Approaches for Improving Health Equity: The Effect of The Gainesville Community Resource Paramedic Program on Reducing Emergency Department Utilization

Abstract

Background. The U.S. healthcare system has consistently struggled with inefficiencies in Emergency Department (ED) usage (Enard & Ganelin, 2013). Other studies have established that interventions focusing on care coordination are not able to reduce utilization (Finkelstein, 2020), and current ED reduction programs in the literature focus on establishing patients in primary care (Raven, 2016). In community paramedicine programs, paramedics collaborate with interdisciplinary partners to address the needs of patients outside of traditional health care settings. The Gainesville Community Resource Paramedic Program (Gainesville CRP) was implemented in 2017 to provide an intervention to address social determinants that primary care providers (PCP) cannot address. Methods. A Student’s t-test for paired samples was used to compare total ED visits as well as ED visits with and without hospital admission six months before and after program enrollment. Pearson’s correlation between final change in total ED visits and total PCP visits for pre-CRP, post-CRP, and full-CRP were calculated to determine if there was evidence for bias in utilization patterns. Results. Among program participants (n = 53), significant reductions were observed among total (mean = 2.94, p < 0.001), without admission (mean = 1.30, p = 0.006), and with admission (mean = 1.64, p = 0.002). Significant reductions were also found among selected demographics and morbidities. Reductions in total ED visits were not associated with visits to a PCP before, after, or throughout. Conclusions. Gainesville CRP was able to reduce ED visits independent of PCPs indicating that the approach could inform other ED diversion programs.