Mobile integrated health-community paramedicine programs' effect on emergency department visits: An exploratory meta-analysis

Tucker Lurie; Srikar Adibhatla; Gail Betz; Jamie Palmer; Alison Raffman; Sanketh Andhavarapu; Andrea Harris; Quincy K Tran; Daniel B Gingold

doi:10.1016/j.ajem.2022.12.041

Mobile integrated health-community paramedicine programs' effect on emergency department visits: An exploratory meta-analysis

Am J Emerg Med. 2023 Apr:66:1-10. doi: 10.1016/j.ajem.2022.12.041. Epub 2022 Dec 29.

Authors

Tucker Lurie¹, Srikar Adibhatla², Gail Betz³, Jamie Palmer⁴, Alison Raffman⁵, Sanketh Andhavarapu⁶, Andrea Harris⁷, Quincy K Tran⁸, Daniel B Gingold⁹

Affiliations

¹ Wellspan York Hospital, Department of Emergency Medicine, 1001 South George Street, York, PA 17403, USA. Electronic address: Tlurie@wellspan.org.
² University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA. Electronic address: Srikar.Adibhatla@som.umaryland.edu.
³ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA. Electronic address: gbetz@hshsl.umaryland.edu.
⁴ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA. Electronic address: Jamie.palmer@som.umaryland.edu.
⁵ Hennepin County Medical Center, Department of Emergency Medicine, 730 S 8th St, Minneapolis, MN 55415, United States of America. Electronic address: Alison.Raffman@hcmed.org.
⁶ University of Maryland at College Park, College Park, MD 20742, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA. Electronic address: sandhava@terpmail.umd.edu.
⁷ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA. Electronic address: Andrea.Harris@som.umaryland.edu.
⁸ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street; 6th Floor, Suite 200, Baltimore, MD 21201, USA; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, Baltimore, MD 21201, USA; The Research Associate Program in Emergency Medicine & Critical Care, University of Maryland School of Medicine, Baltimore, MD; 22 South Greene Street, suite P1G01, Baltimore, MD 21201, USA. Electronic address: Qtran@som.umaryland.edu.
⁹ University of Maryland School of Medicine, 655 West Baltimore Street, Baltimore, MD 21201, USA; Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street; 6th Floor, Suite 200, Baltimore, MD 21201, USA. Electronic address: dgingold@som.umaryland.edu.

PMID: 36640693
DOI: 10.1016/j.ajem.2022.12.041

Abstract

Introduction: Mobile Integrated Health Community Paramedicine (MIH-CP) programs are designed to increase access to care and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. Previous MIH-CP systematic reviews reported varied interventions, effect sizes, and a high prevalence of biased methods. We aimed to perform a meta-analysis on MIH-CP effect on ED visits, and to evaluate study designs' effect on reported effect sizes. We hypothesized biased methods would produce larger reported effect sizes.

Methods: We searched Pubmed, Embase, CINAHL, and Scopus databases for peer-reviewed MIH-CP literature from January 1, 2000, to July 24, 2021. We included all full-text English studies whose program met the National Associations of Emergency Medical Technicians definition, reported ED visits, and had an MIH-CP related intervention and outcome. We established risk ratios for each included study through interpreting the reported data. We performed a random-effects and cumulative meta-analysis of ED visit data, tests of heterogeneity, and a moderator analysis to assess for factors influencing the magnitude of observed effect.

Results: We identified 16 studies that reported ED visit data and included 12 in our meta-analysis. All studies were observational; 3 used matched controls, 6 pre-post controls, and 3 without controls. 7 studies' intervention were diversion/triage while 5 studies intervened with health education/home primary care services. Pooled risk ratio for our data set was 0.56 (95% confidence interval 0.42-0.74). Cumulative meta-analysis revealed that as of 2018 MIH-CP programs began to show consistent reductions in ED visits. Significant heterogeneity was seen among studies, with I-squared >90%. Moderator analysis showed reduced heterogeneity for matched-control studies.

Conclusion: Our data revealed MIH-CP programs were associated with a reduced risk of ED visits. Study design did not have a statistically significant influence on effect size, though it did influence heterogeneity. We would recommend future studies continue to use high levels of control to produce reliable data with lower heterogeneity.

Keywords: Community paramedicine; Emergency department visits; Mobile integrated health; Paramedic; Transport.

Publication types

Meta-Analysis

MeSH terms

Emergency Medical Services*
Emergency Medical Technicians*
Emergency Service, Hospital
Home Care Services*
Humans
Paramedicine