Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries
Abstract Background Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community‐based health care settings. Outreach through community paramedicine to patients with a history of high hospital emerg...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-06-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12988 |
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| _version_ | 1850110658127855616 |
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| author | Jessica Currier Neal Wallace Keshia Bigler Maggie O'Connor Paige Farris Jackilen Shannon |
| author_facet | Jessica Currier Neal Wallace Keshia Bigler Maggie O'Connor Paige Farris Jackilen Shannon |
| author_sort | Jessica Currier |
| collection | DOAJ |
| description | Abstract Background Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community‐based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization. Methods A cluster randomized trial approach with a stepped wedge design was used to test the effect of the community paramedicine intervention. ED utilization for non‐urgent care was measured by emergency medicine ED visits and avoidable ED visits. Results The community paramedicine intervention reduced ED utilization among a sample of 102 medically complex Medicaid beneficiaries with a history of high ED utilization. In the unadjusted models, emergency medical ED visits decreased by 13.9% (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.76–0.98) or 6.1 visits saved for every 100 people. Avoidable emergency department visits decreased by 38.9% (IRR, 0.61; 95% CI, 0.44–0.84) or 2.3 visits saved for every 100 people. Conclusion Our results suggest community paramedicine is a promising model to achieve a reduction in ED utilization among medically complex patients by managing complex health conditions in a home‐based setting. |
| format | Article |
| id | doaj-art-4636ffc486df4a518540abd55b18f956 |
| institution | OA Journals |
| issn | 2688-1152 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-4636ffc486df4a518540abd55b18f9562025-08-20T02:37:48ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522023-06-0143n/an/a10.1002/emp2.12988Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiariesJessica Currier0Neal Wallace1Keshia Bigler2Maggie O'Connor3Paige Farris4Jackilen Shannon5Oregon Health & Science University Knight Cancer Institute Bend Oregon USAOregon Health & Science University‐Portland State University School of Public Health Bend Oregon USACare Oregon Portland Oregon USASt. Charles Health System Bend Oregon USAOregon Health & Science University Knight Cancer Institute Bend Oregon USAOregon Health & Science University Knight Cancer Institute Bend Oregon USAAbstract Background Community paramedicine has emerged as a promising model to redirect persons with nonmedically emergent conditions to more appropriate and less expensive community‐based health care settings. Outreach through community paramedicine to patients with a history of high hospital emergency department (ED) use and chronic health conditions has been found to reduce ED use. This study examined the effect of community paramedicine implemented in 2 rural counties in reducing nonemergent ED use among a sample of Medicaid beneficiaries with complex medical conditions and a history of high ED utilization. Methods A cluster randomized trial approach with a stepped wedge design was used to test the effect of the community paramedicine intervention. ED utilization for non‐urgent care was measured by emergency medicine ED visits and avoidable ED visits. Results The community paramedicine intervention reduced ED utilization among a sample of 102 medically complex Medicaid beneficiaries with a history of high ED utilization. In the unadjusted models, emergency medical ED visits decreased by 13.9% (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.76–0.98) or 6.1 visits saved for every 100 people. Avoidable emergency department visits decreased by 38.9% (IRR, 0.61; 95% CI, 0.44–0.84) or 2.3 visits saved for every 100 people. Conclusion Our results suggest community paramedicine is a promising model to achieve a reduction in ED utilization among medically complex patients by managing complex health conditions in a home‐based setting.https://doi.org/10.1002/emp2.12988community paramedicinecomorbiditiesemergency department utilizationnon‐urgent care |
| spellingShingle | Jessica Currier Neal Wallace Keshia Bigler Maggie O'Connor Paige Farris Jackilen Shannon Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries Journal of the American College of Emergency Physicians Open community paramedicine comorbidities emergency department utilization non‐urgent care |
| title | Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries |
| title_full | Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries |
| title_fullStr | Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries |
| title_full_unstemmed | Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries |
| title_short | Community paramedicine in Central Oregon: A promising model to reduce non‐urgent emergency department utilization among medically complex Medicaid beneficiaries |
| title_sort | community paramedicine in central oregon a promising model to reduce non urgent emergency department utilization among medically complex medicaid beneficiaries |
| topic | community paramedicine comorbidities emergency department utilization non‐urgent care |
| url | https://doi.org/10.1002/emp2.12988 |
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