Care Anywhere With Community Paramedics Program to Reduce Hospitalization

Mayo Clinic250 enrolled

Overview

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.

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

NONE

Enrollment

250

Conditions

Acute Illness

Interventions

Care Anywhere with Community Paramedics programOTHER

Outpatient management with supportive services provided by the community paramedic team.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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.

Locations (2)

Mayo Clinic in Rochester

Rochester, Minnesota, United States

Mayo Clinic Health System

Barron, Wisconsin, United States

Outcomes

Primary Outcomes

Number of days spent outside the hospital and ED

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)

Time frame: 30 days

Secondary Outcomes

Patients with an ED visit hospitalization or death

Proportion of patients with an ED visit, hospitalization, or death within 30-days of the day following randomization

Time frame: 30 days

CACP Program patient satisfaction

Percentage of patients who are "extremely likely" or "very likely" to recommend the program

Time frame: 30 days

Health related quality of life

EQ-5D survey

Time frame: 30 days

Treatment burden

Relevant components of the PETS survey

Time frame: 30 days

Community Paramedic satisfaction with the CACP program

CP survey

Time frame: 30 days

Referring clinician satisfaction with the CACP program

Clinician Survey

Time frame: 30 days

Data from ClinicalTrials.gov

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