U of A Study Examines Emergency Department Use During the Recession

AzPHA member Patrick Wightman from the UA Center for Population Science and Discovery recently published an Issue Brief examining the impact that the freeze on “childless adult” enrollment in AHCCCS during the Great Recession had on the use of hospital and emergency department services. 

Because Arizona conducted a natural experiment by freezing Medicaid enrollment among childless adult, and the fact that data are available to measure the effect of those policy changes, Patrick was able to compare people’s behavior with health insurance to their behavior without it.  The fact that the freeze lasted years allowed him to examine any impact of pent-up demand following the lifting of enrollment freeze.

Here’s a link to the entire Issue Brief , which includes the entire results including several useful graphs, but here’s the Summary from the Issue Brief.

“While the trends presented here are descriptive, they occur in the framework of two significant “natural experiments”, the first drastically restricting low-income individuals’ access to public health insurance, and the second once again expanding that access.  Because these policy changes happen at the state and federal levels, beyond the control of beneficiaries, it can be inferred that, in large part, they are the cause of the beneficiaries’ behavior, in this case their health care utilization.

In this context, the patterns shown here provide strong evidence that health care utilization, at least in the form of ED visits and hospitalizations, follows the availability of health care, in the form of health insurance.  While this finding is not unanticipated in the case of hospital visits, in the case of ED visits it is perhaps somewhat surprising, at least to the extent that ED visits represent “legitimate” medical emergencies.”

Arizona Research will Change EMS Brain Injury Care

Traumatic brain injury is involved in about 1/3 of all injury-related deaths... it’s clearly a public health issue.  That’s why back in 2013 Arizona created the Excellence in Pre-hospital Injury Care (EPIC) project- which has been aimed at improving brain injury outcomes in AZ. 

Back in 2013 the National Institutes of Health chose AZ as the only state to evaluate the national standards for pre-hospital emergency care of brain injury (under a grant application led by AZPHA member Ben Bobrow, MD). 

EPIC has been a unique partnership between state government, the U of A and more than 130 fire departments and ground/air ambulance companies.  Together they implemented a series of pre-hospital traumatic brain injury treatment interventions and measured the effectiveness of the results.

The interventions included: 1) prevention of hypoxia by early oxygen administration; 2) airway interventions to optimize oxygenation; 3) prevention of hyperventilation; and 4) quickly treating low blood pressure by infusing fluids.

Participating EMS agencies sent treatment information to the ADHS and the UA College of Medicine for tracking and evaluation. An early donation from the Ramsey Justice Foundation made it possible for the agencies to receive special breathing devices to implement the new protocol and assist in the treatment patients at no cost.

More than 5 years of work by literally hundreds of Arizonans resulted in the publication of the results this week in JAMA Surgery entitled Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines with Patient Survival Following Traumatic Brain Injury.

Remarkably, the team found that implementation of the protocol doubled the chances of survival among persons with a critical traumatic brain injury and improved neurological outcomes. Doubling the chances of survival is no small thing for a public health intervention, so this is really a landmark study.

This Arizona study will change the way EMS providers treat traumatic brain injury in the field around the globe. That shows the importance of publishing. When hard work like this with dramatic results is published in reputable journals- people take note. It won’t be long before the Arizona protocol becomes a global EMS standard for traumatic brain injury care. For more info go to www.epic.arizona.edu.

A huge public health thank you to the entire research team including Dan Spaite, MD; Ben Bobrow, MD; Sam Keim, MD, MS; Bruce Barnhart, RN, CEP; Vatsal Chikani, MPH; Joshua Gaither, MD; Duane Sherrill, PhD; Kurt Denninghoff, MD; Terry Mullins, MPH, MBA; P. David Adelson, MD; Amber Rice, MD, MS; Chad Viscusi, MD; and Chengcheng Hu, PhD.

Community Paramedicine Continues to Mature in AZ

Community paramedicine has been a paradigm shift for the use of paramedics in the US- and Arizona has been a national leader.  It’s a new model in which paramedics function outside their usual emergency response & transport roles- delving into the world of primary care.  As the health care world increasingly shifts toward prevention and well care- the system will increasingly demand more folks that can function in a community health (primary care and prevention) role.  Community paramedicine is increasingly being recognized as a promising solution to efficiently increase access to care (especially for underserved populations). 

For example- paramedics could shift from a sole focus on emergency response to things like: 1) providing follow-up care for folks recently discharged from the hospital to prevent unnecessary readmissions; 2) providing community-based support for people with diabetes, asthma, congestive heart failure, or multiple chronic conditions; and/or 3) partnering with community health workers and primary care providers in underserved areas to provide preventive care. 

One component of Community Paramedicine is known as “Treat and Refer” and it has really taken a step forward in the last couple of years in Arizona.  A couple of years ago the initiative was launched under the leadership of AzPHA Members David Harden, Terry Mullins, Dr. Ben Bobrow and others at the ADHS.

It’s called the Arizona Treat and Refer Recognition Program and was developed in partnership with the ADHS Bureau of EMS & Trauma Systems, AHCCCS, and the EMS community. Organizations that earn Treat and Refer recognition implement the program under the direction of their medical director and chief executive.  Once recognized, the EMS Agency can seek reimbursement from AHCCCS for the services they provide.  You can check out the AHCCCS website to learn more about provider registration.

Five EMS agencies have now been recognized as Treat & Refer EMS agencies. The T&R Program establishes a means for recognized EMS agencies demonstrating optimal patient safety and quality of care by matching treatment, transport, and care destination options to the needs of the 9-1-1 patient; and provide recognized EMS agencies the opportunity to seek reimbursement from AHCCCS.

The ADHS Bureau of EMS & Trauma Systems offers a pre-application technical review service to EMS agencies considering applying for recognition. The service includes a comprehensive review of EMS agencies’ education modules, standing orders, patient follow-up process, and performance improvement/quality assurance process.