Effect of an Advanced Community Paramedic Program to Shorten or Prevent Hospitalizations: A Pragmatic, Point-of-Care,...

We aimed to evaluate the effectiveness and safety of Care Anywhere with Community Paramedics (CACP), a mobile community paramedic intervention delivering a broad range of clinical services in the home, in preventing or shortening hospitalizations.

In this multicenter, pragmatic, randomized controlled trial, we randomized 240 adults from ambulatory, emergency department (ED), or hospital settings requiring acute care-administered services to CACP or usual care. The trial was conducted from January 2022 to March 2023. The primary outcome was days alive out of hospital/ED within 30 days. Secondary outcomes were 30-day ED and unplanned hospital use, death, health-related quality of life, program satisfaction, medication errors, and falls with injury.

A total of 119 patients were randomized to CACP and 121 to usual care. Mean (SD) age was 68 (14) and 69 (15) years, respectively, 37% and 46% lived in rural areas, the mean (SD) Elixhauser comorbidity index was 10.0 (4.4) and 8.9 (3.7), and 84% and 86% had an unplanned hospitalization in the past 6 months. There was no difference between the CACP and usual care arms in the primary outcome (26.7 [6.6] vs 27.9 [4.2] days; P = .1) or secondary outcomes. The mean satisfaction score was greater for CACP (4.2 [0.8] vs 3.9 [0.9]; P = .02), and 94% were very/extremely likely to recommend CACP to others.

The CACP program, which enrolled highly complex patients with heterogeneous care needs, did not decrease 30-day acute care use compared with alternative usual care pathways, but it improved patient satisfaction and was preferred by most participants. Future research is needed to better tailor community paramedic services to those most likely to benefit.