According to the Institute of Medicine, today’s emergency medical system (EMS) in the United States is overburdened and “at a crossroads,” with emergency departments (EDs) pushed “to the breaking point.” Focus groups indicate that patients with physical and mental health disabilities fear the following: going to EDs, care being delayed because of stigma or incorrect assumptions about their disability, inappropriate or dangerous care because ED staff knows little about their conditions, physical discomfort, and emotional distress. Nonetheless, a responsive EMS is critical to the health and well-being of all Americans, regardless of socioeconomic status, health condition, and geographic location.
Confronting similar EMS breakdowns, other countries have experimented with new ways of delivering urgent care. One promising approach is acute community care (ACC), in which highly trained paramedics evaluate and treat urgent care patients within their homes or institutional residences, such as nursing homes, when medically appropriate. ACC paramedics arrive in an SUV equipped with special diagnostic testing equipment, numerous medications to treat nonemergency problems, and extensive medical supplies, such as intravenous lines and various catheters. Furthermore, ACC paramedics have access to patients’ centralized electronic health records and communicate continuously with on-call clinical staff. ACC aims to avoid unnecessary ED transports that are required by protocol when standard ambulances respond to urgent care calls.
ACC has successfully reduced ED visits in England, Canada, Australia, and New Zealand, but it is not widely used in the United States. The proposed project aims to evaluate a new ACC Program (ACCP) in Massachusetts, a collaboration between the EasCare ambulance service provider and Commonwealth Care Alliance, which serves adults who have both Medicare and Medicaid coverage. This socioeconomically disadvantaged patient population has a heavy burden of chronic disease and physical and mental health disabilities, and, thus frequent urgent care needs.
The project will use a variety of approaches to evaluate ACCP, comparing outcomes between ACCP and standard urgent care. We will look at how often ACCP patients go to the ED despite paramedic care. Lead by Disability Policy Consortium, which represents persons with significant disability and chronic disease, we will conduct interviews and surveys, comparing experiences and perceptions of patients receiving ACCP versus standard urgent care. We will also interview and survey a family member, friend, neighbor, or paid caregiver (for example, personal care assistant) designated by the patient as involved in his or her urgent care episode. We will work with paramedic stakeholders to compare job satisfaction of ACCP paramedics with standard urgent care paramedics. Finally, we will examine resources required and practical issues raised in providing ACCP compared with standard urgent care.