6th UK and Ireland Implementation Science Research Conference 2023
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PRESENter
Terri Menser
Jennifer Ridgeway
presenter biography
Terri Menser is a health services researcher with broad ranging research interests that include patient engagement, assessing health disparities and intervening to increase equity where possible, and system improvement and implementation evaluation efforts to decrease care fragmentation and lessen burnout. She is currently serving as the Internal Communications Director for the Justice, Equity, Diversity, and Inclusion Special Interest Group with ACTS and is also the Treasurer for the Healthcare Management Division of Academy of Management. She was trained at Texas A&M, completed a postdoc at OSU, and conducted research at Houston Methodist hospital prior to joining the Kern Center at Mayo Clinic in August 2022.
Jennifer Ridgeway is an Associate Professor of Health Services Research and a Senior Associate Consultant at Mayo Clinic (Rochester, MN, USA). Her expertise is in qualitative and mixed methods research, formative and process evaluation, and implementation science. Her research interests include relationship-centered care, generalist-specialist collaboration across networks, and implementation of remote and technology-enabled models of multidisciplinary care, especially for patients with multiple chronic conditions and patients in cancer survivorship. She is currently leading a pragmatic trial of shared decision making in three diverse U.S. health systems, and she is a co-investigator on trials of remote cancer symptom management interventions, community paramedicine models of care, and evidence-based approaches to clinical decision making. https://impsciconference.com/speaker/jennifer-ridgeway/
background
Community paramedics (CPs) provide services to patients with intermediate acuity needs in community settings.1 The Care Anywhere with Community Paramedics (CACP) program was evaluated in a pragmatic, point-of-care randomized clinical trial of CACP versus usual care on days alive outside the hospital or emergency department (ED) within 30 days.2 This study reports key informant perspectives of program sustainability at trial completion.
MEthod
The trial was conducted in an academic medical center and affiliated health system (Midwest USA). A purposive sample of CPs, clinicians, and administrators were invited to complete a survey, including items from the Clinical Sustainability Assessment Tool (CSAT).3 A subset were also invited to complete an individual interview. Surveys were analyzed descriptively, and interview transcripts utilized applied thematic analysis.
results
Between January and March 2023, 63 individuals completed surveys and 20 completed interviews. CSAT scores were highest in clinician perspectives of outcomes and effectiveness and lowest in CP perspectives of organizational readiness and among CPs overall. Interviews highlighted clinician views that the program addressed persistent acute care gaps, especially in rural communities, and provided them with important information to manage care and keep patients stable at home. However, CPs suggested that sustainability hinged on a varied nature of referrals—so they were not a “catch all” resource for very complex patients—and improved staffing.
Conclusion
CP programs may provide critically needed options for patients with intermediate acuity needs, but sustainability will require a balance between filling gaps in the healthcare system and CP capacity to address them.
Additional Information
Jennifer L. Ridgeway (1), Olivia A. Smith (1), Michelle A. Lampman (1), Terri Menser (1), Rozalina G. McCoy (1,2,3) (1) Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, 55905, USA; (2) Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, 55905, USA; (3) Community Paramedic Service, Mayo Clinic Ambulance, Rochester, Minnesota, 55905, USA.