The transition between hospital and home is susceptible to lapses in quality and loss of key information regarding a patient's care. Following hospitalization, 40% of patients over age 60 will experience a fall in the next six months and 76% of older adult patients are uncertain about their follow-up care plan. Patients transported home by ambulance following an ED visit are at particularly higher risk for return ED visits and readmissions. The proposed research targets two factors in this recidivism: falls caused by potentially avoidable hazards in the home and uncertainty about follow-up care. It advances the development and evaluation of Transport PLUS, an innovative care model in which specially trained emergency medical technicians (EMTs), who are already transporting an older adult patient home from the ED, add to their service two simple interventions - a home fall hazard assessment (FHA) and discharge comprehension assessment (DCA). Preliminary data collected among elders being transported home from the ED indicates that the Transport PLUS intervention is feasible and addresses a substantive problem with fall risk and discharge comprehension. The PI is an emergency medicine physician with a background in Emergency Medical Services (EMS). This study will cement his transition to aging-related research by expanding the preliminary results to include inpatients and by optimizing the study methods. Specifically, in Aim 1 the training programs and checklists used in Transport PLUS will be refined using qualitative and quantitative methodology, including focus groups of elder patients and EMS providers.
In Aim 2 the intervention will be compared to standard care using a pilot, cluster-randomized control trial in a population of older adult patients being discharged from the hospital. 48 EMS providers will be randomized to either the intervention group or control group yielding ~200 patient participants in each arm of this trial. Primary outcomes will be the rate of falls at 3 months following hospitalization and 3-day and 30-day return ED visits. Process measures will include removal of fall hazards at 3 months and compliance with discharge instructions. The knowledge and experience gained from this research will pave the way for the design and completion of a large-scale, multi- center clinical trial under an R01 mechanism to test the efficacy of the Transport PLUS intervention in a diverse group of hospitals.
elderly patients transported home by ambulance following an ED visit or hospitalization experience high rates of return ED visits and readmissions. Contributory factors include frequent falls following an acute illness and confusion about the care plan. This study evaluates Transport PLUS, an innovative care model that uses Emergency Medical Technicians in an enhanced role to reduce the risk of falls after hospitalization and improve transitions of care.
