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Randomized Controlled Trial
. 2018 May 3;18(1):104.
doi: 10.1186/s12877-018-0792-5.

A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits

Ranran Mi  1 , Matthew M Hollander  1 , Courtney M C Jones  2 , Eva H DuGoff  3 , Thomas V Caprio  4 , Jeremy T Cushman  2 , Amy J H Kind  5   6 , Michael Lohmeier  1 , Manish N Shah  7   8   9
Affiliations
Randomized Controlled Trial

A randomized controlled trial testing the effectiveness of a paramedic-delivered care transitions intervention to reduce emergency department revisits

Ranran Mi et al. BMC Geriatr. .

Abstract

Background: Approximately 20% of community-dwelling older adults discharged from the emergency department (ED) return to an ED within 30 days, an occurrence partially resulting from poor care transitions. Prior published interventions to improve the ED-to-home transition have either lacked feasibility or effectiveness. The Care Transitions Intervention (CTI) has been validated to decrease rehospitalization among patients transitioning from the hospital to the home but has never been tested for patients transitioning from the ED to the home. Paramedics, traditionally involved only in emergency care, are well-positioned to deliver the CTI, but have never been previously evaluated in this role.

Methods: This single-blinded randomized controlled trial tests whether the paramedic-delivered ED-to-home CTI reduces community-dwelling older adults' ED revisits in the 30 days after an index visit. We are prospectively recruiting patients aged≥ 60 years at 3 EDs in Rochester, NY and Madison, WI to enroll 2400 patient subjects. Subjects are randomized into control and treatment groups, with the latter receiving the adapted CTI. The intervention consists of the paramedic performing one home visit and up to three follow-up phone calls. During these interactions, the paramedic follows the CTI approach by coaching patients toward their goals, with a focus on their personal health record, medication management, red flags, and primary care follow-up. We follow patient participants for 30 days. All receive a survey during the index ED visit to capture baseline demographic and health information and two telephone-based surveys to assess process objectives and outcomes. We also perform a medical record review. The primary outcome is the odds of ED revisit within 30 days after discharge from the index ED visit.

Discussion: This is the first study to test whether the CTI, applied to the ED-to-home transition and delivered by community paramedics, can decrease the rate at which older adults revisit an ED. Outcomes from this research will help address a major emergency care challenge by supporting older adults in the transition from the ED to home, thereby improving health outcomes for this population and reducing potentially avoidable ED visits.

Trial registration: ClinicalTrials.gov Registration: NCT02520661 . Trial registration date: August 13, 2015.

Keywords: Care transitions; Community paramedicine; Emergency department; Older adults.

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Conflict of interest statement

Ethics approval and consent to participate

The Institutional Review Boards (IRB) at UW-Madison and the University of Rochester approved this study. The trial was registered at ClinicalTrials.gov (NCT02520661, registration date: August 13, 2015). All subjects provide written informed consent for participation in the study. Those subjects without decisional capacity must have a legally authorize representative present who provides written informed consent, with assent from the patient. Institutional regulations are followed in all circumstances.

Competing interests

The authors declare that they have no competing interests. The study sponsor does not have any role in the study design, collection, management, analysis, interpretation, or preparation of this manuscript.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Emergency Department-to-Home Care Transitions Intervention
Fig. 2
Fig. 2
Overview of Research Activities: Participant Flow, Actions, and Measurements
See this image and copyright information in PMC

References

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