Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative. (4th May 2022)

• Record Type: Journal Article
• Authors: Quatman-Yates, Catherine C.; Wisner, David; Weade, Mark; Gabriel, Mindy; Wiseman, Jessica M.; Sheridan, Elizabeth; Garvin, Jennifer H.; Bridges, John F. P.; Santry, Heena P.; Panchal, Ashish R.; Fernandez, Soledad; Quatman, Carmen E.
• Is Part Of: Prehospital emergency care. Volume 26:Number 3(2022)
• Page Start: 410
• Page End: 421
• Publication Date: 2022-05-04
• Subjects: community paramedicine -- older adult falls -- fall prevention -- injury prevention; 362.18
• DOI: 10.1080/10903127.2021.1922556
• Languages: English
• ISSNs: 1090-3127

Abstract

Abstract: Background: Getting effective fall prevention into the homes of medically and physically vulnerable individuals is a critical public health challenge. Community paramedicine is emerging globally as a new model of care that allows emergency medical service units to evaluate and treat patients in non-emergency contexts for prevention efforts and chronic care management. The promise of community paramedicine as a delivery system for fall prevention that scales to community-level improvements in outcomes is compelling but untested. Objective: To study the impact of a community paramedic program's optimization of a fall prevention system entailing a clinical pathway and learning health system (called Community-FIT) on community-level fall-related emergency medical service utilization rates. Methods: We used an implementation science framework and quality improvement methods to design and optimize a fall prevention model of care that can be embedded within community paramedic operations. The model was implemented and optimized in an emergency medical service agency servicing a Midwestern city in the United States (∼35, 000 residents). Primary outcome measures included relative risk reduction in the number of community-level fall-related 9-1-1 calls and fall-related hospital transports. Interrupted time series analysis was used to evaluate relative risk reduction from a 12-month baseline period (September 2016 - August 2017) to a 12-month post-implementation period (September 2018–August 2019). Results: Community paramedic home visits increased from 25 in 2017, to 236 in 2018, to 517 in 2019, indicating a large increase in the number of households that benefited from the efforts. A relative risk reduction of 0.66 (95% [CI] 0.53, 0.76) in the number of fall calls and 0.63 (95% [CI] 0.46, 0.75) in the number of fall-related calls resulting in transports to the hospital were observed. Conclusions: Community-FIT may offer a powerful mechanism for community paramedics to reduce fall-related 9-1-1 calls and transports to hospitals that can be implemented in emergency medical agencies across the country.