title: Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.
abstract: BACKGROUND
  The incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.
  
  
  METHODS
  This will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.
  
  
  CONCLUSIONS
  The results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT02034045. Date: 9 January 2014.
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute, St, Michael's Hospital, 30 Bond St, Toronto, ON M5B 1W8, Canada. DrennanI@smh.ca.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Drennan
authors.forename: Katie N
authors.initials: KN
authors.lastname: Dainty
authors.forename: Paul
authors.initials: P
authors.lastname: Hoogeveen
authors.forename: Clare L
authors.initials: CL
authors.lastname: Atzema
authors.forename: Norm
authors.initials: N
authors.lastname: Barrette
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Hoch
authors.forename: Wanrudee
authors.initials: W
authors.lastname: Isaranuwatchai
authors.forename: Jane
authors.initials: J
authors.lastname: Philpott
authors.forename: Chris
authors.initials: C
authors.lastname: Spearen
authors.forename: Walter
authors.initials: W
authors.lastname: Tavares
authors.forename: Linda
authors.initials: L
authors.lastname: Turner
authors.forename: Melissa
authors.initials: M
authors.lastname: Farrell
authors.forename: Tom
authors.initials: T
authors.lastname: Filosa
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kane
authors.forename: Alex
authors.initials: A
authors.lastname: Kiss
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
mesh_terms: D002908:Chronic Disease; D002985:Clinical Protocols; D003153:Community Health Services / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D004636:Emergency Service, Hospital; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D009864:Ontario; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D012044:Regression Analysis; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome