Impact of COVID-19 on Home-Based Community Paramedicine and High-Risk Elder Patients

Study Objectives: Using paramedics to evaluate and treat medically complex elderly patients in the home setting has implications for community health, cost, and patient satisfaction. We aim to determine the impact of COVID-19 on Tandem, a home-based community paramedicine program (HBCPP) that provides comprehensive solutions for geriatric patients with highly trained community integrated paramedics, nurses, and social workers. Methods: This was a retrospective cohort analysis of elderly patients (>65 years) who triggered emergency medical services (EMS) dispatch with urgent medical calls over a two-year study period within the Grand Rapids metropolitan out-of-hospital area. HBCPP members were compared to non-members (control group) in terms of demographics, Charlson Comorbidity Index (CCI), presenting complaints, out-of-hospital inventions, transport to the emergency department (ED), and length-of-stay (LOS). Chi-squared and t-tests were used to compare the two study groups across key demographic and outcome variables. Results: During the two-year study period, there were nearly 4500 EMS calls from elderly patients with high acuity conditions which include: fever, altered mental status, fall, dysuria, cardio-pulmonary complaints, and fatigue/weakness. The average age was 79.4 + 9.7;49.1% were female. A total of 969 and 471 urgent HBCPP assessments were completed in 2019 and 2020, respectively. In both years, HBCPP members had increased comorbidities compared to control population: hypertension (61% vs. 14%), diabetes mellitus (39% vs. 19%), and congestive heart failure (17% vs. 4.0%). In 2019, members had reduced ED transport compared to control (15.0% vs. 73%) (p<0.001) with higher admission rates (51.7% vs. 20.4%) and identical length of stay (LOS) (4.6d vs. 4.6d) (p<0.001). In 2020, Tandem patients had reduced ED transport (11.7% vs. 88.3%) with increased average LOS (5.4d vs.5.0d). For HBCPP patients not transported to the ED they had a 17% chance of ED evaluation within seventy-two hours in 2019 and 13% in 2020. Our home based-community paramedicine program experienced decreased emergency department utilization rates during the COVID-19 pandemic in 2020 compared to 2019 (11.7% vs. 15.0%) with a subsequent increased LOS. Program members evaluated in the home but not transported to the ED also had decreased 72-hour ED utilization rates. One limitation from this work is we had nearly 50% reduction in the number of urgent assessments completed in the home during 2020. Conclusion: Our HBCPP was started as a solution for at-risk seniors who have difficulty navigating the health care system to get the care they need. During the COVID-19 pandemic, our results suggest that the HBCP program reduced ED utilization during 2020 but had longer LOS. Further research into the safety, associated and comparative LOS, and expansion of such programs will be informative on large scale generalizability of such programs.