Diagnosis Prevalence and Comorbidity in a Population of Mobile Integrated Community Health Care Patients

Abstract

IntroductionFrequent calls to 911 and requests for emergency services by individuals place a costly burden on emergency response systems and emergency departments (EDs) in the United States. Many of the calls by these individuals are non-emergent exacerbations of chronic conditions and could be treated more effectively and cost efficiently through another health care service. Mobile integrated community health (MICH) programs present a possible partial solution to the over-utilization of emergency services by addressing factors which contribute to a patient’s likelihood of frequent Emergency Medical Services (EMS) use. To provide effective care to eligible individuals, MICH providers must have a working understanding of the common conditions they will encounter.ObjectiveThe purpose of this descriptive study was to evaluate the diagnosis prevalence and comorbidity among participants in the Queen Anne’s County (Maryland USA) MICH Program. This fundamental knowledge of the most common medical conditions within the MICH Program will inform future mobile integrated health programs and providers.MethodsThis study examined preliminary data from the MICH Program, as well as 2017 Maryland census data. It involved secondary analysis of de-identified patient records and descriptive statistical analysis of the disease prevalence, degree of comorbidity, insurance coverage, and demographic characteristics among 97 program participants. Diagnoses were grouped by their ICD-9 classification codes to determine the most common categories of medical conditions. Multiple linear regression models and chi-squared tests were used to assess the association between age, sex, race, ICD-9 diagnosis groups, and comorbidity among program enrollees.ResultsResults indicated the most prevalent diagnoses included hypertension, high cholesterol, esophageal reflux, and diabetes mellitus. Additionally, 94.85% of MICH patients were comorbid; the number of comorbidities per patient ranged from one to 13 conditions, with a mean of 5.88 diagnoses per patient (SD=2.74).ConclusionOverall, patients in the MICH Program are decidedly medically complex and may be well-suited to additional community intervention to better manage their many conditions. The potential for MICH programs to simultaneously improve patient outcomes and reduce health care costs by expanding into larger public health and addressing the needs of the most vulnerable citizens warrants further study.ScharfBM, BissellRA, TrevittJL, JenkinsJL.Diagnosis prevalence and comorbidity in a population of mobile integrated community health care patients.Prehosp Disaster Med. 2019;34(1):46–55.

Designing and Governing Responsive Local Care Systems – Insights from a Scoping Review of Paramedics in Integrated Models of Care

“…– Clients with certain risk profiles rostered to programs by primary care providers [ 81 82 92 112 126 ], hospitals [ 51 52 95 108 120 127 ], or by paramedic services [ 55 56 128 ]…”

Experiences and views of people who frequently call emergency ambulance services: A qualitative study of UK service users

“…16,17 Some studies suggest that they may have unresolved problems or call frequently because they are not aware of an alternative pathway to access appropriate care. 6,[16][17][18][19][20][21] A 2022 review identified only one qualitative paper-from Canada-reporting experiences of people making frequent emergency ambulance calls. 22 Management of people who make frequent calls to ambulance services is a priority for United Kingdom (UK) ambulance services.…”

“…People who make frequent calls are often vulnerable, 6,13–15 more likely to: be from low socioeconomic groups; live alone; experience mental health challenges including self‐harming behaviour; live with chronic conditions; and have increased chances of falling 16,17 . Some studies suggest that they may have unresolved problems or call frequently because they are not aware of an alternative pathway to access appropriate care 6,16–21 . A 2022 review identified only one qualitative paper—from Canada—reporting experiences of people making frequent emergency ambulance calls 22 …”

“… 16 , 17 Some studies suggest that they may have unresolved problems or call frequently because they are not aware of an alternative pathway to access appropriate care. 6 , 16 , 17 , 18 , 19 , 20 , 21 A 2022 review identified only one qualitative paper—from Canada—reporting experiences of people making frequent emergency ambulance calls. 22 …”