Community paramedic hospital reduction and mitigation program: study protocol for a randomized pragmatic clinical...

Area of Science:

• Health Services Research
• Implementation Science
• Public Health

Background:

• New patient-centered care models are essential to individualize treatment and decrease high-cost healthcare utilization, such as emergency department (ED) visits and hospitalizations for low- and intermediate-acuity conditions.
• Community Paramedics (CPs) possess advanced skills for managing diverse health conditions, providing patient education, and addressing social determinants of health in home settings.
• The Care Anywhere with Community Paramedics (CACP) program aims to reduce acute care utilization through innovative community-based interventions.

Purpose of the Study:

• To evaluate the effectiveness of the CACP program in reducing acute care utilization.
• To assess the implementation outcomes of the CACP program using a pragmatic, hybrid type 1 randomized clinical trial design.
• To gather qualitative data on patient, CP, and healthcare team perceptions to inform program refinement and scalability.

Main Methods:

• A 1:1 randomized clinical trial comparing the CACP program to usual care in two US Midwest sites (small metropolitan and rural areas).
• Primary outcome: days alive outside the ED or hospital within 30 days post-randomization. Secondary outcomes include quality of life, treatment burden, and healthcare utilization.
• Mixed methods, including formative evaluation and qualitative analysis (RE-AIM framework), were used to assess implementation, sustainability, and equity.

Main Results:

• The study is designed to provide robust evidence on the CACP program's effectiveness.
• Implementation outcomes will be measured to inform scalability and sustainability.
• Qualitative data will offer insights into stakeholder experiences and recommendations for improvement.

Conclusions:

• The CACP program shows promise for improving patient care and reducing healthcare costs.
• This study will yield timely evidence to support the potential large-scale implementation of community paramedic programs.
• Findings will guide refinements for optimal scale-up and long-term sustainability of CACP.