Date of Award
College of Nursing
Doctor of Nursing Practice (DNP)
Diane F Switzer
Benjamin J Miller
Background: Emergency Medical Services (EMS) and Emergency Departments (EDs) are experiencing an increase in low-acuity and high frequency patients. Treating non-emergent patients with emergency resources drives up healthcare costs, leads to delays in care for all patients, and increases strain on emergency resources. To address the increase in low-acuity and high-frequency patients within the 911 system and emergency departments, mobile integrated healthcare (MIH) has emerged as an EMS-based intervention to connect patients with community resources and reduce non-emergent transports and ED visits. This program evaluation examines the impact of nurse-social worker teams in a fire-based MIH program by measuring 911 and ED use and patient activation before and after MIH interventions.
Methods: Participants were enrolled in the program evaluation by the MIH field teams. Participants were either new or existing MIH patients and enrollment occurred over a 2-month period. Participants completed the patient activation questionnaire (PAM-13) at the time of enrollment and again between 8 and 12 weeks later. The number of 911 calls, transports, and ED visits for each participant was extracted from Julota and EPIC for a period of 12 weeks prior to and after the date of enrollment. The pre and post data and PAM-13 scores were compared using Wilcoxon Signed Ranks Test of Significance. The mean pre and post PAM-13 scores were also compared to evaluate the difference.
Results: 19 participants were enrolled in the study. One participant died during the follow-up period. Of the remaining 18 participants, 4 completed the second PAM-13 questionnaire. There was a statistically significant reduction in 911 calls (p=0.015), transports (p=0.021), and ED visits (p=0.006) following MIH intervention (n=19). The change in PAM-13 scores (n=4) was not significant (p=0.655). The difference in the means of the pre and post PAM-13 questionnaires was an increase of 1.75.
Conclusions: MIH intervention reduced 911 calls, transports, and ED visits in this program evaluation. The effect on patient activation as measured by the PAM-13 questionnaire was not significant. Given the statistical significance in reducing use of emergency services for this small sample, a longer evaluation with more participants is needed to determine if fire-based MIH using a nurse and social worker is effective in reducing emergency resource use.
Olin, Jocelin, "The Impact of Mobile Integrated Healthcare on 911 Use and Patient Activation" (2023). Doctor of Nursing Practice Projects. 78.