Background: Repeat ED visits are common among older adults, particularly among rural patients who frequently have unmet medical and social needs. Community paramedicine (CP) has significant potential to optimize this ED-to-home care transition. We sought to design and evaluate a CP program designed specifically to reduce repeat ED visits among rural older adults.
Methods: We conducted a prospective multi-site study in a rural Upstate NY county. The intervention centered on leveraging the Coleman Care Transitions Intervention (CTI) as a guiding framework. All community paramedics received training including completion of the in-person Coleman CTI course, shadowing geriatricians, motivational interviewing, and research ethics. Intervention subjects were recruited from three EDs and were given a home-visit within 48 hours of ED discharge, conducted by a community paramedic, and up to 3 follow-up phone calls. Baseline surveys were administered in the ED and research follow-up calls were conducted at 4 and 30 days. An administrative control group was used with a 1:2 intervention to control ratio. Matching criteria included: age, acuity level, and day of ED presentation. A blinded medical record review was conducted to obtain health care utilization. Due to the matched design, a McNemar’s test was used to compare 30-day repeat ED visits among intervention versus control subjects. In the event a patient did not complete the home visits, the intention-to-treat principle was used.
Results: A total of 276 intervention subjects were included with a mean age of 73 years; 85% of whom completed the home visit. There were no statistically significant differences in any of repeat ED visits at 30-days between the intervention and control groups (14.5% vs. 14.9%). However, intervention subjects had fewer number of ED visits within the 30-day period, with only 9.4% of intervention subjects having 2 or more repeat ED visits, compared to 16.9% among controls. Additionally, intervention subjects who returned to the ED were significantly less likely to require admission compared to controls (25.6% vs. 34.2%).
Conclusion: In our sample of rural older adults, a CP CTI program did not reduce repeat ED visits at 30 days. However, intervention subjects had fewer repeat ED visits within 30 days and were less likely to be admitted. The potential benefits of a CP CTI program warrant further study.