Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative.
Assessment of Fall-Related Emergency Medical Service Calls and Transports after a Community-Level Fall-Prevention Initiative.
复制标题
DOI：
10.1080/10903127.2021.1922556
复制
发表时间：
2022-05
影响因子：
2.4
通讯作者：
Quatman CE
中科院分区：
文献类型：
--
作者：
Quatman-Yates CC;Wisner D;Weade M;Gabriel M;Wiseman JM;Sheridan E;Garvin JH;Bridges JFP;Santry HP;Panchal AR;Fernandez S;Quatman CE
将有效的跌倒预防措施送到身体和医学上脆弱的个人家中是一项关键的公共卫生挑战。社区护理作为一种新的护理模式正在全球范围内兴起，它允许紧急医疗服务单位在非紧急情况下评估和治疗患者，以进行预防工作和慢性病护理管理。社区护理作为跌倒预防的提供系统，可以扩大到社区层面的结果改善，这一承诺是令人信服的，但未经检验。研究社区护理计划的跌倒预防系统的优化，需要一个临床路径和学习健康系统（称为社区FIT）对社区一级跌倒相关的紧急医疗服务利用率的影响。我们使用实施科学框架和质量改进方法来设计和优化可以嵌入社区护理操作的跌倒预防护理模型。该模型在美国中西部城市（约35，000名居民）的紧急医疗服务机构中实施和优化。主要结果指标包括社区跌倒相关9-1-1呼叫和跌倒相关医院转运数量的相对风险降低。中断时间序列分析用于评估从12个月基线期（2016年9月至2017年8月）到12个月实施后期（2018年9月至2019年8月）的相对风险降低。社区护理人员家访从2017年的25次增加到2018年的236次，再到2019年的517次，这表明受益于这些努力的家庭数量大幅增加。观察到跌倒呼叫次数的相对风险降低0.66（95% [CI] 0.53，0.76），导致送往医院的跌倒相关呼叫次数的相对风险降低0.63（95% [CI] 0.46，0.75）。社区FIT可以为社区护理人员提供一个强大的机制，以减少与跌倒有关的9-1-1呼叫和运送到医院，可以在全国各地的紧急医疗机构实施。
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. 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. 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). 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 benefitted 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. 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.