Paramedic-Assisted Community Evaluation After Discharge: The PACED Intervention.
Laurel O'Connor, Stephanie Sison, Kimberly Eisenstock and 12 others
PMID 39030939WHAT IT FOUND
Paramedic home visits within 72 hours of discharge were feasible for frail older adults, found medication discrepancies and fall risks, and were associated with lower 30-day rehospitalization in this unblinded study.
Key findings
01All 100 participants who agreed to PACED completed a home visit, and 91 (91.0%) visits occurred within 72 hours.
02Medication discrepancies were found in 34 (36.9%) completed reconciliations, and 31 were remediated during the visit.
03The PACED intervention, described in the text as a paramedic home visit with synchronous physician telehealth precepting and an escalation strategy, was associated with lower risk of 30-day rehospitalization (0.40 [0.19-0.84]).
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for RNs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
This was a pilot feasibility study, not a randomized trial, and outcome abstractors were not blinded. The control group was made of eligible patients who lived outside the paramedic service area, so they may have differed in ways that affect hospital readmission. The intervention group had a higher frailty score (median 0.42 versus 0.39, p=0.013) and more chronic obstructive pulmonary disease (28.0% versus 6.7%, p=0.03), which could affect outcomes. The PACED bundle included several components, so the contribution of any single part cannot be separated. Only 30-day outcomes were reported, and intervention costs were not measured. High protocol fidelity was achieved during a period of intensive study-team effort and may not persist after the pilot.
Declared interests
The supplied article text does not give an author conflict-of-interest or funding statement. The provided metadata lists research support from NIH extramural and non-U.S. government sources.
The easy way to misread this
Do not read the lower 30-day rehospitalization risk as proof the paramedic visit caused it. This was an unblinded, nonrandomized pilot with a geographically selected control group, and the PACED components described in the text included a paramedic home visit, physician telehealth precepting, and escalation, so the contribution of any single component cannot be separated.