Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database
Evans CS, Platts-Mills TF, Fernandez AR, et al. Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database. Ann Emerg Med. 2017;70(4):506-515.e3. [PMID: 28559037]
Background & Objectives:
Adults aged 65 and older make up a significant proportion of the population (estimated to be approximately 20% of the total US population by 2030). In addition, this subset of patients has disproportionate utilization of EDs as well as EMS services (estimated at 38% of EMS transports). Little is known regarding the precise characteristics of this population that is associated with higher utilization of EMS. The investigators of the study aimed to investigate the proportion of older adults receiving repeat transport within 30 days and to potentially identify characteristics that were associated with repeat use of EMS.
The investigators conducted a retrospective analysis of EMS transports listed in the North Carolina Prehospital Medical Information Systems (PreMIS) database from 2010 to 2015. In particular, EMS encounters that were associated with 911 calls for adults aged 65 years or older that resulted in transport were examined. The primary outcome that was evaluated was repeated EMS transport within 30 days. Additional secondary outcomes that were examined included stratification of individuals by total number of EMS transports during the study period within 30 days. A multivariable logistic regression model was used to calculate adjusted odds ratios and 95% confidence intervals of repeated EMS transport within 30 days.
A total of 1,719,998 transports for individuals aged 65 or greater were analyzed during the study period, of which 689,664 were for unique individuals. In this specific population, the key findings were as follows:
- 17.7% (303,099 transports) had at least one repeated transport within 30 days
- Odds of repeated transport within 30 days was higher in the following individuals:
- Those from healthcare/residential facilities (OR 1.42 CI 1.38 to 1.47)
- Black vs white (OR 1.29 95% CI 1.24 to 1.33)
- Dispatch complaint of “sick person”, “fall”, “breathing problem”, “abdominal pain”, “diabetic problem”, “unknown person/person down”, “back pain”, “psychiatric problem”, “headache”
- 15.6% of all repeated transports were related to falls
- Greater than 1 in 6 EMS transports of individuals greater than the age of 65 is followed by a repeated transport within 30 days.
- Individuals in healthcare/residential settings and blacks (versus whites) have increased odds of repeated transport within 30 days
What this means for EMS:
Repeat transport of elderly adults is associated with significant healthcare costs and utilization of limited resources both in the hospital and pre-hospital setting. Identification of specific variables that are associated with repeated transport may assist with the development of targeted strategies to both improve patient outcomes and simultaneously decrease the demand for EMS resources that are already stretched very thin.