title: The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS.
abstract: OBJECTIVE
  The San Francisco Fire Department's (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States' first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team's existence was examined.
  
  
  METHODS
  A retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.
  
  
  RESULTS
  A total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.
  
  
  CONCLUSIONS
  Frequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage. Tangherlini N , Villar J , Brown J , Rodriguez RM , Yeh C , Friedman BT , Wada P . The HOME Team: evaluating the effect of an EMS-based outreach team to decrease the frequency of 911 use among high utilizers of EMS. Prehosp Disaster Med. 2016;31(6):603-607.
authors.affiliation: 1San Francisco Fire Department,EMS Division,San Francisco,CaliforniaUSA.
authors.forename: Niels
authors.initials: N
authors.lastname: Tangherlini
authors.affiliation: 2Stanford University,Emergency Medicine,Palo Alto,CaliforniaUSA.
authors.forename: Julian
authors.initials: J
authors.lastname: Villar
authors.affiliation: 3University of California - San Francisco (UCSF),Emergency Medicine,San Francisco,CaliforniaUSA.
authors.forename: John
authors.initials: J
authors.lastname: Brown
authors.affiliation: 3University of California - San Francisco (UCSF),Emergency Medicine,San Francisco,CaliforniaUSA.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Rodriguez
authors.affiliation: 1San Francisco Fire Department,EMS Division,San Francisco,CaliforniaUSA.
authors.forename: Clement
authors.initials: C
authors.lastname: Yeh
authors.affiliation: 4University of Washington School of Medicine,Division of Emergency Medicine,Seattle,WashingtonUSA.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Friedman
authors.affiliation: 1San Francisco Fire Department,EMS Division,San Francisco,CaliforniaUSA.
authors.forename: Paul
authors.initials: P
authors.lastname: Wada
mesh_terms: D002140:California; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control* / Q000639:trends*; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D015397:Program Evaluation; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States
keywords:  ED emergency department;  EMS Emergency Medical Services;  HOME Homeless Outreach and Medical Emergency;  SFFD San Francisco Fire Department; Emergency Medical Services; health services needs; substance-related services