Retrospective Cohort Study of Rates of Return Emergency Department Visits Among Patients Transported Home by Ambulance

Munjal, Kevin; Shastry, Siri; Chapin, Hugh H.; Tan, Nadir; Misra, Anjali; Greenberg, Eric; Traisman, Benjamin; Kleiman, Rose; Loo, George; Grudzen, Corita; Chason, Kevin; Richardson, Lynne D.

doi:10.1016/j.jemermed.2020.04.043

Cited by 5 publications

(9 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This hypothesis would be consistent with previous ndings that discharge comprehension issues and postdischarge falls are highly prevalent, that both are linked to readmission, and that patients transported home by ambulance are known to be at high risk for readmission. [3,4,6] Several challenges pertaining to the feasibility of the Transport PLUS intervention were identi ed and addressed during this pilot study. Training was initially in-person but the program experienced high EMS staff turnover rates, leading to a need for online training.…”

Section: Discussionmentioning

confidence: 99%

“…[3] It is also known that older adult patients face a statistically signi cant increased risk of 30-day readmission to the emergency department (ED) when transported home by ambulance. [4] The frequent and diverse utilization of healthcare services by the elderly requires attention to risks in transition of care and lapses of patient education, particularly as they transition from hospital environment to home. Two key risks are addressed in this demonstration: falls in the home and comprehension of discharge instructions.…”

Section: Introductionmentioning

confidence: 99%

“…As previously mentioned, among older patients, those transported home by ambulance are particularly vulnerable. [4] The evolving practice, often referred to as "community paramedicine" or "mobile integrated healthcare", seeks to expand the role of emergency medical technicians (EMTs) and paramedics to help support patients' needs in the home and in the community. The intent of these programs is to prevent emergencies in the community, thereby decreasing the present burden on crowded emergency departments.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study

Munjal

Yeturu

Chapin

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

Background: The growing population of patients over the age of 65 faces particular vulnerability following discharge after hospitalization or an emergency room visit. Specific areas of concern include a high risk for falls and poor comprehension of discharge instructions. Emergency Medical Technicians (EMTs), who frequently transport these patients home from the hospital, are uniquely positioned to aid in mitigating transition of care risks and are both trained and utilized to do so using the Transport PLUS intervention. Methods: Existing literature and focus groups of various stakeholders were utilized to develop two checklists: the Fall Safety Assessment (FSA) and the Discharge Comprehension Assessment (DCA). EMTs were trained to administer the intervention to eligible patients in the geriatric population. Using data from the checklists, follow-up phone calls, and electronic health records, we measured the presence of hazards, removal of hazards, presence of discharge comprehension issues, and correction or reinforcement of comprehension. These results were validated during home visits by community health workers (CHWs). Feasibility outcomes included patient acceptance of the Transport PLUS intervention and accuracy of the EMT assessment. Qualitative feedback via focus groups was also obtained. Clinical outcomes measured included 3-day and 30-day readmission or ED revisit. Results: 103 EMTs were trained to administer the intervention and participated in 439 patient encounters. The intervention was determined to be feasible, and patients were highly amenable to the intervention, as evidenced by a 92% and 74% acceptance rate of the DCA and FSA, respectively. The majority of patients also reported that they found the intervention helpful (90%), and self-reported removing 40% of fall hazards; 85% of such changes were validated by CHWs. Readmission/revisit rates are also reported.Conclusions: The Transport PLUS intervention is a feasible, easily implemented tool in preventative community paramedicine with high levels of patient acceptance. Further study is merited to determine the effectiveness of the intervention in reducing rates of readmission or revisit. A randomized control trial has since begun utilizing the knowledge gained within this study. Trial Registration: Not Applicable

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study

Munjal

Yeturu

Chapin

et al. 2022

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…EMS provides transportation of particularly vulnerable patients to their home setting from both hospital inpatient stays, as well as from the ED. As previously mentioned, among older patients, those transported home by ambulance are particularly vulnerable [4].…”

Section: Introductionmentioning

confidence: 95%

“…One study demonstrated that 40% of adults aged 60 or older will face a fall in 6 months following a hospitalization, and over half of these result in injury [3]. It is also known that older adult patients face a statistically significant increased risk of 30-day readmission to the emergency department (ED) when transported home by ambulance [4]. The frequent and diverse utilization of healthcare services by the elderly requires attention to risks in transition of care and lapses of patient education, particularly as they transition from hospital environment to home.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of the Transport PLUS intervention to improve the transitions of care for patients transported home by ambulance: a non-randomized pilot study

Munjal

Yeturu

Chapin

et al. 2022

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

Background The growing population of patients over the age of 65 faces particular vulnerability following discharge after hospitalization or an emergency room visit. Specific areas of concern include a high risk for falls and poor comprehension of discharge instructions. Emergency medical technicians (EMTs), who frequently transport these patients home from the hospital, are uniquely positioned to aid in mitigating transition of care risks and are both trained and utilized to do so using the Transport PLUS intervention. Methods Existing literature and focus groups of various stakeholders were utilized to develop two checklists: the fall safety assessment (FSA) and the discharge comprehension assessment (DCA). EMTs were trained to administer the intervention to eligible patients in the geriatric population. Using data from the checklists, follow-up phone calls, and electronic health records, we measured the presence of hazards, removal of hazards, the presence of discharge comprehension issues, and correction or reinforcement of comprehension. These results were validated during home visits by community health workers (CHWs). Feasibility outcomes included patient acceptance of the Transport PLUS intervention and accuracy of the EMT assessment. Qualitative feedback via focus groups was also obtained. Clinical outcomes measured included 3-day and 30-day readmission or ED revisit. Results One-hundred three EMTs were trained to administer the intervention and participated in 439 patient encounters. The intervention was determined to be feasible, and patients were highly amenable to the intervention, as evidenced by a 92% and 74% acceptance rate of the DCA and FSA, respectively. The majority of patients also reported that they found the intervention helpful (90%) and self-reported removing 40% of fall hazards; 85% of such changes were validated by CHWs. Readmission/revisit rates are also reported. Conclusions The Transport PLUS intervention is a feasible, easily implemented tool in preventative community paramedicine with high levels of patient acceptance. Further study is merited to determine the effectiveness of the intervention in reducing rates of readmission or revisit. A randomized control trial has since begun utilizing the knowledge gained within this study.

show abstract

Site of Ambulance Origination and Billing for Out-of-Network Services

Gong,

Azad,

Zhang

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceThe No Surprises Act implemented in 2022 aims to protect patients from surprise out-of-network (OON) bills, but it does not include ground ambulance services. Understanding ground ambulance OON and balance billing patterns from previous years could guide legislation aimed to protect patients following ground ambulance use.ObjectiveTo characterize OON billing from ground ambulance services by evaluating whether OON billing risk differs by the site of ambulance origination (home, hospital, nonhospital medical facility, or scene of incident).Design, Setting, and ParticipantsCross-sectional study of the Merative MarketScan dataset between January 1, 2015, and December 31, 2020, using claims-based data from employer-based private health insurance plans in the US. Participants included patients who utilized ground ambulances during the study period. Data were analyzed from June to December 2023.ExposureMedical encounter requiring ground ambulance transportation.Main Outcomes and MeasuresGround ambulance OON billing prevalence was calcuated. Linear probability models adjusted for state-level mixed effects were fit to evaluate OON billing probability across ambulance origins. Secondary outcomes included the allowed payment, patient cost-sharing amounts, and potential balance bills for OON ambulances.ResultsAmong 2 031 937 ground ambulance services (1 375 977 unique patients) meeting the inclusion and exclusion criteria, 1 072 791 (52.8%) rides transported men, and the mean (SD) patient age was 41 (18) years. Of all services, 1 113 676 (54.8%) were billed OON. OON billing probabilities for ambulances originating from home or scene were higher by 12.0 percentage points (PP) (95% CI, 11.8-12.2 PP; P &lt; .001 for home; 95% CI, 11.7-12.2 PP; P &lt; .001 for scene) vs those originating from hospitals. Mean (SD) total financial burden, including cost-sharing and potential balance bills per ambulance service, was $434.70 ($415.99) per service billed OON vs $132.21 ($244.92) per service billed in-network.Conclusions and RelevanceIn this cross-sectional study of over 2 million ground ambulance services, ambulances originating from home, the scene of an incident, and nonhospital medical facilities were more likely to result in OON bills. Legislation is needed to protect patients from surprise billing following use of ground ambulances, more than half of which resulted in OON billing. Future legislation should at minimum offer protections for these subsets of patients often calling for an ambulance in urgent or emergent situations.

show abstract

Retrospective Cohort Study of Rates of Return Emergency Department Visits Among Patients Transported Home by Ambulance

Cited by 5 publications

References 15 publications

Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study

Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study

Feasibility of the Transport PLUS intervention to improve the transitions of care for patients transported home by ambulance: a non-randomized pilot study

Site of Ambulance Origination and Billing for Out-of-Network Services

Contact Info

Product

Resources

About