Prof. Keefe & Colleagues Say In-Home Medical Care May Solve Overcrowded ERs

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As hospital emergency departments (ED) struggle with overcrowding, experts are now studying alternative solutions to these visits. For many patients suffering from unexpected medical issues, visiting the ED is a common catch-all solution regardless of whether or not their problem is an emergency. A study by BUSSW Prof. Bronwyn Keefe and colleagues proposes that in-home medical care for non-emergent needs could reduce ED crowds, improve patient health, and boost patients’ perception of health care. 

“There is strong evidence regarding the negative impact of ED crowding on clinical outcomes, mortality rates, treatment times, and rates of patients leaving against medical advice without receiving treatment,” the authors explain. “The long wait times of crowded EDs and impaired communication with ED staff reduce patient satisfaction. Crowded EDs can be perceived as uncomfortable, inefficient, and even dangerous places to obtain care.” By empowering non-emergent patients with in-home paramedic care options, providers can improve the experiences of medical professionals, ED visitors, and patients who choose to receive health care at home. 

To explore alternative solutions, the researchers collaborated with a local ambulance service provider and a Massachusetts health care delivery system. Together, they developed a Mobile Integrated & Community Paramedic (MIH/CP) urgent care program that could evaluate and treat patients at their homes or institutional residences between 6pm and 2am. Due to a special project waiver from the Mass. Department of Public Health, the program was able to reach patients across Greater Boston who were eligible for both Medicare and Medicaid.

To gauge the effectiveness of this MIH/CP system, the study surveyed patients who had recently visited the ED and those who had received in-home care. Nearly 9 of 10 patients treated by community paramedics at home said they had excellent or very good quality care, while only 65% of ED patients reported the same. “Patients treated by community paramedics believed that in-home treatment saved them time compared with going to the ED and that in-home treatment carried a lower risk of their illness worsening,” the authors report. “Overall, patients who experienced the program perceived in-home care as less burdensome than ED-based care.” 

Since this study explored one Massachusetts health care delivery system, future research is needed to deliver a larger and more diverse analysis of both patients and health care providers. However, this study marks an important first step in providing better health care services to those in need. “Knowing that patients consider this care model acceptable suggests that it has potential as a capacity management tool, optimizing care delivery and reducing ED crowding.”

Co-authors are Joseph Palmisano, MA, MPH from Boston University School of Public Health; Stephen C. Dorner, MD, MPH, MSc and Amy J. Wint, MSc from Massachusetts General Hospital; Lisa I. Iezzoni, MD, MSc from Harvard University; and Philip S. Brenner, PhD from University of Massachusetts Boston.

Read the full study.

Learn More About Prof. Keefe’s Research