The Aging Research Group at the BerbeeWalsh Department of Emergency Medicine will be presenting a poster at the 13th Annual Conference on the Science of Dissemination and Implementation in Health from December 15-17, 2020. The virtual conference is co-hosted by the National Institutes of Health (NIH) and AcademyHealth, and by outlining the priorities in the field, the conference aims to ensure that evidence is used to inform decisions that will improve the health of individuals and communities.
The emergency department (ED) is a common source of acute illness care for older adults. Many older adults who are discharged home from the ED return within 30 days due to numerous challenges faced during the ED- to-home transition. Improvements in ED-to-home transitions are needed to mitigate and reduce the health and financial costs to a growing population of older adults in the U.S.
This intervention study, conducted in partnership with the University of Rochester Medical Center, aimed to test whether Coleman’s Care Transitions Intervention (CTI), which has demonstrated improvements in hospital-to-home transitions for older adults on key metrics such as readmission rates, post-hospital follow-up, and medication adherence, could be effectively implemented by trained community paramedic coaches to help older adults maintain their health and independence after an ED visit. The research evaluated the process, ED use, and cost outcomes of a community- based, paramedic-coordinated Care Transitions Intervention.
The multi-site study focused on the following intervention content areas in adults ages 60 or older led by a community paramedic coach through an in-person home visit 24-72 hours post-ED discharge and up to three follow-up phone sessions.
- Medication review
- Outpatient follow-up
- Red flag knowledge
- Personal health record
- Goal setting
The study was funded by the National Institute on Aging (NIH) and the Clinical and Translational Science Award program through the NIH National Center for Advancing Translational Sciences. Manish N. Shah, MD, MPH was the principal investigator of the study, and Gwen Costa Jacobsohn, PhD created and presented the poster at the D&I Conference.
Implications of the Study
Trained community paramedic coaches delivered the adapted CTI with high fidelity, demonstrating the feasibility of implementing this intervention following ED discharge. Participants acceptance and adoption of behaviors emphasizes the potential of this program to improve post-ED outcomes in ways similar to post-hospitalization CTI implementation. Intervention effectiveness analyses are currently in progress.