title: Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program-Preliminary Data.
abstract: Models addressing urgent clinical needs for older adults with multiple advanced chronic conditions are lacking. This observational study describes a Community Paramedicine (CP) model for treatment of acute medical conditions within an Advanced Illness Management (AIM) program, and compares its effect on emergency department (ED) use and subsequent hospitalization with that of traditional emergency medical services (EMS). Community paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals' homes. They were also able to transport to the ED if needed. The CP model was implemented between January 1, 2014, and April 30, 2015 in a suburban-urban AIM program. Participants included 1,602 individuals enrolled in the AIM program with high rates of dementia, decubitus ulcers, diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. Participants had a median age of 83 and an average of five activity of daily living dependencies (range 0-6). During the study period, there were 664 CP responses and 1,091 traditional EMS transports to the ED among 773 individuals. Only 22% of CP responses required transport; 78% were evaluated and treated in the home. Individuals that community paramedics transported to the ED had higher rates of hospitalization (82.2%) than those using traditional EMS (68.9%) (P < .001). Post-CP surveys showed that all respondents felt the program was of high quality. Results support the potential benefits of CP and invite further evaluation of this innovative care model.
authors: Department of Internal Medicine, Hoftstra-Northwell School of Medicine, New Hyde Park, New York.
authors: Karen A
authors: KA
authors: Abrashkin
authors: Center for Emergency Medical Services, Northwell Health, New Hyde Park, New York.
authors: Jonathan
authors: J
authors: Washko
authors: Department of Internal Medicine, Hoftstra-Northwell School of Medicine, New Hyde Park, New York.
authors: Jenny
authors: J
authors: Zhang
authors: Department of Internal Medicine, Hoftstra-Northwell School of Medicine, New Hyde Park, New York.
authors: Asantewaa
authors: A
authors: Poku
authors: Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota.
authors: Hyun
authors: H
authors: Kim
authors: Department of Internal Medicine, Hoftstra-Northwell School of Medicine, New Hyde Park, New York.
authors: Kristofer L
authors: KL
authors: Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel / Q000193:education; D003153:Community Health Services; D005260:Female; D005853:Geriatrics / Q000193:education; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D008952:Mobile Health Units; D009519:New York City; D011361:Professional Competence; D017216:Telemedicine; D000078329:Workforce
keywords: Advanced Illness Management; Community Paramedicine; Mobile Integrated Healthcare; acute care; community paramedics