion program on ED transport, number of EMS vehicles dispatched, and EMS time on task for low-acuity emergency calls in a midsized urban setting characterized by a high prevalence of health disparities, concentrated poverty, and limited access to primary care between October 2018 and January 2020. We also used direct variable cost to estimate the return on investment attributable to avoided ED visits. RESULTS Of 3725 calls that met eligibility criteria, the program responded to 1084 (29.1%), with 56.7% of those resulting in an ED visit, compared with 64.6% of the 492 control calls that were eligible but were dispatched when program services were unavailable. Of 1084 calls receiving response, 213 (19.6%) were enrolled in the program, and 8.5% of those were transported by EMS to the ED. Adjusted results show EMS time on task was 23.4 min less for enrolled calls vs. controls. The program can achieve a positive return on investment by enrolling 2.9 patients/day. CONCLUSIONS A prehospital diversion program reduced ED visits and EMS transport times. Improved targeting of patients for enrollment would further increase the intervention's efficacy and cost savings.
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Affiliation(s)
| | | | - Yuanyuan Liang
- Department of Epidemiology and Public Health, Division of Biostatistics and Bioinformatics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Erinn Harris
- Baltimore City Fire Department, Baltimore, Maryland
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14
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Leyenaar MS, McLeod B, Jones A, Brousseau AA, Mercier E, Strum RP, Nolan M, Sinha SK, Agarwal G, Tavares W, Costa AP. Paramedics assessing patients with complex comorbidities in community settings: results from the CARPE study. CAN J EMERG MED 2021; 23:828-836. [PMID: 34403118 PMCID: PMC8575756 DOI: 10.1007/s43678-021-00153-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
Objectives The aim for this study was to provide information about how community paramedicine home visit programs best “navigate” their role delivering preventative care to frequent 9-1-1 users by describing demographic and clinical characteristics of their patients and comparing them to existing community care populations. Methods Our study used secondary data from standardized assessment instruments used in the delivery of home care, community support services, and community paramedicine home visit programs in Ontario. Identical assessment items from each instrument enabled comparisons of demographic, clinical, and social characteristics of community-dwelling older adults using descriptive statistics and z-tests. Results Data were analyzed for 29,938 home care clients, 13,782 community support services clients, and 136 community paramedicine patients. Differences were observed in proportions of individuals living alone between community paramedicine patients versus home care clients and community support clients (47.8%, 33.8%, and 59.9% respectively). We found higher proportions of community paramedicine patients with multiple chronic disease (87%, compared to 63% and 42%) and mental health-related conditions (43.4%, compared to 26.2% and 18.8% for depression, as an example). Conclusion When using existing community care populations as a reference group, it appears that patients seen in community paramedicine home visit programs are a distinct sub-group of the community-dwelling older adult population with more complex comorbidities, possibly exacerbated by mental illness and social isolation from living alone. Community paramedicine programs may serve as a sentinel support opportunity for patients whose health conditions are not being addressed through timely access to other existing care providers. Protocol registration ISRCTN 58273216. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-021-00153-4.
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Affiliation(s)
- Matthew S Leyenaar
- Prince Edward Island Department of Health and Wellness, Charlottetown, PEI, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
| | - Brent McLeod
- Hamilton Niagara Haldimand Brant Local Health Integration Network, Grimsby, ON, Canada
| | - Aaron Jones
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | | | - Eric Mercier
- Département de Médecine Familiale et Médecine d'Urgence, Faculté de Médecine de l'Université Laval, Quebec, QC, Canada
| | - Ryan P Strum
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Michael Nolan
- County of Renfrew Paramedic Service, Pembroke, ON, Canada
| | | | - Gina Agarwal
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.,Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Walter Tavares
- Faculty of Medicine, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Heath, University of Toronto, Toronto, ON, Canada.,York Region Paramedic Services, Regional Municipality of York, Sharon, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
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15
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Rasku T, Kaunonen M, Thyer E, Paavilainen E, Joronen K. Community nurse-paramedics' sphere of practice in primary care; an ethnographic study. BMC Health Serv Res 2021; 21:710. [PMID: 34275436 DOI: 10.1186/s12913-021-06691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 06/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Primary care, the principal function of the health care system, requires effort from all local primary health care teams. Community Paramedicine (CP) has managed to reduce the use of Emergency Medical Services (EMS) for non-emergency calls, but for the paramedic to move from traditional emergency calls to non-emergency care will mean new demands. There is a paucity of research exploring nurse-paramedics’ experiences and perceptions of their novel roles as community paramedics in Finland. This study aims to explore the community nurse-paramedics’ (CNP) experiences in their new sphere of practice. Methods A descriptive ethnographic study was conducted, to collect data through participant observation (317 h total) and semi-structured interviews (N = 22) in three hospital districts (HD) where the CNPs have worked for at least 1 year. Both data sets were combined, organised, and analysed using inductive content analysis. Results Five main categories were developed by applying inductive content analysis: the new way of thinking, the broad group of patients, the way to provide care, the diversity of multidisciplinary collaboration, and tailored support from the organisation. The CNP was identified as needing an appropriate attitude towards care and a broader way of thinking compared to the traditional practice of taking care of the patient and the family members. The diversity of multidisciplinary collaboration teams can be a sensitive but worthwhile topic for offering new possibilities. Tailored support from the organisation includes tools for future CP models. Conclusions Our results indicate the CNPs’ deep involvement in patients’ and families’ care needs and challenges with their skills and competencies. Their professional attitudes and eagerness to develop and maintain multidisciplinary collaboration can offer preventive and long-term caring solutions from which citizens, allied health, safety, and social care providers benefit locally and globally.
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16
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Reinhartz V, Kearns S, Haas M, Landau S, Richardson T. Impact of community paramedicine program on APPE student skillsets. Curr Pharm Teach Learn 2021; 13:729-735. [PMID: 33867072 DOI: 10.1016/j.cptl.2021.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/29/2020] [Accepted: 01/21/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND PURPOSE This article describes the clinical and educational impact resulting from interprofessional (IP) collaboration between fourth-year advanced pharmacy practice experience (APPE) pharmacy students and community paramedics within a community paramedicine (CP) program. EDUCATIONAL ACTIVITY AND SETTING The Manatee County, Florida CP program partnered with Lake Erie College of Osteopathic Medicine School of Pharmacy faculty to reduce 911 calls, emergency room visits, and hospital readmissions for underserved populations. The CP-pharmacist partnership optimized medication therapy, chronic disease management, and access to care through scheduled in-home visits with an IP team. With guidance from the pharmacist, APPE student responsibilities included comprehensive medication review, medication action plan development, communication with providers, and patient counseling to resolve medication issues. FINDINGS Survey data demonstrated this approach to APPEs increased student confidence in optimizing care plans (100%), assessing vitals (76%), identifying medical emergencies (84%), and communicating with patients (96%). Student incorporation into a CP program augmented the pharmacist's ability to successfully correct medication use errors and improve nonadherence through patient counseling. Medication interventions were successful in 693 of 799 scenarios, for a success rate of 86.7%. SUMMARY Results from this analysis reinforced prior research indicating pharmacy students can be successfully incorporated into a CP program, with resulting improvement in student clinical skills, communication strategies, and successful medication intervention outcomes.
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Affiliation(s)
- Victoria Reinhartz
- LECOM School of Pharmacy, 5000 Lakewood Ranch Blvd, Lakewood Ranch, FL 34211, United States.
| | - Shelly Kearns
- Lee Health System, 2776 Cleveland Ave, Fort Myers, FL 33901, United States.
| | - Matthew Haas
- LECOM School of Pharmacy, 5000 Lakewood Ranch Blvd, Lakewood Ranch, FL 34211, United States.
| | - Shelby Landau
- LECOM School of Pharmacy, 5000 Lakewood Ranch Blvd, Lakewood Ranch, FL 34211, United States.
| | - Tayanna Richardson
- LECOM Bradenton School of Pharmacy, 5000 Lakewood Ranch Blvd, Bradenton, FL 34211, United States.
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17
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van Vuuren J, Thomas B, Agarwal G, MacDermott S, Kinsman L, O'Meara P, Spelten E. Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review. BMC Health Serv Res 2021; 21:29. [PMID: 33407406 PMCID: PMC7789625 DOI: 10.1186/s12913-020-06037-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system. Methods A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data. Results Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system. Conclusions The use of community paramedics in care delivery could be beneficial to both patients’ health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06037-0.
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Affiliation(s)
- Julia van Vuuren
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia.
| | - Brodie Thomas
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sean MacDermott
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Leigh Kinsman
- University of Newcastle and Mid-North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, Australia
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Peninsula Campus, Melbourne, Australia
| | - Evelien Spelten
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
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Agarwal G, Bhandari M, Pirrie M, Angeles R, Marzanek F. Feasibility of implementing a community cardiovascular health promotion program with paramedics and volunteers in a South Asian population. BMC Public Health 2020; 20:1618. [PMID: 33109135 PMCID: PMC7590723 DOI: 10.1186/s12889-020-09728-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 10/19/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The South Asian population in Canada is growing and has elevated risk of cardiovascular disease and diabetes. This study sought to adapt an evidence-based community risk assessment and health promotion program for a South Asian community with a large proportion of recent immigrants. The aims were to assess the feasibility of implementing this program and also to describe the rates of cardiometabolic risk factors observed in this sample population. METHODS This was a feasibility study adapting and implementing the Community Paramedicine at Clinic (CP@clinic) program for a South Asian population in an urban Canadian community for 14 months. CP@clinic is a free, drop-in chronic disease prevention and health promotion program implemented by paramedics who provide health assessments, health education, referrals and reports to family doctors. All adults attending the recreation centre and temple where CP@clinic was implemented were eligible. Volunteers provided Hindi, Punjabi and Urdu translation. The primary outcome of feasibility was evaluated using quantitative process measures and a qualitative key informant interview. For the secondary outcome of cardiometabolic risk factor, data were collected through the CP@clinic program risk assessments and descriptively analyzed. RESULTS There were 26 CP@clinic sessions held and 71 participants, predominantly male (56.3-84.6%) and South Asian (87.3-92.3%). There was limited participation at the recreation centre (n = 19) but CP@clinic was well-attended when relocated to the local Sikh temple (n = 52). Having the volunteer translators was critical to the paramedics being able to collect the full risk factor data and there were some challenges with ensuring enough volunteers were available to staff each session; as a result, there were missing risk factor data for many participants. In the 26 participants with complete or almost complete risk factor data, 46.5% had elevated BP, 42.3% had moderate/high risk of developing diabetes, and 65.4% had an indicator of cardiometabolic disease. CONCLUSION Implementing CP@clinic in places of worship is a feasible approach to adapting the program for the South Asian population, however having a funded translator in addition to the volunteers would improve the program. Also, there is substantial opportunity for addressing cardiometabolic risk factors in this population using CP@clinic.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada.
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada.
| | - Manika Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
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19
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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] [What about the content of this article? (0)] [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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Agarwal G, Pirrie M, McLeod B, Angeles R, Tavares W, Marzanek F, Thabane L. Rationale and methods of an Evaluation of the Effectiveness of the Community Paramedicine at Home (CP@home) program for frequent users of emergency medical services in multiple Ontario regions: a study protocol for a randomized controlled trial. Trials 2019; 20:75. [PMID: 30674347 PMCID: PMC6343307 DOI: 10.1186/s13063-018-3107-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Frequent users of emergency medical services for issues that could be more appropriately managed through non-urgent care deplete the limited resources of the health-care system. Community paramedicine is an emerging field that extends the role of paramedics beyond the traditional emergency response. The goal of the current study is to evaluate the impact of a community paramedicine home-visit intervention with frequent users on reducing ambulance calls, hospital visits, and admissions. The study will also provide a cross-sectional description of the characteristics of frequent users of emergency medical services. METHODS/DESIGN An open-label, pragmatic, randomized controlled trial with parallel intervention and control groups will be conducted in four paramedic services in Ontario. The sample size has been calculated as 261 per group for a 25% reduction in ambulance calls. Eligible participants will be frequent callers (three or more calls in 6 months), individuals who call for at least one lift assist, or individuals referred to the program by a paramedic. Individuals will be randomly allocated to receive either the Community Paramedicine at Home (CP@home) program intervention or their usual care (control). Intervention participants will receive up to three visits from a community paramedic, who will conduct health risk assessments, provide health promotion and education, provide referrals to local resources, and fax reports back to the family physician. Data will be collected from administrative databases (e.g., paramedic services), a custom CP@home program database, participant surveys, and key informant interviews. An intention-to-treat analysis will be conducted, including descriptive statistics and multi-level modeling to find factors predictive of primary and secondary outcomes. A thematic analysis will be used to analyze the qualitative outcomes. An economic analysis will consider the cost-effectiveness of the program. DISCUSSION CP@home has the potential to reduce the health-care system burden significantly by targeting current frequent users of emergency medical services. By targeting this population, CP@home aims to decrease ambulance calls and emergency department visits, reducing health-care costs and improving the quality of life of a vulnerable population. If successful, CP@home will inform the development of community paramedicine policies and the expanding role of paramedics in regions across Canada. TRIAL REGISTRATION ClinicalTrials.gov, NCT02835989 . Registered on July 14 2016.
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Affiliation(s)
- Gina Agarwal
- Department of Family Medicine, McMaster University, 100 Main Street W, Hamilton, ON L8P 1H6 Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Melissa Pirrie
- Department of Family Medicine, McMaster University, 100 Main Street W, Hamilton, ON L8P 1H6 Canada
| | - Brent McLeod
- Hamilton Paramedic Services, Hamilton, ON Canada
| | - Ricardo Angeles
- Department of Family Medicine, McMaster University, 100 Main Street W, Hamilton, ON L8P 1H6 Canada
| | - Walter Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4 Canada
- Post-MD Education, University of Toronto, Toronto, ON Canada
- Paramedic and Senior Services, Community and Health Services Department, Regional Municipality of York, Newmarket, ON Canada
| | - Francine Marzanek
- Department of Family Medicine, McMaster University, 100 Main Street W, Hamilton, ON L8P 1H6 Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- St. Joseph’s Healthcare Hamilton, McMaster University, 25 Charlton Avenue East, Hamilton, ON L8N 1Y2 Canada
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Kant RE, Vejar M, Parnes B, Mulder J, Daddato A, Matlock DD, Lum HD. Outcomes and provider perspectives on geriatric care by a nurse practitioner-led community paramedicine program. Geriatr Nurs 2018; 39:574-579. [PMID: 29731391 DOI: 10.1016/j.gerinurse.2018.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/27/2018] [Accepted: 04/02/2018] [Indexed: 11/30/2022]
Abstract
This study explores the use of a nurse practitioner-led paramedicine program for acute, home-based care of geriatric patients. This case series describes patients, outcomes, and geriatric primary care provider perspectives related to use of this independent paramedicine program. There were 40 patient visits from August 2016-May 2017. We reviewed patient demographics, medical conditions, healthcare utilization, and communication processes and used semi-structured interviews and content analysis to explore staff perspectives. The most commonly treated diagnoses were respiratory conditions, urinary tract infections, and gastrointestinal concerns. Two patients required an immediate transfer to a higher level of care. Six patients had emergency department visits and five patients were hospitalized within two weeks. Geriatric providers identified three themes including: potential benefits to geriatric patients, importance of enhanced care coordination and communication, and considerations for the specific role of nurse practitioner-led community paramedicine programs for geriatric patient care.
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Affiliation(s)
- Rebecca E Kant
- Division of General Internal Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, United States
| | - Maria Vejar
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, United States
| | - Bennett Parnes
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, United States
| | - Joy Mulder
- University of Colorado Hospital, 12605 E. 16th Avenue, Aurora, CO, 80045, United States
| | - Andrea Daddato
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, United States
| | - Daniel D Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, United States; Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, 1055 Clermont Street, Denver, CO 80220, United States
| | - Hillary D Lum
- Division of Geriatric Medicine, University of Colorado School of Medicine, 12631 E. 17th Avenue, Aurora, CO, 80045, United States; Veterans Affairs Eastern Colorado Geriatric Research Education and Clinical Center, 1055 Clermont Street, Denver, CO 80220, United States.
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Mi R, Hollander MM, Jones CMC, DuGoff EH, Caprio TV, Cushman JT, Kind AJH, Lohmeier M, Shah MN. A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits. BMC Geriatr 2018; 18:104. [PMID: 29724172 PMCID: PMC5934842 DOI: 10.1186/s12877-018-0792-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 04/16/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Approximately 20% of community-dwelling older adults discharged from the emergency department (ED) return to an ED within 30 days, an occurrence partially resulting from poor care transitions. Prior published interventions to improve the ED-to-home transition have either lacked feasibility or effectiveness. The Care Transitions Intervention (CTI) has been validated to decrease rehospitalization among patients transitioning from the hospital to the home but has never been tested for patients transitioning from the ED to the home. Paramedics, traditionally involved only in emergency care, are well-positioned to deliver the CTI, but have never been previously evaluated in this role. METHODS This single-blinded randomized controlled trial tests whether the paramedic-delivered ED-to-home CTI reduces community-dwelling older adults' ED revisits in the 30 days after an index visit. We are prospectively recruiting patients aged≥ 60 years at 3 EDs in Rochester, NY and Madison, WI to enroll 2400 patient subjects. Subjects are randomized into control and treatment groups, with the latter receiving the adapted CTI. The intervention consists of the paramedic performing one home visit and up to three follow-up phone calls. During these interactions, the paramedic follows the CTI approach by coaching patients toward their goals, with a focus on their personal health record, medication management, red flags, and primary care follow-up. We follow patient participants for 30 days. All receive a survey during the index ED visit to capture baseline demographic and health information and two telephone-based surveys to assess process objectives and outcomes. We also perform a medical record review. The primary outcome is the odds of ED revisit within 30 days after discharge from the index ED visit. DISCUSSION This is the first study to test whether the CTI, applied to the ED-to-home transition and delivered by community paramedics, can decrease the rate at which older adults revisit an ED. Outcomes from this research will help address a major emergency care challenge by supporting older adults in the transition from the ED to home, thereby improving health outcomes for this population and reducing potentially avoidable ED visits. TRIAL REGISTRATION ClinicalTrials.gov Registration: NCT02520661 . Trial registration date: August 13, 2015.
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Affiliation(s)
- Ranran Mi
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Matthew M Hollander
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Courtney M C Jones
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Eva H DuGoff
- Department of Health Services Administration, University of Maryland-College Park, Baltimore, Maryland, USA
| | - Thomas V Caprio
- Department of Medicine (Geriatrics), University of Rochester Medical Center, Rochester, NY, USA
| | - Jeremy T Cushman
- Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Amy J H Kind
- Department of Medicine (Geriatrics and Gerontology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,VA Geriatrics Research Education and Clinical Center, Madison, USA
| | - Michael Lohmeier
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Manish N Shah
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. .,Department of Medicine (Geriatrics and Gerontology), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA. .,VA Geriatrics Research Education and Clinical Center, Madison, USA.
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Dainty KN, Seaton MB, Drennan IR, Morrison LJ. Home Visit-Based Community Paramedicine and Its Potential Role in Improving Patient-Centered Primary Care: A Grounded Theory Study and Framework. Health Serv Res 2018. [PMID: 29542111 DOI: 10.1111/1475-6773.12855] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Community paramedicine (CP) is a model of community-based health care being used around the world. Our objective was to study the patient perspective and valuation of this type of program to understand its potential value for primary care innovation in the future. STUDY SETTING The EPIC community paramedicine program is a partnership between primary care physicians and specially trained community paramedics, designed to provide in-home support for complex chronic disease patients in Ontario, Canada. STUDY DESIGN As part of an ongoing clinical trial we designed an embedded qualitative evaluation using constructionist grounded theory methodology. DATA COLLECTION METHODS Data collection included in-depth interviews with 30 patients and/or family members and 60 hours of observation. PRINCIPAL FINDINGS The health care needs of this complex population are largely attributes that impact a patient's quality of life-including recognition of their vulnerability, providing a safety-net in times of exacerbation and health education and accountability. This seems to be facilitated by a relationship with a dedicated provider that increases continuity of care. CONCLUSIONS Home-based community paramedicine programs like EPIC appear to be able to create a patient-centered, safe, responsive therapeutic relationship that is often not possible within the standard primary health care system.
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Affiliation(s)
- Katie N Dainty
- North York General Hospital, North York, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, North York, Toronto, ON, Canada.,Institute of Health Policy Management and Evaluation, University of Toronto, North York, Toronto, ON, Canada.,Office of Research and Innovation, North York General Hospital, North York, Toronto, Ontario, Canada
| | - M Bianca Seaton
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Ian R Drennan
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie J Morrison
- Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
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Agarwal G, Angeles R, Pirrie M, Marzanek F, McLeod B, Parascandalo J, Dolovich L. Effectiveness of a community paramedic-led health assessment and education initiative in a seniors' residence building: the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). BMC Emerg Med 2017; 17:8. [PMID: 28274221 PMCID: PMC5343405 DOI: 10.1186/s12873-017-0119-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 02/17/2017] [Indexed: 12/19/2022] Open
Abstract
Background Seniors living in subsidized housing have lower income, poorer health, and increased risk for cardiometabolic diseases and falls. Seniors also account for more than one third of calls to Emergency Medical Services (EMS). This study examines the effectiveness of the Community Health Assessment Program through EMS (CHAP-EMS) in reducing blood pressure, diabetes risk, and EMS calls. Methods Paramedics on modified duty (e.g. injured) conducted weekly, one-on-one drop-in sessions in a common area of one subsidized senior’s apartment building in Hamilton, Ontario. Paramedics assessed cardiovascular, diabetes, and fall risk, provided health education, referred participants to local resources, and encouraged participants to return to CHAP-EMS for follow-up. Reports were faxed to the family physician regularly. Blood pressure was collected throughout the one year intervention, while diabetes risk was assessed at baseline and after 6–12 months. EMS call volumes were collected from the Hamilton Paramedic Service for two years pre-intervention and one year during the intervention. Results There were 79 participants (mean age = 72.2 years) and 1,365 participant visits to CHAP-EMS. The majority were female (68%), high school educated or less (53%), had a family doctor (90%), history of hypertension (58%), high waist circumference (64%), high body mass index (61%), and high stress (53%). Many had low physical activity (42%), high fat intake (33%), low fruit/vegetable intake (30%), and were current smokers (29%). At baseline, 42% of participants had elevated blood pressure. Systolic blood pressure decreased significantly by the participant’s 3rd visit to CHAP-EMS and diastolic by the 5th visit (p < .05). At baseline, 19% of participants had diabetes; 67% of those undiagnosed had a moderate or high risk based on the Canadian Diabetes Risk (CANRISK) assessment. 15% of participants dropped one CANRISK category (e.g. high to moderate) during the intervention. EMS call volume decreased 25% during the intervention compared to the previous two years. Conclusions CHAP-EMS was associated with a reduction in emergency calls and participant blood pressure and a tendency towards lowered diabetes risk after one year of implementation within a low income subsidized housing building with a history of high EMS calls. Trial registration Retrospectively registered on May 12th 2016 with clinicaltrials.gov: NCT02772263
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Affiliation(s)
- G Agarwal
- Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada.
| | - R Angeles
- Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - M Pirrie
- Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - F Marzanek
- Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - B McLeod
- Hamilton Paramedic Services, City of Hamilton, Canada
| | - J Parascandalo
- Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
| | - L Dolovich
- Departments of Family Medicine, Clinical Epidemiology and Biostatistics, Quality Assurance Program Coordinator for Family Medicine Residency, Residency Program Research Coordinator, Family Medicine Residency Program, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada
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25
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Brydges M, Denton M, Agarwal G. The CHAP-EMS health promotion program: a qualitative study on participants' views of the role of paramedics. BMC Health Serv Res 2016; 16:435. [PMID: 27557895 PMCID: PMC4997682 DOI: 10.1186/s12913-016-1687-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/17/2016] [Indexed: 12/03/2022] Open
Abstract
Background Expanded roles for paramedics, commonly termed community paramedicine, are becoming increasingly common. Paramedics working in community paramedicine roles represent a distinct departure away from the traditional emergency paradigm of paramedic services. Despite this, little research has addressed how community paramedics are perceived by their clients. Methods This study took an interpretivist qualitative approach to examine participants’ perceptions of paramedics providing a community paramedicine program, named the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). Both participant observation and semi-structured interviews conducted with program participants were used to gain insight into the on-the-ground experiences of the program. Thematic analysis was employed to analyze all data. Results Three themes emerged: i) Caring and trusting relationships; ii) paramedics as health advocates; iii) the added value of EMS skills. Paramedics were perceived by residents as having dual identities: first in a novel role as health advocates and secondly in a traditional role as emergency experts despite lacking contextual features associated with emergency response. Conclusions From this exploratory, qualitative study we present an emerging framework in which to conceptualize paramedic roles in community paramedicine settings. Future research should address the saliency of these roles in different contexts and how these roles relate to paramedic practice. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1687-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Madison Brydges
- Department of Health, Aging & Society, McMaster University, 1280 Main St W, Hamilton, ON, Canada
| | - Margaret Denton
- Department of Health, Aging & Society, McMaster University, 1280 Main St W, Hamilton, ON, Canada
| | - Gina Agarwal
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th Floor, Hamilton, ON, L8P 1H6, Canada. .,Department of Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main St W, Hamilton, ON, Canada.
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