Paramedic-Assisted Community Evaluation After Discharge: The PACED Intervention

Area of Science:

• Gerontology
• Public Health
• Health Services Research

Background:

• Early rehospitalization of frail older adults poses significant risks and challenges.
• Mobile Integrated Health (MIH) offers a potential solution for community-based transitional care.

Purpose of the Study:

• To assess the feasibility and implementation of an MIH transitional care program for frail older adults post-hospital discharge.
• To evaluate the impact of MIH transitional care on rehospitalization and emergency department (ED) visits.

Main Methods:

• A pilot clinical trial involving home visits by MIH paramedics within 72 hours of hospital discharge.
• Eligible participants were adults aged 65+ with a high eFrailty index, compared to a geographically excluded control group.
• Primary outcomes were feasibility and implementation; secondary outcomes included 30-day ED visits and rehospitalization rates.

Main Results:

• The MIH transitional care program (PACED) was feasible, with 92% protocol fidelity.
• Paramedics identified clinical issues, requested services, and detected medication errors in a significant number of visits.
• The PACED group showed a significantly lower risk of 30-day rehospitalization (RR 0.40, P=.03) and a trend toward fewer ED visits.

Conclusions:

• The MIH transitional care program is feasible and demonstrates high fidelity in implementation.
• Preliminary evidence suggests that MIH programs can decrease rehospitalization rates in frail older adults.
• This study supports further investigation into MIH as a model for post-discharge transitional care.