A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits

dc.contributor.authorMi, Ranran
dc.contributor.authorHollander, Matthew M.
dc.contributor.authorJones, Courtney M. C.
dc.contributor.authorDuGoff, Eva H.
dc.contributor.authorCaprio, Thomas V.
dc.contributor.authorCushman, Jeremy T.
dc.contributor.authorKind, Amy J. H.
dc.contributor.authorLohmeier, Michael
dc.contributor.authorShah, Manish N.
dc.date.accessioned2021-07-09T13:44:30Z
dc.date.available2021-07-09T13:44:30Z
dc.date.issued2018-05-03
dc.description.abstractApproximately 20% of community-dwelling older adults discharged from the emergency department (ED) return to an ED within 30 days, an occurrence partially resulting from poor care transitions. Prior published interventions to improve the ED-to-home transition have either lacked feasibility or effectiveness. The Care Transitions Intervention (CTI) has been validated to decrease rehospitalization among patients transitioning from the hospital to the home but has never been tested for patients transitioning from the ED to the home. Paramedics, traditionally involved only in emergency care, are well-positioned to deliver the CTI, but have never been previously evaluated in this role. This single-blinded randomized controlled trial tests whether the paramedic-delivered ED-to-home CTI reduces community-dwelling older adults’ ED revisits in the 30 days after an index visit. We are prospectively recruiting patients aged≥ 60 years at 3 EDs in Rochester, NY and Madison, WI to enroll 2400 patient subjects. Subjects are randomized into control and treatment groups, with the latter receiving the adapted CTI. The intervention consists of the paramedic performing one home visit and up to three follow-up phone calls. During these interactions, the paramedic follows the CTI approach by coaching patients toward their goals, with a focus on their personal health record, medication management, red flags, and primary care follow-up. We follow patient participants for 30 days. All receive a survey during the index ED visit to capture baseline demographic and health information and two telephone-based surveys to assess process objectives and outcomes. We also perform a medical record review. The primary outcome is the odds of ED revisit within 30 days after discharge from the index ED visit. This is the first study to test whether the CTI, applied to the ED-to-home transition and delivered by community paramedics, can decrease the rate at which older adults revisit an ED. Outcomes from this research will help address a major emergency care challenge by supporting older adults in the transition from the ED to home, thereby improving health outcomes for this population and reducing potentially avoidable ED visits.en_US
dc.description.urihttps://doi.org/10.1186/s12877-018-0792-5
dc.identifierhttps://doi.org/10.13016/5j3u-d5qi
dc.identifier.citationMi, R., Hollander, M.M., Jones, C.M.C. et al. A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits. BMC Geriatr 18, 104 (2018).en_US
dc.identifier.urihttp://hdl.handle.net/1903/27324
dc.language.isoen_USen_US
dc.publisherSpringer Natureen_US
dc.relation.isAvailableAtHealth Services Administration
dc.relation.isAvailableAtSchool of Public Health
dc.relation.isAvailableAtDigital Repository at the University of Maryland (DRUM)
dc.relation.isAvailableAtUniversity of Maryland (College Park, MD)
dc.subjectCare transitionsen_US
dc.subjectCommunity paramedicineen_US
dc.subjectEmergency departmenten_US
dc.subjectOlder adultsen_US
dc.titleA randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisitsen_US
dc.typeArticleen_US

Files

Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
s12877-018-0792-5.pdf
Size:
635.23 KB
Format:
Adobe Portable Document Format
Description:
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.57 KB
Format:
Item-specific license agreed upon to submission
Description: