Management of frequent ED users by community paramedics improves patient experiences and reduces EMS utilization

Oluwakemi Aiyedun Adio, Louisiana State University and Agricultural and Mechanical CollegeFollow
Laura Ikuma, Louisiana State UniversityFollow
Sonja Wiley, Louisiana State UniversityFollow

Abstract

This study examined a suburban emergency medical system (EMS)-led community paramedicine (CP) program in terms of adherence to protocol, patient-paramedic interactions, patient experience, and cost. Participants (n=57) are frequent emergency department (ED) users (≥ 4 ED visits/year), with a mean age of 59.8±17.6 years and have multiple chronic conditions. Of these, 36 completed a modified Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey at 3- and 6-months following program enrollment. The main outcome measures were adherence to intake goals; types, modes, and frequencies of CP interventions; CG-CAHPS patient experience scores; and cost savings. Cost savings compared EMS transports, ED visits, and hospital admissions during CP enrollment versus the previous year. Analysis also correlated participant demographics with the type and frequency of interventions. Adherence to enrollee intake protocols range from 5.3% for medication reconciliation to 78.9% for assessments of daily living (ADL) and home safety. The most popular interventions were follow-up and wellness checks occurring primarily in patients’ homes, and 97% of participants would recommend the program to friends/relatives. Females and African-Americans had increased CP interventions (p <.0001). Mean post-program 911 calls decreased significantly from pre-program levels, from 14.1 to 7.8 (p = .0012), as did ED transports (10.1 to 5.6, p = .002), and non-ED transports (4 to 2.2, p = .0380). The estimated annual return on investment (ROI) is >51%. This study objectively illustrates program success, showing that carefully designed and managed CP programs can deliver Triple Aim objectives.

Experience Framework

This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework. (http://bit.ly/ExperienceFramework)

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Recommended Citation

Adio OA, Ikuma L, Wiley S. Management of frequent ED users by community paramedics improves patient experiences and reduces EMS utilization. Patient Experience Journal. 2020; 7(3):174-188. doi: 10.35680/2372-0247.1397.