Patient Perspectives on EMS Alternate Destination Models

Introduction: Studies have shown that a large number of ambulance transports to emergency departments (ED) could have been safely treated in an alternative environment, prompting interest in the development of more patient-centered models for prehospital care. We examined patient attitudes, perspectives, and agreement/comfort with alternate destinations and other proposed innovations in Emergency Medical Services (EMS) care delivery and determined whether demographic, socioeconomic, acuity, and EMS utilization history factors impact levels of agreement. Methods: We conducted a cross-sectional study on a convenience sample of patients and caregivers presenting to an urban academic ED between July 2012 and May 2013. Respondents were surveyed on levels of agreement with 13 statements corresponding to various aspects of a proposed patient-centered emergency response system including increased EMS access to healthcare records, shared decision making with the patient and/or primary care physician, transport to alternative destinations, and relative importance of EMS assessment versus transportation. Information on demographic and socioeconomic factors, level of acuity, and EMS utilization history were also determined via survey and chart review. Responses were analyzed descriptively and compared across patient characteristics using chi-square and regression analyses. Results: A total of 621 patients were enrolled. The percentage of patients who agreed or strongly agreed with each of the 13 statements ranged from 48.2 to 93.8%. About 86% agreed with increased EMS access to healthcare records; approximately 72% agreed with coordinating disposition decisions with a primary physician; and about 58% supported transport to alternative destinations for low acuity conditions. No association was found between levels of agreement and the patient's level of acuity or EMS utilization history. Only Black or Hispanic race showed isolated associations with lower rates of agreement with some aspects of an innovative EMS care delivery model. Conclusion: A substantial proportion of patients surveyed in this cross sectional study agreed with a more patient-centered approach to prehospital care where a 9-1-1 call could be met with a variety of treatment and transportation options. Agreement was relatively consistent among a diverse group of patients with varying demographics, levels of acuity and EMS utilization history. MeSH Key words: emergency medical services; triage; telemedicine; surveys and questionnaires; transportation of patients研究背景：研究表明，大量被转运至急诊室（Emergency Department, ED）的救护车接诊病例，本可在其他替代医疗环境中获得安全救治，这推动了以患者为中心的院前急救模式研发的相关兴趣。本研究旨在调查患者对替代接诊目的地及急救医疗服务（Emergency Medical Services, EMS）诊疗流程中其他拟议创新方案的态度、看法与认同/接受度，并探究人口统计学、社会经济状况、病情严重程度及EMS就诊史等因素是否会影响患者的认同水平。 研究方法：本研究于2012年7月至2013年5月期间，针对就诊于某城市教学医院急诊室的患者及陪护人员开展便利抽样横断面研究。研究对象需针对13项表述填写认同程度，这些表述涵盖拟议的以患者为中心的应急响应系统的多个维度，包括提升EMS对患者医疗记录的访问权限、与患者及/或初级保健医师共同制定诊疗决策、转运至替代医疗目的地，以及EMS评估与转运的相对优先级。研究同时通过问卷调查与病历审查，收集了研究对象的人口统计学与社会经济特征、病情严重程度及EMS就诊史等信息。对研究结果进行描述性统计分析，并采用卡方检验与回归分析，基于患者特征进行分组比较。 研究结果：本研究共纳入621名患者。针对13项表述，表示同意或完全同意的患者占比介于48.2%至93.8%之间。约86%的患者认同提升EMS对医疗记录的访问权限；约72%的患者支持与初级保健医师协同制定患者转诊决策；约58%的患者支持为低病情严重程度患者转运至替代医疗目的地。未发现患者的认同程度与病情严重程度或EMS就诊史存在关联。仅黑人或西班牙裔种族在部分创新EMS诊疗模式的认同率上呈现出显著偏低的孤立关联。 研究结论：本横断面研究的受访患者中，有相当比例的人群认同更具以患者为中心的院前急救模式：即拨打911急救电话后，可获得多样化的救治与转运方案。在人口统计学特征、病情严重程度及EMS就诊史各异的多样化患者群体中，认同度相对一致。 医学主题词（MeSH）关键词：急救医疗服务；分诊；远程医疗；问卷调查；患者转运