Indicators of paramedic service use by community dwelling older adults

Matthew S Leyenaar, Walter Tavares, Gina Agarwal, Andrew P Costa

DOI: http://dx.doi.org/10.32378/ijp.v4i1.74

Abstract

Introduction:  Home care clients represent a patient group that may be served through community paramedicine (CP) programs.  The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population.  This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores.

Methods: A retrospective cohort study was conducted using regularly collected administrative data.  Home care assessment data were supplemented with data on emergency department (ED) visits.  Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables.

Results:  Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year.  About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation.  DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78

Conclusion:  DIVERT was not developed to consider means of transportation to the ED.  The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED.  Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted.  Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.


Keywords

Emergency department use, Paramedic service use, Repeated use, Case-finding, Risk scale

Full Text:

PDF

References

Costa AP, Harkness K, Haughton D, Heckman GA, Mckelvie RS, Harkness K, et al. Risk of emergency department use among community-dwelling older adults : a review of risk factors and screening methods. Clin Pract [Internet]. 2014 Dec [cited 2016 Dec 15];11(6):763-76. Available from: http://www.futuremedicine.com/doi/abs/10.2217/cpr.14.66

Costa AP, Hirdes JP, Bell CM, Bronskill SE, Heckman GA, Mitchell L, et al. Derivation and validation of the detection of indicators and vulnerabilities for emergency room trips scale for classifying the risk of emergency department use in frail community-dwelling older adults. J Am Geriatr Soc. 2015;63(4):763-9.

Singal BM, Hedges JR, Rousseau EW, Sanders AB, Berstein E, McNamara RM, et al. Geriatric patient emergency visits. Part I: Comparison of visits by geriatric and younger patients. Ann Emerg Med [Internet]. 1992 Jul [cited 2016 Dec 15];21(7):802-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/1610036

Munjal KG, Silverman RA, Freese J, Braun JD, Kaufman BJ, Isaacs D, et al. Utilization of emergency medical services in a large urban area: description of call types and temporal trends. Prehosp Emerg Care [Internet]. 2011;15(3):371-80. Available from: http://www.tandfonline.com/doi/abs/10.3109/10903127.2011.561403%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed/21521036

Sinha SK, Bessman ES, Flomenbaum N, Leff B. A systematic review and qualitative analysis to inform the development of a new emergency department-based geriatric case management model. Ann Emerg Med. 2011;57(6):672-82.

Coe AB. Identifying Problems during Transitions of Care and Reasons for Emergency Department Utilization in Community-Dwelling Older Adults. 2015;290. Available from: http://search.proquest.com/docview/1758894743?accountid=13042

Morris JN, Howard EP, Steel K, Schreiber R, Fries BE, Lipsitz LA, et al. Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data. BMC Health Serv Res [Internet]. 2014;14(1):519. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4236798&tool=pmcentrez&rendertype=abstract

Kessler C, Williams MC, Moustoukas JN, Pappas C. Transitions of Care for the Geriatric Patient in the Emergency Department. Clin Geriatr Med [Internet]. 2013 [cited 2016 Dec 15];29:49-69. Available from: http://dx.doi.org/10.1016/j.cger.2012.10.005

Ruest M, Stitchman A, Day C. Evaluating the impact on 911 calls by an in-home programme with a multidisciplinary team. Int Paramed Pract. 2012;1(4):125-32.

Pines JM, Mullins PM, Cooper JK, Feng LB, Roth KE. National trends in emergency department use, care patterns, and quality of care of older adults in the United States. J Am Geriatr Soc. 2013;61(1):12-7.

Kellermann AL. Emergency medicine and public health: Stopping emergencies before the 9-1-1 call. Acad Emerg Med. 2009;16(11):1060-4.

Community Paramedicine: Framework for program development. Toronto, ON: CSA Group; 2017.

Lee JS, Verbeek PR, Schull MJ, Calder L, Stiell IG, Trickett J, et al. Paramedics assessing Elders at Risk for Independence Loss (PERIL): Derivation, Reliability and Comparative Effectiveness of a Clinical Prediction Rule. CJEM [Internet]. 2016;18(2):121-32. Available from: http://www.journals.cambridge.org/abstract_S1481803516000142

Agarwal G, Mcdonough B, Angeles R, Pirrie M, Marzanek F, Mcleod B, et al. Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors' housing b. BMJ Open [Internet]. 2015;5(6):e008110-e008110. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=4466604&tool=pmcentrez&rendertype=abstract

Agarwal G, Angeles R, Pirrie M, Marzanek F, McLeod B, Parascandalo J, et al. Effectiveness of a community paramedic-led health assessment and education initiative in a seniors' residence building: the Community Health Assessment Program through Emergency Medical Services (CHAP-EMS). BMC Emerg Med [Internet]. 2016;17(1):8. Available from: http://bmcemergmed.biomedcentral.com/articles/10.1186/s12873-017-0119-4

Morris JN, Fries BE, Bernabei R, Steel K, Ikegami N, Carpenter I, et al. RAI-Home Care ( RAI-HC ) Manual. Second. interRAI Corporation; 2002.

Scott J, Strickland AP, Warner K, Dawson P. Describing and predicting frequent callers to an ambulance service: analysis of 1 year call data. Emerg Med J [Internet]. 2013;1-7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/23413152

Cantwell K, Morgans A, Smith K, Livingston M, Spelman T, Dietze P. Time of Day and Day of Week Trends in EMS Demand. Prehospital Emerg Care [Internet]. 2015;19(3):425-31. Available from: http://www.tandfonline.com/doi/full/10.3109/10903127.2014.995843



DOI: http://dx.doi.org/10.32378/ijp.v4i1.74

Refbacks

  • There are currently no refbacks.




Copyright (c) 2019 Matthew S. Leyenaar, Walter Tavares, Gina Agarwal, Andrew P. Costa

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

IJP is an Open Access journal and articles published are distributed under the terms of the Creative Commons Attribution-NonCommercial License (CC BY-NC). Article copyright remains with individual authors. Authors grant unrestricted copyright license to the IJP. Readers may copy, distribute, build upon, reproduce, and display the work for non-commercial purposes with the proper citation of the original work in this publication. DPLA Rights statement: http://rightsstatements.org/page/InC-NC/1.0/?language=en. The IJP supports the National Principles for Open Access Policy Statement.

CC-BY-SA-NC 4/0

Electronic ISSN: 2009-938X.

We deposit a copy of all Irish healthcare related articles with Lenus, the Irish Health Repository and eDepositIreland, ensuring a full-text copy is always available and securely stored. The IJP is also listed with DOAJGoogle ScholarScienceOpen and other indexing services.

Crossref Member Badge