Effects of an Emergency Medical Services–based Resource Access Program on Frequent Users of Health Services

Tadros, Anthony; Castillo, Edward M.; Chan, Theodore C.; Jensen, Anne Marie; Patel, Ekta; Watts, K D; Dunford, James V.

doi:10.3109/10903127.2012.689927

Cited by 44 publications

(40 citation statements)

References 28 publications

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“…Previously published definitions of repeat or frequent EMS use differ 37 including: five or more EMS encounters in one year, 34,38 six or more EMS encounters in a 23 month period, 26 ten or more EMS transports in one year, 39 and three or more EMS transports in one year. 40 We chose to focus on repeat use of EMS within 30 days because 30 days is a commonly used outcome for decision instruments in emergency medicine, 41,42 and is the time frame used by the Centers for Medicare and Medicaid Services as a quality measure for hospital readmissions.…”

Section: Discussionmentioning

confidence: 99%

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Evans

Platts‐Mills

Fernández

et al. 2017

Annals of Emergency Medicine

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OBJECTIVE The objective of this study was to characterize repeat Emergency Medical Services (EMS) transports among older adults across a large and socioeconomically diverse region. METHODS Using the North Carolina Prehospital Medical Information System (PreMIS), we analyzed the frequency of repeat EMS transports within 30 days of an index EMS transport among adults aged 65 years and older from 2010–2015. We used multivariable logistic regressions to determine characteristics associated with repeat EMS transport. RESULTS Over the 6-year period, EMS performed 1,711,669 transports for 689,664 unique older adults in North Carolina. Of these, 303,099 (17.7%) transports were followed by another transport of the same patient within 30 days. The key characteristics associated with an increased adjusted odds ratio of repeat transport within 30 days include: transport from an institutionalized setting (OR 1.42, 95% Confidence Interval (CI) 1.38–1.47), Blacks compared to Whites (OR 1.29, 95% CI 1.24–1.33), a dispatch complaint of psychiatric problems (OR 1.38, 95% CI 1.25–1.52), back pain (OR 1.35, 95% CI 1.26–1.45), breathing problems (OR 1.21, 95% CI 1.15–1.30), and diabetic problems (OR 1.14, 95% CI 1.06–1.22). Falls accounted for 15.6% of all transports and had a modest association with repeat transports (OR 1.07, 95% CI 1.00–1.14). CONCLUSIONS More than 1 in 6 EMS transports of older adults in North Carolina are followed by a repeat transport of the same patient within 30 days. Patient characteristics and chief complaints may identify increased risk for repeat transport and suggest the potential for targeted interventions to improve outcomes and manage EMS utilization.

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Section: Discussionmentioning

confidence: 99%

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Evans

Platts‐Mills

Fernández

et al. 2017

Annals of Emergency Medicine

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“…8,25 Drug and alcohol use has been repeatedly shown to be strongly associated with frequent use of services in a variety of emergency settings. 8,11,22,[26][27][28][29] Thus, the disproportionately high alcohol involvement in EMS superusers is not surprising. However, our study provides empirical evidence that alcohol involvement increases exponentially in moderate-use, high-use, and superuser EMS groups when compared to the low-use group, suggesting that superusers have distinct characteristics and health-care demands.…”

Section: Discussionmentioning

confidence: 99%

“…17,18,22 Yet beyond anecdotal evidence or reports from the lay press, little is known about highly frequent "superusers" of EMS services. In this regard, a preliminary understanding of the population served by EMS, including its characteristics and impact on health-care finances, is critical if interventions to improve care are to be developed and implemented.…”

Section: Rationalementioning

confidence: 99%

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Hall¹,

Raven²,

Hall³

et al. 2014

Prehospital Emergency Care

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Objective. Emergency medical services (EMS) "superusers" -those who use EMS services at extremely high rateshave not been well characterized. Recent interest in the small group of individuals who account for a disproportionate share of health-care expenditures has led to research on frequent users of emergency departments and other health services, but little research has been done regarding those who use EMS services. To inform policy and intervention implementation, we undertook a descriptive analysis of EMS superusers in a large urban community. In this paper we compare EMS superusers to low, moderate, and high users to characterize factors contributing to EMS use. We also estimate the financial impact of EMS superusers. Methods. We conducted a retrospective cross-sectional study based on 1 year of data from an urban EMS system. Data for all EMS encounters with patients age ≥18 years were extracted from electronic records generated on scene by paramedics. We identified demographic and clinical variables associated with levels of EMS use. EMS users were characterized by the annual number of EMS encounters: low (1), moderate (2-4), high (5-14), and superusers (≥15). In addition, we performed a financial analysis using San Francisco Fire Department of 31,462 adults generated 43,559 EMS ambulance encounters, which resulted in 39,107 transports (a 90% transport rate). Encounters for general medical reasons were common among moderate and high users and less frequent among superusers and low users, while alcohol use was exponentially correlated with encounter frequency. Superusers were significantly younger than moderate EMS users, and more likely to be male. The superuser group created a significantly higher financial burden/person than any other group, comprising 0.3% of the study population, but over 6% of annual EMS charges and reimbursements. Conclusions. In this retrospective study, adult EMS "superusers" emerged as a distinct, predominantly male population and their EMS encounters were associated with alcohol use. Continued analysis of this unique, high-cost, and frequently transported population will likely illuminate specific intervention strategies.

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“…14,23,24 One study found that 308 homeless individuals in San Diego, California incurred 2,335 EMS transports over a 4-year period. 25 In recent years, interventions to reduce EMS use among individuals who consume a disproportionate amount of services have shown promise, including a case management and referral program 26 and a 6-month outpatient treatment program. 25 …”

mentioning

confidence: 99%

Housing First Is Associated with Reduced Use of Emergency Medical Services

Mackelprang¹,

Collins²,

Clifasefi³

2014

Prehospital Emergency Care

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Objective Chronically homeless adults with severe alcohol problems are disproportionately burdened with healthcare problems and are high utilizers of emergency medical services (EMS). Single-site Housing First (HF), which provides immediate, permanent, low-barrier, nonabstinence-based, supportive housing, has been associated with reduced publicly funded service utilization. The aims of the current study were to determine whether time spent in single-site HF predicted decreases in EMS contacts 2 years subsequent to single-site HF move-in, and to describe medical conditions and injuries associated with EMS contacts in a sample of chronically homeless individuals with severe alcohol problems. Methods Participants were 91 chronically homeless adults with severe alcohol problems who were enrolled in a single-site HF program between December 2005 and March 2007 in Seattle, Washington. We obtained administrative data on exposure to HF and EMS utilization for the 2 years prior to and the 2 years subsequent to participants’ move-in date. EMS utilization variables included patient type (i.e., primary presenting problem), trauma/injury mechanism (i.e., EMS classification of the cause of the trauma or injury), level of care (i.e., basic life support, advanced life support), and transport destination. Results After controlling for baseline EMS contacts, participants evinced 3% fewer EMS contacts for each additional month of single-site HF exposure. From the baseline to follow-up period, the mean number of EMS contacts declined from 15.85 (SD = 22.96) to 9.54 (SD = 15.08), representing a 54% reduction in the number of EMS contacts. Most calls were responded to by EMTs providing basic life support, and the majority resulted in transport to a local level I trauma center. The most common presenting difficulties were medical illness and trauma. Substance use and psychiatric difficulties were infrequently documented as the primary problem. Conclusions Our findings support recent assertions that housing is health care and indicate that the amount of time spent in single-site HF is associated with significant reductions in EMS utilization for at least 2 years subsequent to move-in. These findings also underscore the high levels of medical illness and trauma exposure among chronically homeless adults with severe alcohol problems.

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Effects of an Emergency Medical Services–based Resource Access Program on Frequent Users of Health Services

Cited by 44 publications

References 28 publications

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

EMS-STARS: Emergency Medical Services “Superuser” Transport Associations: An Adult Retrospective Study

Housing First Is Associated with Reduced Use of Emergency Medical Services

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