Using Home-Based Community Paramedics to Reduce Emergency Department Utilization by High-Risk Elder Patients

Community paramedicine and mobile integrated healthcare is forming a new paradigm and national model for twenty-first century healthcare. Using paramedics to evaluate and treat medically complex elderly patients in the home setting could have wide-reaching implications for health management, cost of care, and patient satisfaction. EMS’ 1996 Agenda for the Future illustrated a vision of a community-based health management system that provided health services integration (1).

We aimed to determine the effect of Tandem 365, a home-based community paramedicine program (HBCPP) in West Michigan on emergency department utilization, diagnostics and administered procedures, rate of transport and admission, and length of stay. Tandem 365 is a highly integrated, mobile integrated healthcare organization partnered with a single insurance payor, Priority Health, that provides comprehensive solutions for geriatric patients with highly trained community integrated paramedics, nurses, and social workers. The organization initially began treating patients in 2014 as a joint venture between four continuous care retirement communities and one ambulance agency with an initial mission of decreasing hospital readmissions in vulnerable older adult populations. The program has since transformed into a community health system partner where hospital systems and insurance payers refer patients to Tandem for inclusion based on age, comorbidities, utilization, and projected life expectancy. Since its creation, Tandem 365 has treated more than 2800 patients.

In 2019 and 2020, a total of 1,419 urgent assessment calls (37.3%) were from HBCPP members. Of this, 2389 (62.7%) were traditional EMS calls and served as our control. In terms of age, the mean age of the HBCPP population was younger but within 1 SD (77.6 vs. 79.64). In 2019 HBCPP members had reduced ED transport compared to control (15.0% vs. 73%)(p<0.001) with higher admission rates (51.7% vs. 20.4%). Moreover, the patients within the HBCPP had an identical admission LOS (4.6d vs. 4.6d) (p<0.001). In 2020 when the COVID-19 global pandemic began, HBCPP patients continued to have reduced ED transport (11.7% vs. 73%) with an increased admission rate of 63.6%, an 18.7% increase from the previous year. Additionally, 2020 also possessed an increased LOS of 5.44, 0.48 days (nearly ½ day) increase. Comparing 2019 vs. 2020, HBPC patients not transported to the ED had subsequent ED evaluation rates within one day of assessment of 22.0% vs. 10.9%. In terms of discharge disposition, 2019 HBCPP required increased skilled nursing facilities (35% vs. 20%), reduced discharge to home (23% vs. 43%), and identical mortality rates (3% vs. 3%).

Our home-based community paramedicine program was started as a solution for at-risk seniors who have difficulty navigating the healthcare system to get the care they need and maintaining their independence at home. These results suggest that the HBCPP program reduced ED utilization during the study years of 2019-2020 with no increased in subsequent mortality.

References

1. National Highway Traffic Safety Administration. “EMS Agenda for the Future.” 16 April, 1996. Learn More. 21 June 2021.

Cozzi NP, Nelson G, Rushton M, Fennema P, Barnhart C, Anderson S, Chassee T, Jones J