title: A pragmatic quasi-experimental multi-site community intervention trial evaluating the impact of Emergency Care Practitioners in different UK health settings on patient pathways (NEECaP Trial).
abstract: BACKGROUND
  Emergency Care Practitioners (ECPs) are operational in the UK in a variety of emergency and urgent care settings. However, there is little evidence of the effectiveness of ECPs within these different settings. The aim of this study was to evaluate the impact of ECPs on patient pathways and care in different emergency care settings.
  
  
  METHODS
  A pragmatic quasi-experimental multi-site community intervention trial comprising five matched pairs of intervention (ECP) and control services (usual care providers): ambulance, care home, minor injury unit, urgent care centre and GP out-of-hours. The main outcome being assessed was patient disposal pathway following the care episode.
  
  
  RESULTS
  5525 patient episodes (n=2363 intervention and n=3162 control) were included in the study. A significantly greater percentage of patients were discharged by ECPs working in mobile settings such as the ambulance service (percentage diff. 36.7%, 95% CI 30.8% to 42.7%) and care home service (36.8%, 26.7% to 46.8%). In static services such as out-of-hours (-17.9%, -30.8% to -42.7%) and urgent care centres (-11.5%, -18.0% to -5.1%), a significantly greater percentage of patients were discharged by usual care providers.
  
  
  CONCLUSIONS
  ECPs have a differential impact compared with usual care providers dependent on the operational service settings. Maximal impact occurs when they operate in mobile settings when care is taken to the patient. In these settings ECPs have a broader range of skills than the usual care providers (eg, paramedic), and are targeted to specific clinical groups who can benefit from alternative pathways of care (such as older people who have fallen). Trial Registration No ISRCTN22085282 (Controlled trials.com).
authors.affiliation: School of Health and Related Research, University of Sheffield, Sheffield, UK. s.mason@sheffield.ac.uk
authors.forename: Suzanne
authors.initials: S
authors.lastname: Mason
authors.forename: Colin
authors.initials: C
authors.lastname: O'Keeffe
authors.forename: Emma
authors.initials: E
authors.lastname: Knowles
authors.forename: Mike
authors.initials: M
authors.lastname: Bradburn
authors.forename: Mike
authors.initials: M
authors.lastname: Campbell
authors.forename: Patricia
authors.initials: P
authors.lastname: Coleman
authors.forename: Chris
authors.initials: C
authors.lastname: Stride
authors.forename: Rachel
authors.initials: R
authors.lastname: O'Hara
authors.forename: Jo
authors.initials: J
authors.lastname: Rick
authors.forename: Malcolm
authors.initials: M
authors.lastname: Patterson
mesh_terms: D019091:Critical Pathways / Q000458:organization & administration*; D004632:Emergency Medical Services / Q000458:organization & administration*; D004634:Emergency Medical Technicians; D006801:Humans; D016555:Matched-Pair Analysis; D010351:Patient Discharge / Q000706:statistics & numerical data; D024382:Professional Role; D012017:Referral and Consultation / Q000706:statistics & numerical data; D006113:United Kingdom