Allina Health Emergency Medical Services, St. Paul, Minnesota, USA.
Care Delivery Research, Allina Health, Minneapolis, Minnesota, USA.
Prehosp Emerg Care. 2023;27(5):704-711. doi: 10.1080/10903127.2022.2086653. Epub 2022 Jun 27.
Many community paramedic interventions aim to reduce unnecessary emergency department visits among high utilizers of acute care, but fewer focus specifically on reducing summons for emergency medical services (EMS). We implemented an EMS-based pilot program that identified high utilizers of 9-1-1 and facilitated community paramedic outreach encounters to understand and address potentially unnecessary 9-1-1 calls. This study compares the pre- and post-intervention incidence rate of 9-1-1 calls among program participants.
This retrospective evaluation was conducted using pilot data from a single U.S. EMS agency that responds to approximately 100,000 9-1-1 calls annually. High utilizers, defined as individuals with ≥3 9-1-1 calls in 90 days, were identified for recruitment between February 1, 2019 and December 31, 2019. Community paramedics recruited participants via phone and then conducted home visits to assist them with navigation away from unnecessary 9-1-1 use. Dispatch data from September 1, 2018 to December 31, 2019 were used to compute the incidence rate of 9-1-1 calls per 30 person-days of observation before and after the initial home visits.
Data from 108 program participants were analyzed. The majority were over the age of 50 (79%), and 33% completed more than one visit. Median person-days of observation before and after the initial home visit were 354 days and 132 days, respectively. Participants called 9-1-1 an average of 0.68 times per 30 person-days prior to the community paramedic intervention, and 0.51 times per 30 person-days after the intervention, which represents an overall mean decrease in 9-1-1 utilization of 25% (p < 0.001). Although a decrease in 9-1-1 utilization was observed in the majority of participants, the 9-1-1 call rate increased in 29% of participants. No statistically significant changes in 9-1-1 use were observed in participants who received more than one home visit or who were in the highest quartile of 9-1-1 use prior to the intervention.
This pilot work demonstrates the feasibility of an EMS-based, community paramedic-only intervention to reduce unnecessary 9-1-1 calls and suggests that some modest reductions in EMS use may be achievable by dispatching community paramedics to conduct home visits with frequent users of 9-1-1.
许多社区急救医疗干预旨在减少急性护理高使用者不必要的急诊就诊次数，但很少有专门针对减少紧急医疗服务 (EMS) 召唤的干预措施。我们实施了一项基于 EMS 的试点计划，该计划确定了大量使用 9-1-1 的高使用者，并促进了社区急救医疗人员的外展接触，以了解和解决潜在的不必要的 9-1-1 呼叫。本研究比较了该计划参与者在干预前后的 9-1-1 呼叫发生率。
这是一项使用来自美国一家 EMS 机构的试点数据进行的回顾性评估，该机构每年应对约 100,000 次 9-1-1 呼叫。高使用者定义为在 90 天内有≥3 次 9-1-1 呼叫的个体，于 2019 年 2 月 1 日至 12 月 31 日期间通过电话招募参与者，然后由社区急救医疗人员进行家访，帮助他们避免不必要的 9-1-1 使用。使用 2018 年 9 月 1 日至 2019 年 12 月 31 日的调度数据，计算初始家访前后每 30 人天观察期内的 9-1-1 呼叫发生率。
对 108 名计划参与者的数据进行了分析。大多数参与者年龄超过 50 岁（79%），33%的参与者完成了一次以上的家访。初始家访前后的中位观察人天数分别为 354 天和 132 天。参与者在社区急救医疗干预前平均每 30 人天呼叫 9-1-1 0.68 次，干预后每 30 人天呼叫 0.51 次，总体平均 9-1-1 使用率降低了 25%（p<0.001）。尽管大多数参与者的 9-1-1 使用率有所下降，但仍有 29%的参与者的 9-1-1 呼叫率增加。在接受多次家访或在干预前 9-1-1 使用量最高的四分位数的参与者中，未观察到 9-1-1 使用的统计学显著变化。
这项试点工作证明了基于 EMS 的社区急救医疗人员干预措施减少不必要的 9-1-1 呼叫是可行的，并表明通过派遣社区急救医疗人员对频繁使用 9-1-1 的人员进行家访，可能会适度减少对 EMS 的使用。
