The validation of a care partner-derived frailty index based upon comprehensive geriatric assessment (CP-FI-CGA) in emergency medical services and geriatric ambulatory care

Introduction: Hospitalization due to ambulatory care sensitive conditions (ACSC) is a proxy measure for access to primary care. Emergency medical services (EMS) are increasingly called when primary care cannot be accessed. A novel paramedic-nurse EMS Mobile Care Team (MCT) was implemented in an under-serviced community. The MCT responds in a non-transport unit to bookings from EMS, emergency and primary care and to low-acuity 911 calls in a defined geographic region. Our objective was to compare the prevalence of ACSC in ground ambulance (GA) responses before and after the introduction of the MCT. Methods: A cross-sectional analysis of GA and MCT patients with ACSC (determined by chief complaint, clinical impression, treatment protocol and medical history) one year pre- and one year post-MCT implementation was conducted for the period Oct. 1, 2012 to Sept. 30, 2014. Demographics were described. Predictors of ACSC were identified via logistic regression. Prevalence was compared with chi-squared analysis. Results: There were 975 calls pre- and 1208 GA/95 MCT calls post-MCT. ACSC in GA patients pre- and post-MCT was similar: n=122, 12.5% vs. n=185, 15.3%; p=0.06. ACSC in patients seen by EMS (GA plus MCT) increased in the post-period: 122 (12.5%) vs. 204 (15.7%) p=0.04. Pre vs post, GA calls differed by sex (p=0.007) but not age (65.38 ± 15.12 vs. 62.51 ± 20.48; p=0.16). Post-MCT, prevalence of specific ACSC increased for GA: hypertension (p<0.001) and congestive heart failure (p=0.04). MCT patients with ACSC were less likely to have a primary care provider compared to GA (90.2% and 87.6% vs. 63.2%; p=0.003, p=0.004). Conclusion: The prevalence of ACSC did not decrease for GA with the introduction of the MCT, but ACSC in the overall patient population served by EMS increased. It is possible more patients with ACSC call or are referred to EMS for the new MCT service. Given that MCT patients were less likely to have a primary care provider this may represent an increase in access to care, or a shift away from other emergency/episodic care. These associations must be further studied to inform the ideal utility of adding such services to EMS and healthcare systems.

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P048: Listening to care partners: a feasible method to screen for frailty in emergency medical services?

CJEM ◽

10.1017/cem.2016.224 ◽

2016 ◽

Vol 18 (S1) ◽

pp. S94-S95

Author(s):

J. Goldstein ◽

K. Rockwood

Keyword(s):

Emergency Medical Services ◽

Frailty Index ◽

Outcome Data ◽

Medical Services ◽

Future Research ◽

Clinical Frailty Scale ◽

Emergency Medical ◽

Care Partners ◽

One Year

Introduction: Frailty is a state of vulnerability, and may go unrecognized in emergency medical services (EMS). Identifying frailty earlier may allow for services to be offered proactively to maintain function and prevent further health deterioration. The Clinical Frailty Scale (CFS) can be used to screen for frailty, but has only been validated when used by physicians. Our objective was to evaluate the feasibility and validity of a Care Partner-completed CFS, facilitated by a paramedic or nurse. Methods: A prospective sample of older adults (age ≥ 70 years) presenting in two settings (to EMS, following a 911 call, and to Geriatric Ambulatory Care) between February 2009 and March 2010 were included. Care partners completed a survey that included the nine-point CFS, which grades from 1 (very fit) to 9 (terminally ill). Demographic, clinical and outcome data were collected from the health care record, with one year follow-up. Based on clinical evaluations a frailty index was calculated for each patient. In each setting, descriptive statistics were used to compare fitter patients (CFS scores <5) to frailer ones (CFS scores >4). Results: The mean age was 82.2 ± 5.9 years (n=198) and most were women (n = 118, 62.1%). The Care Partner-CFS was incomplete for 3 surveys. The median CFS score in both the clinic and EMS groups was 5 (interquartile range = 4-6). The Care Partner-CFS correlated moderately with their independently assessed frailty index (0.64; p<0.01; n=195). Most patients (n=125; 64%) had frailty scores > 4. Frail patients were older and had worse health outcomes than the patients with score <5. More EMS patients were severely frail or very severely frail compared to the geriatric clinic patients (n = 19, 19% vs. n =5, 5%). Conclusion: The Care Partner-CFS is a feasible and valid method for evaluating frailty in the EMS and medical clinic settings where frailty was common. It may be a useful EMS screening tool to identify those that could benefit from comprehensive assessment and follow-up after emergency care. Future research will evaluate this approach in multiple populations with community based follow-up intervention for those at higher risk.

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