Care Anywhere With Community Paramedics Program to Reduce Hospitalization

Mayo Clinic

Status: Completed

Conditions: Acute Illness

Treatments: Other: Care Anywhere with Community Paramedics program

Study type: Interventional

Funder types: Other

Identifiers

NCT05232799

21-010816

Details and patient eligibility

About

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.

Full 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.

Enrollment: 250 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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250 participants in 2 patient groups

Care Anywhere with Community Paramedics program

Experimental group

Description:

Subjects will be discharged from a pre-hospital setting, Emergency Department or the hospital with community paramedic services ordered and overseen by the treating clinical team per current standard of care.

Treatment:

Other: Care Anywhere with Community Paramedics program

Standard of Care

No Intervention group

Description:

Subjects will receive continued usual care