RESUMO
A new model of community health delivery has utilized emergency medical services (EMS) to manage care transitions and provide chronic care services in patients' homes. The authors performed a retrospective, case-controlled analysis of a quality improvement project that examined whether an EMS home visit to recently discharged inpatients from the zip code where EMS provides services can reduce 30-day unscheduled ED visits and hospital readmissions. Additionally, the financial impact from the perspective of the community-based EMS provider and the community hospital from which patients were discharged was examined. A total of 53 patients and 53 controls were matched on the following variables: readmission risk score, age, sex, insurance status, and case management intervention. Patients who received the intervention had a 44% relative reduction of 30-day ED visits (17% vs 24.5%, P = 0.3381) and a 28.4% relative reduction in 30-day readmissions (18.9% vs 26.4%, P = 0.3532) but neither achieved statistical significance. The intervention cost to EMS was $1937; the intervention led to a $3626 profit for the hospital compared to a loss of $9915 for the control group. Use of local EMS providers may lead to enhanced health care and financial outcomes for community hospitals but the study was underpowered to make a definitive conclusion. However, the results may allow health systems to assess whether collaboration with local EMS providers can improve outcomes at a lower cost.
