A Mobile Integrated Health Program for the Management of Undifferentiated Acute Complaints in Older Adults is Safe and Feasible

Overview

Journal Acad Emerg Med

Publisher Wiley

Specialty Emergency Medicine

Date 2023 Aug 19

PMID 37597241

Authors

Laurel OConnor

Martin Reznek

Michael Hall

Julie Inzerillo

John P Broach

Edwin Boudreaux

Affiliations

Soon will be listed here.

Abstract

Background: Poor care access and lack of proper triage of medical complaints leads to inappropriate use of acute care resources. Mobile integrated health (MIH) programs may offer a solution by providing adaptable on-demand care. There is little information describing programs that manage undifferentiated complaints in the community. The objective of this study was to assess the safety and feasibility of an MIH program that responds to the community to manage medical complaints in older adults.

Methods: This was a prospective observational study examining a pilot MIH program. Seven ambulatory clinics and their affiliated patients aged 65 and older were oriented to the program and invited to use its services. Visit and follow-up data for all patients who underwent an MIH visit were abstracted, along with 30-day follow-up information. All demographic data and outcomes were reported descriptively.

Results: In 21 months, 153 MIH visits were completed, involving 91 patients (mean age 81 years, 60.4% female). The most common chief complaints were generalized weakness (28.8%) and shortness of breath (18.9%). Electrocardiogram (57.5%) and point-of-care bloodwork (34.6%) were the most common diagnostic tests performed. Sixteen visits (10.4%) were followed by an emergency department (ED) visit within 72 h. In 11 encounters, the patient was referred to the ED; in five cases, the ED visit was unforeseen. Fifteen patients (9.8%) were admitted to the hospital after an MIH visit. There were two deaths within 30 days following an index visit.

Conclusions: An MIH program designed to address the acute complaints of community-dwelling older adults was feasible and safe, with low rates of unforeseen emergency services utilizations. MIH programs have valuable diagnostic and therapeutic capabilities and may serve to help triage the acute medical needs of patients. Further study is required to validate the efficacy and cost-effectiveness of MIH programs.

Citing Articles

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OConnor L, Behar S, Tarrant S, Stamegna P, Pretz C, Shirshac J Res Sq. 2024; .

PMID: 39606445 PMC: 11601823. DOI: 10.21203/rs.3.rs-5084150/v1.

Rationale and design of healthy at home for COPD: an integrated remote patient monitoring and virtual pulmonary rehabilitation pilot study.

OConnor L, Behar S, Tarrant S, Stamegna P, Pretz C, Wang B Pilot Feasibility Stud. 2024; 10(1):131.

PMID: 39468649 PMC: 11520050. DOI: 10.1186/s40814-024-01560-x.

Paramedic-Assisted Community Evaluation After Discharge: The PACED Intervention.

OConnor L, Sison S, Eisenstock K, Ito K, McGee S, Mele X J Am Med Dir Assoc. 2024; 25(10):105165.

PMID: 39030939 PMC: 11486595. DOI: 10.1016/j.jamda.2024.105165.

Beyond flashing lights and sirens: Community paramedicine as health safety nets for older adults.

Ulintz A, Quatman C J Am Geriatr Soc. 2024; 72(9):2640-2643.

PMID: 39007359 PMC: 11368620. DOI: 10.1111/jgs.19087.

Factors Impacting the Implementation of Mobile Integrated Health Programs for the Acute Care of Older Adults.

OConnor L, Behar S, Refuerzo J, Mele X, Sundling E, Johnson S Prehosp Emerg Care. 2024; 28(8):1037-1045.

PMID: 38498782 PMC: 11436480. DOI: 10.1080/10903127.2024.2333034.

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