Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-25T17:19:41.807Z Has data issue: false hasContentIssue false
  • English
  • Français

The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS

Published online by Cambridge University Press:  19 September 2016

Niels Tangherlini ,
Julian Villar ,
John Brown ,
Robert M. Rodriguez ,
Clement Yeh ,
Benjamin T. Friedman  and
Paul Wada
Niels Tangherlini*
Affiliation:
San Francisco Fire Department, EMS Division, San Francisco, CaliforniaUSA
Julian Villar
Affiliation:
Stanford University, Emergency Medicine, Palo Alto, CaliforniaUSA
John Brown
Affiliation:
University of California – San Francisco (UCSF), Emergency Medicine, San Francisco, CaliforniaUSA
Robert M. Rodriguez
Affiliation:
University of California – San Francisco (UCSF), Emergency Medicine, San Francisco, CaliforniaUSA
Clement Yeh
Affiliation:
San Francisco Fire Department, EMS Division, San Francisco, CaliforniaUSA
Benjamin T. Friedman
Affiliation:
University of Washington School of Medicine, Division of Emergency Medicine, Seattle, WashingtonUSA
Paul Wada
Affiliation:
San Francisco Fire Department, EMS Division, San Francisco, CaliforniaUSA
*
Correspondence: Niels Tangherlini, EMTP, BA San Francisco Fire Department EMS Division San Francisco, California USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The San Francisco Fire Department’s (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States’ first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team’s existence was examined.

Methods

A retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.

Results

A total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.

Conclusion

Frequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage.

TangherliniN, VillarJ, BrownJ, RodriguezRM, YehC, FriedmanBT, WadaP. The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS. Prehosp Disaster Med. 2016;31(6):603–607.

Keywords

Emergency Medical Serviceshealth services needssubstance-related services
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 31 , Issue 6 , December 2016 , pp. 603 - 607
Copyright
© World Association for Disaster and Emergency Medicine 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. McCaig, LF, Burt, CW. National Hospital Ambulatory Medical Care Survey: 1999 emergency department summary. Adv Data. 2001 Jun 25; (320):1-34.Google Scholar
2. Niska, R, Bhuiya, F, Xu, J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010 Aug 6; (26):1-31.Google Scholar
3. Hunt, KA, Weber, EJ, Showstack, JA, Colby, DC, Callaham, ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48(1):1-8.Google Scholar
4. Tangherlini, N, Pletcher, M, Covec, M, Brown, J. Frequent use of Emergency Medical Services by the elderly. Prehosp Disaster Med. 2010;25(3):258-264.CrossRefGoogle ScholarPubMed
5. Shah, MN, Glushak, K, Karrison, TH, et al. Predictors of Emergency Medical Services utilization by elders. Acad Emerg Med. 2003;10(1):52-58.Google Scholar
6. South Carolina Public Health Institute. A report on frequent users of hospital emergency departments in South Carolina. Columbia, South Carolina USA: SCPHI; February 2011.Google Scholar
7. Weiss, SJ, Ernst, A, Miller, P, Russel, S. Repeat EMS transports among elderly emergency department patients. Prehosp Emerg Care. 2002;6(1):6-10.CrossRefGoogle ScholarPubMed
8. LaCalle, E, Rabin, E. Frequent users of emergency departments: the myths, the data, and policy implications. Ann Emerg Med. 2010;56(1):42-48.CrossRefGoogle ScholarPubMed
9. Martinez, JD, Burt, M. Impact of permanent supportive housing on the use of acute care health services by homeless adults. Psychiatr Serv. 2006;57(7):992-999.CrossRefGoogle ScholarPubMed
10. Byrne, M, Murphy, A, Plunkett, P, McGee, H, Murphy, A, Bury, G. Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics. Ann Emerg Med. 2003;41(3):309-318.Google Scholar
11. Owens, PL, Mutter, R, Stocks, C. Mental health and substance abuse-related emergency department visits among adults 2007: statistical brief #92. Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, Maryland USA: Agency for Health Care Policy and Research (US); February 2006-July 2010.Google Scholar
12. Larkin, GL, Claasen, CA, Pelletier, AJ, Camergo, CA Jr. National study of ambulance transports to United States emergency departments; importance of mental health problems. Prehosp Disaster Med. 2006;21(2):82-90.Google Scholar
13. Shumway, M, Boccellari, A, O’Brien, K, Okin, R. Cost-effectiveness of clinical case management for ED frequent users: results of a randomized trial. Am J Emerg Med. 2008;26(2):155-164.Google Scholar
14. Okin, R, Boccellari, A, Azocar, F, et al. The effects of clinical case management on hospital service use among ED frequent users. Am J Emerg Med. 2000;18(5):603-608.CrossRefGoogle ScholarPubMed
15. Pope, D, Fernandes, C, Bouthillette, F, Etherington, J. Frequent users of the emergency department: a program to improve care and reduce visits. CMAJ. 2000;162(7):1017-1020.Google ScholarPubMed
16. Rinke, M, Dietrich, E, Kodeck, T, Westcoat, K. Operation care: a pilot case management intervention for frequent emergency medical system users. Am J Emerg Med. 2012;30(2):352-357.Google Scholar
17. Loneck, B, Garrett, JA, Banks, SM. A comparison of the Johnson Intervention with four other methods of referral to outpatient treatment. Am J Drug Alcohol Abuse. 1996;22(2):233-246.Google Scholar
18. Gilbert, E, Lowenstein, S, Kazial-McLain, J, Barta, D, Steiner, J. Chart reviews in emergency medicine research: where are the methods? Ann Emerg Med. 1996;(3)27:305-308.Google Scholar
19. Dean, AG, Sullivan, KM, Soe, MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version. www.OpenEpi.com. Updated May 4, 2015. Accessed March 2, 2016.Google Scholar
20. Jamieson, D. The treatment of Kenny Farnsworth. Washington Post Magazine. 2009 Nov 11 (Magazine W12).Google Scholar
21. International Association of Firefighters. Emergency Medical Services: Paramedic Expanded Scope. Monograph 6. Washington, DC USA: IAFF; 1997.Google Scholar
22. Mandelberg, J, Kuhn, R, Kohn, M. Epidemiologic analysis of an urban, public emergency department’s frequent users. Acad Emerg Med. 2000;7(6):637-646.Google Scholar
23. Spillane, L, Lumb, E, Cobaugh, D, Wilcox, S, Clark, K, Schneider, S. Frequent users of the emergency department: can we intervene? Acad Emerg Med. 1997;4(6):574-580.CrossRefGoogle ScholarPubMed
24. Weiss, S, Ernst, A, Ong, M, et al. Effects of a social services intervention among 911 repeat users. Am J Emerg Med. 2005;23(4):492-496.Google Scholar
25. National Highway Traffic Safety Administration. EMS Agenda for the Future. Washington, DC USA: NHTSA; 1996.Google Scholar
26. Joint Committee on Rural Emergency Care, National Association of State EMS Officials. Beyond 911: state and community strategies for expanding the primary care role of first responders. National Conference of State Legislatures. December 2010.Google Scholar