Acute Illness
Conditions
Keywords
Community Paramedicine, Acute care, Home care
Brief summary
The purpose of this research is to compare the effectiveness of the Care Anywhere with Community Paramedics program with usual care in a pragmatic randomized controlled trial. The goal of the Care Anywhere with Community Paramedics program is to prevent or shorten hospitalizations among patients who are being treated in the clinic/ambulatory setting (prehospital setting), emergency department, or hospital and are clinically appropriate to be cared for at home with community paramedic services.
Detailed description
This pragmatic randomized controlled trial will randomize, with 1:1 allocation, 240 adults being treated in the pre-hospital setting, emergency department or hospital to either availability of the Care Anywhere with Community Paramedics (CACP) program or to no availability of the CACP program (i.e. usual care). Patients randomized to the CACP program will be able to receive in-home medical care - as ordered by their treating clinicians - from the Mayo Clinic Ambulance Community Paramedic Service. Primary outcome is going to be days alive spent at home without hospitalization (excluding planned admissions), emergency department visits, or skilled nursing facility care.
Interventions
OTHERCare Anywhere with Community Paramedics program
Outpatient management with supportive services provided by the community paramedic team.
Sponsors
Mayo Clinic
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Adult (age ≥ 18 years) patients currently admitted to the ED, hospital or are in a pre-hospital setting but being considered for referral to the ED or hospital in Mayo Clinic Rochester, MN and Barron, WI but do not require hospital-level monitoring or care other than services that could be delivered by CPs in the ambulatory setting. * Must reside within approximately a 40-mile radius of Rochester, MN or within the service radius of Barron, WI. * Participants who require assistance with activities of daily living, or who are at increased risk for falls, need to have a caregiver available at home
Exclusion criteria
* Referring clinician and the community paramedic service do not believe the patient to be clinically appropriate for outpatient care with the CACP program. * Inability or unwillingness of individual or legal guardian/representative to give written informed consent. * Clinical, behavioral, or cognitive instability, determined by the referring clinician or the CACP service. * Living conditions unsafe for CPs to enter (patient refuses to secure weapons or animals prior to CP's arrival). * Enrolled in the trial during an earlier hospitalization or ED visit.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of days spent outside the hospital and ED | 30 days | The number of days spent outside the hospital and ED during the 30 days following enrollment to the trial. (not in the hospital, ED, or nursing home; not counting planned admissions) |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| CACP Program patient satisfaction | 30 days | Percentage of patients who are extremely likely or very likely to recommend the program |
| Health related quality of life | 30 days | EQ-5D survey |
| Patients with an ED visit hospitalization or death | 30 days | Proportion of patients with an ED visit, hospitalization, or death within 30-days of the day following randomization |
| Community Paramedic satisfaction with the CACP program | 30 days | CP survey |
| Referring clinician satisfaction with the CACP program | 30 days | Clinician Survey |
| Treatment burden | 30 days | Relevant components of the PETS survey |
Countries
United States
Outcome results
None listed