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The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS

Published online by Cambridge University Press:  19 September 2016

Niels Tangherlini*
Affiliation:
San Francisco Fire Department, EMS Division, San Francisco, CaliforniaUSA
Julian Villar
Affiliation:
Stanford University, Emergency Medicine, Palo Alto, CaliforniaUSA
John Brown
Affiliation:
University of California – San Francisco (UCSF), Emergency Medicine, San Francisco, CaliforniaUSA
Robert M. Rodriguez
Affiliation:
University of California – San Francisco (UCSF), Emergency Medicine, San Francisco, CaliforniaUSA
Clement Yeh
Affiliation:
San Francisco Fire Department, EMS Division, San Francisco, CaliforniaUSA
Benjamin T. Friedman
Affiliation:
University of Washington School of Medicine, Division of Emergency Medicine, Seattle, WashingtonUSA
Paul Wada
Affiliation:
San Francisco Fire Department, EMS Division, San Francisco, CaliforniaUSA
*
Correspondence: Niels Tangherlini, EMTP, BA San Francisco Fire Department EMS Division San Francisco, California USA E-mail: niels.tangherlini@gmail.com

Abstract

Objectives

The San Francisco Fire Department’s (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States’ first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team’s existence was examined.

Methods

A retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.

Results

A total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.

Conclusion

Frequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage.

TangherliniN, VillarJ, BrownJ, RodriguezRM, YehC, FriedmanBT, WadaP. The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS. Prehosp Disaster Med. 2016;31(6):603607.

Type
Original Research
Copyright
© World Association for Disaster and Emergency Medicine 2016 

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