Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database - 23/09/17
, Timothy F. Platts-Mills, MD, MSc c, ⁎ , Antonio R. Fernandez, PhD, NRP c, d, Joseph M. Grover, MD c, Jose G. Cabanas, MD, MPH c, e, Mehul D. Patel, PhD c, Gary M. Vilke, MD e, Jane H. Brice, MD, MPH cAbstract |
Study objective |
The objective of this study is to characterize repeated emergency medical services (EMS) transports among older adults across a large and socioeconomically diverse region.
Methods |
Using the North Carolina Prehospital Medical Information System, we analyzed the frequency of repeated EMS transports within 30 days of an index EMS transport among adults aged 65 years and older from 2010 to 2015. We used multivariable logistic regressions to determine characteristics associated with repeated EMS transport.
Results |
During the 6-year period, EMS performed 1,711,669 transports for 689,664 unique older adults in North Carolina. Of these, 303,099 transports (17.7%) were followed by another transport of the same patient within 30 days. The key characteristics associated with an increased adjusted odds ratio of repeated transport within 30 days include transport from an institutionalized setting (odds ratio [OR] 1.42; 95% confidence interval [CI] 1.38 to 1.47), blacks compared with whites (OR 1.29; 95% CI 1.24 to 1.33), a dispatch complaint of psychiatric problems (OR 1.38; 95% CI 1.25 to 1.52), back pain (OR 1.35; 95% CI 1.26 to 1.45), breathing problems (OR 1.21; 95% CI 1.15 to 1.30), and diabetic problems (OR 1.14; 95% CI 1.06 to 1.22). Falls accounted for 15.6% of all transports and had a modest association with repeated transports (OR 1.07; 95% CI 1.00 to 1.14).
Conclusion |
More than 1 in 6 EMS transports of older adults in North Carolina are followed by a repeated transport of the same patient within 30 days. Patient characteristics and chief complaints may identify increased risk for repeated transport and suggest the potential for targeted interventions to improve outcomes and manage EMS use.
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| Please see page 507 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Steven M. Green, MD |
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| Author contributions: All authors contributed to study concept, study design, interpretation of data, and preparation of the article. CSE, TFP-M, and ARF were responsible for data acquisition and data analysis. TFP-M takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist. Dr. Platts-Mills is supported by a K23 career development award from the National Institute on Aging (K23AG038548). |
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Vol 70 - N° 4
P. 506 - octobre 2017 Retour au numéro
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