R Epeat Ems T Ransports Among E Lderly E Mergency D Epartment P Atients

Weiss, Steven J.; Ernst, Amy A.; Miller, Penny; Russell, Steve

doi:10.1080/10903120290938698

Cited by 31 publications

(12 citation statements)

References 26 publications

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“…Our results were slightly lower than the 78% reported in a urban study 9. This difference may be due to methodological differences as Weiss et al based their calculations on patients transported to a single institution while this study was community-based.…”

Section: Discussioncontrasting

confidence: 84%

“…Investigators seeking to study prehospital care often must estimate the proportion of emergency medical services (EMS) requests that arise from unique subjects, or individuals making their first request of EMS services during a study period. For many studies, subjects cannot be repeatedly enrolled in the study protocol; therefore, using unadjusted EMS case volumes would significantly over-estimate the number of eligible subjects 9, 10. The over-estimation problem may be further exacerbated when recruitment is limited to older adults (age≥65) because of their relatively high rates of EMS use, which may increase the probability of repeat use 11.…”

Section: Introductionmentioning

confidence: 99%

“…The over-estimation problem may be further exacerbated when recruitment is limited to older adults (age≥65) because of their relatively high rates of EMS use, which may increase the probability of repeat use 11. The only published study that sought to quantify this phenomenon in an urban community showed that only 78% of EMS calls by older adults were from unique individuals 9. No other studies were identified that could be useful in guiding investigators developing estimates for prehospital studies recruiting older adults in rural settings.…”

Section: Introductionmentioning

confidence: 99%

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Repeat Emergency Medical Services Use by Older Adults in a Rural Community: Impact on Research Methods andStudy Length

Shah

Swanson

Rajasekaran

et al. 2009

Prehospital Emergency Care

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OBJECTIVES-To evaluate the proportion of EMS requests in a rural community made by unique, non-institutionalized, older adults, or individuals making their first request of EMS services during the study period, and the impact on research parameters. . The Geneseo Fire Department Ambulance response territory is a rural community in Upstate New York. We obtained demographic information including age, race, gender, call location, and the frequency of EMS use from the medical record, as well as clinical information including level of prehospital care, chief complaint, and disposition. Descriptive statistics were used for the analysis, along with 95% confidence intervals. METHODS-ThisRESULTS-Over two 16-month periods, approximately 70% of the EMS calls by community dwelling (non-institutionalized) older adults were from unique individuals. The monthly proportion ranged from between 75-100% during the first four months to between 43-80% for the remaining 12 months for both groups.CONCLUSION-In rural, prehospital studies that enroll older adults and last more than four months, approximately 70% of EMS requests are made by unique older adults, or individuals making their first request of EMS services. Investigators must consider these results when estimating the enrollment period for prehospital studies.

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Section: Discussioncontrasting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Repeat Emergency Medical Services Use by Older Adults in a Rural Community: Impact on Research Methods andStudy Length

Shah

Swanson

Rajasekaran

et al. 2009

Prehospital Emergency Care

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“…In a recent study by Shah et al, only 70% of EMS calls over a 16 month period for community dwelling elders were for unique individuals 28. Compared with other studies of EMS use by the elderly, our study found that our trauma patients had a higher rate of repeat EMS use within a year of their index visit (37%) than a sample of elders presenting to the emergency department by EMS for all causes studied by Weiss et al (23%) 29. While this might suggest that injury results in a higher need for subsequent EMS care, Weiss et al's study included patients who were sent home from the emergency department and were therefore less sick than our cohort of admitted patients.…”

Section: Discussioncontrasting

confidence: 71%

Injury Hospitalization as a Marker for Emergency Medical Services Use in Elderly Patients

Fleischman

McConnell

Adams

et al. 2010

Prehospital Emergency Care

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The elderly utilize emergency medical services (EMS) at a higher rate than younger patients, yet little is known about the influence of injury on subsequent EMS utilization and costs.Objective-To assess injury hospitalization as a potential marker for subsequent EMS utilization and costs by Medicare patients.Methods-This observational study analyzed a retrospective cohort of all Medicare patients (≥67 years) with an ICD-9 injury diagnosis admitted to 125 Oregon and Washington hospitals during 2001-2002 who survived to hospital discharge. The number of EMS transports and total EMS costs were compared one year before and for one year following the index hospitalization.Results-There were 30,655 injured elders in our cohort. Their mean ICD-9 based injury severity score was 0.97, with 4.1% meeting a definition of severe injury and 37% having hip fractures. The mean (range) number of EMS transports before and after the injury was 0.5 (0-45) and 0.9 (0-56), for an unadjusted incidence rate ratio (IRR) of 1.7 (95% CI 1.7-1.8). The increase in EMS utilization following an injury hospitalization was even greater after adjusting for risk period and other model predictors (IRR 2.4, 95% CI 2.3-2.5). Annual EMS costs rose 74% following the injury hospitalization from $211 to $367 mean dollars per person. The greatest increase was in non-emergent EMS use, accounting for 67% of the increase in the number of uses. Institutionalization in a skilled nursing or rehabilitation facility either before or after injury was strongly associated with the need for EMS care.Conclusion-An injury hospitalization in the elderly serves as a sentinel marker for an abrupt increase in EMS utilization and costs, even after accounting for confounders. This supports systems planning, research and programs to prevent injuries in elders and alternative, costeffective modes of transport to accommodate this need.

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“…[11][12][13][14] This may be due to the fact that older adults with high comorbidity (>3 chronic conditions) report poorer health, take more prescription medications and have the highest rate of healthcare visits. 15 Data from Hamilton Paramedic Service indicate that tenants in 'seniors' buildings' in underserved areas of lower socioeconomic status in Hamilton, a medium sized city in Canada, with a population of just over 500 000 people, are the most frequent callers to the emergency 911 medical service.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors’ housing buildings in Ontario, Canada

et al. 2015

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IntroductionChronic diseases and falls substantially contribute to morbidity/mortality among seniors, causing this population to frequently seek emergency medical care. Research suggests the paramedic role can be successfully expanded to include community-based health promotion and prevention. This study implements a community paramedicine programme targeting seniors in subsidised housing, a high-risk population and frequent users of emergency medical services (EMS). The aims are to reduce EMS calls, improve health outcomes and healthcare utilisation.Methods/analysisThis is a pragmatic clustered randomised control trial in four communities across Ontario, Canada. Within each, four to eight seniors’ apartment buildings will be paired and within each pair one building will be randomly assigned to receive the Community Health Assessment Programme through EMS (CHAP-EMS) intervention, while the other building receives no intervention. During the 1-year intervention, paramedics will run weekly sessions in a common area of the building, assessing risk factors for cardiovascular disease, diabetes and falls; providing health education and referrals to community programmes; and communicating results to the participant's primary physician. The primary outcomes are rate of emergency calls per 100 residents, change in blood pressure and change in Canadian Diabetes Risk (CANRISK) score, as collected by the local EMS and study databases. The secondary outcomes are change in health behaviours, measured using a preintervention and postintervention survey and healthcare utilisation, available through administrative databases. Analysis will mainly consist of descriptive statistics and generalised estimating equations, including subgroup cluster analysis.Ethics/disseminationThis study is approved by the Hamilton Integrated Research Ethics Board and will follow the Tri-Council Policy Statement. Findings will be disseminated through reports to local stakeholders, publication in peer-reviewed journals and conference presentations.Trial registration numberNCT02152891.

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R Epeat Ems T Ransports Among E Lderly E Mergency D Epartment P Atients

Cited by 31 publications

References 26 publications

Repeat Emergency Medical Services Use by Older Adults in a Rural Community: Impact on Research Methods andStudy Length

Repeat Emergency Medical Services Use by Older Adults in a Rural Community: Impact on Research Methods andStudy Length

Injury Hospitalization as a Marker for Emergency Medical Services Use in Elderly Patients

Rationale and methods of a multicentre randomised controlled trial of the effectiveness of a Community Health Assessment Programme with Emergency Medical Services (CHAP-EMS) implemented on residents aged 55 years and older in subsidised seniors’ housing buildings in Ontario, Canada

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