Community Paramedicine at Home (CP@Home)

Community Paramedicine at Home (CP @Home)

Community Paramedicine @Home (CP@Home) is a novel community paramedicine health assessment program for high users of Emergency Medical Services (EMS). Individuals who have been identified as active callers to EMS, individuals who have called EMS for lift-assists, and direct paramedic referrals are referred into the community paramedicine home visit program. The program will focus on in-home chronic disease management, community health service connections, and EMS usage education. Aside from chronic disease management, aspects of the program include health-related quality of life, social isolation and other social determinants of health. Participants in the program will have up to 3 one-on-one home visits from a community paramedic to ultimately reduce repeat EMS calls and improve their overall health.

Study Overview

• Status: Completed
• Conditions: Cardiovascular Disease; Diabetes Mellitus; Food Insecurity; Accidental Falls; Social Isolation
• Intervention / Treatment: Other: CP@Home

• Study Type: Interventional
• Enrollment (Actual): 2826
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Hamilton, Ontario, Canada, L8S4K1
      • McMaster University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 3 or more EMS calls in the last 6 months from intervention start date AND active caller in the last 30 days OR
• Any call for a lift assist to EMS in the past 30 days OR
• Paramedic referral into program (identified by paramedic through usual practice)

Exclusion Criteria:

• Individuals living in long term care facilities
• Individuals currently involved in a home visit or social navigator program

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Single Group Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control; Usual Care
Experimental: CP@Home Intervention; The experimental group will receive the CP@Home program. The main elements of this program include BP assessment, diabetes risk assessment, falls risk assessment, heart failure risk assessment, neurologic assessment, psychiatric assessment, depression screening, health-related quality of life analysis (including pain, mobility, anxiety/depression, ADLs), social isolation screening, and food and income security. The program is targeted at referrals to appropriate community resources, identification and referral of high-risk patients to their family physician (FP), as well as regular communication of participants' health information to their physician. The intervention will be implemented by community paramedics from the local paramedic service who have undergone a structured training program (4 hours of online, interactive training modules, including case studies and the observation of an intervention visits led by another paramedic) to assure intervention fidelity.	Other: CP@Home; Community paramedics (CPs) will be assigned to visiting the participants for a first time the week following the initial EMS call. Participants will complete the informed consent process with a CP on their first visit. This visit will also include a full assessment and risk analysis that will take approximately 90 minutes and will be located in the participant's home. As a result of the initial visit, the CP will make all relevant clinical referrals and decisions based on predetermined @Home algorithms. A second visit will be made to the participant 2-4 weeks following the initial call for a streamlined follow-up and reassessment during a 30 minute period. A final visit will be made 6-8 weeks following the initial call for a final evaluation of their situation. It is anticipated the patient will be discharged from the CP@Home program at this point. If the patient calls EMS following the third visit, if they meet the inclusion criteria, they will be re-entered into the CP@Home program.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in number of repeat EMS calls	Individual-level change in EMS call rate resulting in ambulance dispatch (pre-post intervention)	Baseline and 1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in number of ED presentations	Individual-level change in number of ED presentations (pre-post)	Baseline and 1 year
Change in number of hospital admissions	Individual-level change in number of hospital admissions (pre-post)	Baseline and 1 year

Collaborators and Investigators

• Sponsor: McMaster University
• Investigators: Principal Investigator: Gina Agarwal, MBBS MRCGP CCFP PhD, McMaster University

Publications and helpful links

General Publications

• Agarwal G, Pirrie M, McLeod B, Angeles R, Tavares W, Marzanek F, Thabane L. Rationale and methods of an Evaluation of the Effectiveness of the Community Paramedicine at Home (CP@home) program for frequent users of emergency medical services in multiple Ontario regions: a study protocol for a randomized controlled trial. Trials. 2019 Jan 23;20(1):75. doi: 10.1186/s13063-018-3107-4.

Study record dates

Study Major Dates

• Study Start (Actual): October 25, 2018
• Primary Completion (Actual): July 20, 2020
• Study Completion (Actual): December 31, 2021

Study Registration Dates

• First Submitted: July 14, 2016
• First Submitted That Met QC Criteria: July 14, 2016
• First Posted (Estimate): July 18, 2016

Study Record Updates

• Last Update Posted (Actual): September 22, 2022
• Last Update Submitted That Met QC Criteria: September 21, 2022
• Last Verified: September 1, 2022

More Information

Terms related to this study

• Keywords: Emergency Medical Services; Paramedic; Community Paramedicine; High Frequency Callers; Lift Assists
• Additional Relevant MeSH Terms: Cardiovascular Diseases
• Other Study ID Numbers: 2153

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No