The Impact of Mobile Integrated Healthcare on 911 Use and Patient Activation

Abstract

Background: Emergency Medical Services (EMS) and Emergency Departments (EDs) are experiencing an increase in low-acuity and high frequency patients. Treating non-emergent patients with emergency resources drives up healthcare costs, leads to delays in care for all patients, and increases strain on emergency resources. To address the increase in low-acuity and high-frequency patients within the 911 system and emergency departments, mobile integrated healthcare (MIH) has emerged as an EMS-based intervention to connect patients with community resources and reduce non-emergent transports and ED visits. This program evaluation examines the impact of nurse-social worker teams in a fire-based MIH program by measuring 911 and ED use and patient activation before and after MIH interventions. Methods: Participants were enrolled in the program evaluation by the MIH field teams. Participants were either new or existing MIH patients and enrollment occurred over a 2-month period. Participants completed the patient activation questionnaire (PAM-13) at the time of enrollment and again between 8 and 12 weeks later. The number of 911 calls, transports, and ED visits for each participant was extracted from Julota and EPIC for a period of 12 weeks prior to and after the date of enrollment. The pre and post data and PAM-13 scores were compared using Wilcoxon Signed Ranks Test of Significance. The mean pre and post PAM-13 scores were also compared to evaluate the difference. Results: 19 participants were enrolled in the study. One participant died during the follow-up period. Of the remaining 18 participants, 4 completed the second PAM-13 questionnaire. There was a statistically significant reduction in 911 calls (p=0.015), transports (p=0.021), and ED visits (p=0.006) following MIH intervention (n=19). The change in PAM-13 scores (n=4) was not significant (p=0.655). The difference in the means of the pre and post PAM-13 questionnaires was an increase of 1.75. Conclusions: MIH intervention reduced 911 calls, transports, and ED visits in this program evaluation. The effect on patient activation as measured by the PAM-13 questionnaire was not significant. Given the statistical significance in reducing use of emergency services for this small sample, a longer evaluation with more participants is needed to determine if fire-based MIH using a nurse and social worker is effective in reducing emergency resource use