Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study

Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study Kevin G Munjal, Sai Kaushik Yeturu, Hugh H Chapin, Nadir Tan, and 15 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1453848/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: The growing population of patients over the age of 65 faces particular vulnerability following discharge after hospitalization or an emergency room visit. Specific areas of concern include a high risk for falls and poor comprehension of discharge instructions. Emergency Medical Technicians (EMTs), who frequently transport these patients home from the hospital, are uniquely positioned to aid in mitigating transition of care risks and are both trained and utilized to do so using the Transport PLUS intervention. Methods: Existing literature and focus groups of various stakeholders were utilized to develop two checklists: the Fall Safety Assessment (FSA) and the Discharge Comprehension Assessment (DCA). EMTs were trained to administer the intervention to eligible patients in the geriatric population. Using data from the checklists, follow-up phone calls, and electronic health records, we measured the presence of hazards, removal of hazards, presence of discharge comprehension issues, and correction or reinforcement of comprehension. These results were validated during home visits by community health workers (CHWs). Feasibility outcomes included patient acceptance of the Transport PLUS intervention and accuracy of the EMT assessment. Qualitative feedback via focus groups was also obtained. Clinical outcomes measured included 3-day and 30-day readmission or ED revisit. Results: 103 EMTs were trained to administer the intervention and participated in 439 patient encounters. The intervention was determined to be feasible, and patients were highly amenable to the intervention, as evidenced by a 92% and 74% acceptance rate of the DCA and FSA, respectively. The majority of patients also reported that they found the intervention helpful (90%), and self-reported removing 40% of fall hazards; 85% of such changes were validated by CHWs. Readmission/revisit rates are also reported. Conclusions: The Transport PLUS intervention is a feasible, easily implemented tool in preventative community paramedicine with high levels of patient acceptance. Further study is merited to determine the effectiveness of the intervention in reducing rates of readmission or revisit. A randomized control trial has since begun utilizing the knowledge gained within this study. Trial Registration: Not Applicable Emergency Medical Technicians Prehospital Care Community Paramedicine Mobile Integrated Healthcare Discharge Comprehension Fall Safety Emergency Medical Services Readmissions Transitions of Care Figures Figure 1 Figure 2 Key Messages Regarding Feasibility 1) What uncertainties existed regarding the feasibility? Prior to this pilot study, Transport PLUS was a novel intervention that had not previously been implemented or attempted. It was unknown whether prehospital providers could be easily trained and whether the intervention could be operationalized within an EMS agency. There was also uncertainty regarding the prehospital providers’ capacity to accurately complete the assessment and whether patients would be amenable to receiving the intervention, particularly if they would be accepting of EMS providers performing the discharge comprehension assessment and in-home fall safety assessments. Specific items to be included in the relevant surveys and the training format/ delivery also required development and feedback. 2) What are the key feasibility findings? Training providers using a combination of in-person practical and online didactic training was feasible and effective. To address high provider turnover, the study team developed online asynchronous learning tools; however, the in-person practical remained necessary to ensure competency and fidelity of the intervention. Dispatch was found to be capable of assigning appropriate units when patients were eligible. Patients were highly amenable to the intervention, though with some reservations on specific items of the Fall Safety Assessment. Community Health Worker validation resulted in high reliability of reported findings. Finally, paper checklists utilized in this study were difficult to integrate into the patient’s electron health records. 3) What are the implications of the feasibility findings for the design of the main study? These positive feasibility findings of patient acceptance and provider capacity provided sufficient basis with which to design a subsequent randomized control trial to further evaluate the intervention. The feasibility findings directly informed improvements to the checklist and to the training program to be used in the main study. Items of the fall safety assessment, particularly high-reach items in cabinets, were modified in the main study to be a question as opposed to a visual survey, thereby addressing patient and provider concerns about discomfort in searching patient home cabinets. The checklists utilized in the interventions were also digitized, resolving the troubles of transmitting data from the intervention by paper. Background Adults aged 65 and older accounted for approximately 23 million emergency department (ED) visits in the United States in 2016,[ 1 ] a number expected to continue to grow as the population of adults in this age group is anticipated to double over the next 40 years.[ 2 ] These patients are especially vulnerable following a hospitalization, which is often associated with functional decline. One study demonstrated that 40% of adults aged 60 or older will face a fall in the 6 months following a hospitalization, and over half of these result in injury.[ 3 ] It is also known that older adult patients face a statistically significant increased risk of 30-day readmission to the emergency department (ED) when transported home by ambulance.[ 4 ] The frequent and diverse utilization of healthcare services by the elderly requires attention to risks in transition of care and lapses of patient education, particularly as they transition from hospital environment to home. Two key risks are addressed in this demonstration: falls in the home and comprehension of discharge instructions. Older adults face a variety of comorbidities and serious risk of injury due to falls which may result in hip fractures, head injuries, and other serious trauma. The fall-related mortality rate for older adults increased by 30% from 2007 to 2016. The same report indicates that falls among the elderly are not only serious, but also a costly public health concern, comprising 50 billion USD in 2015 healthcare spending with Medicare and Medicaid covering 75% of those costs.[ 5 ] Transport PLUS offers a unique opportunity to deliver an in-home fall prevention intervention targeted to high-risk patients transported home by ambulance following hospital or ED discharge. Meanwhile, patient discharge instructions are often dense with information and difficult for patients to comprehend. Competing priorities among patients, caregivers, and providers can contribute to confusion, and time pressures often leave little opportunity for the patient to obtain clarity before leaving the hospital. In one study of ED discharge instruction comprehension, at all ages, it was found that 78% of patients have a deficiency in their understanding of their own aftercare. More alarmingly, among this same cohort of patients, deficient comprehension was only recognized by the patient 20% of the time where it was demonstrated, highlighting that patients frequently are unaware when they fail to understand their aftercare.[ 6 ] Lack of comprehension in discharge care is prevalent outside of the ED as well, with adults 65 and older discharged from medical and surgical units demonstrating non-comprehension of recommended follow-up appointments (5%), medications (27%), exercise (48%) and diet (50%).[ 7 ] For patients transported home by ambulance, this is an opportunity to improve understanding of discharge instructions. Emergency Medical Services (EMS), while still most commonly recognized for 9-1-1 emergency response, are already being utilized to transport patients home by ambulance. More can be accomplished by these medically trained professionals, and they have the capacity to directly improve the patient’s transition of care. EMS provides transportation of particularly vulnerable patients to their home setting from both hospital inpatient stays, as well as from the ED. As previously mentioned, among older patients, those transported home by ambulance are particularly vulnerable.[ 4 ] The evolving practice, often referred to as “community paramedicine” or “mobile integrated healthcare”, seeks to expand the role of emergency medical technicians (EMTs) and paramedics to help support patients’ needs in the home and in the community. The intent of these programs is to prevent emergencies in the community, thereby decreasing the present burden on crowded emergency departments. Transport PLUS , a collaboration between Mount Sinai Health System and partner commercial ambulance agencies, was designed to train and utilize EMTs as a valuable member of the continuum of high-quality healthcare delivery. EMTs were trained to perform a discharge comprehension assessment and a home fall safety assessment for patients over the age of 65 and their families or caregivers during routine transports to the home after being discharged from the ED or from inpatient units. In this paper, we describe the implementation of the Transport PLUS intervention and present the results of a feasibility study to evaluate whether EMTs were able to successfully perform the intervention and whether patients found the intervention helpful. Methods The Transport PLUS Program is a novel EMS transition of care intervention that trains EMTs who are already transporting older adult patients (65 + years in age) home from a single, urban academic hospital by ambulance. The study was conducted between November, 2013 and July, 2014. EMTs were trained to perform two simple interventions: a home fall safety assessment (FSA) and a discharge comprehension assessment (DCA). Patients transitioning to other hospitals, nursing homes, or any other institution providing formal post-discharge care were excluded from the study. Both the FSA and DCA were developed using a checklist developed through a comprehensive review of the literature and existing tools. Development of the Transport PLUS intervention The home fall safety assessment (FSA) is a brief scan of the home or apartment for easily recognized fall hazards. The extensive literature search, which included publications from the fields of nursing and physical therapy, generated a long list of fall hazards potentially present in the home.[ 8 – 13 ] Given that the Transport PLUS intervention was to be administered by EMTs, and not overly extend the amount of time the EMTs were spending in the home, we developed a simple, brief, and manageable checklist. The fall hazards selected for the checklist were those that are common, easily assessed with a high degree of inter-rater reliability, modifiable by the patient or their caregiver, and most likely to make an impact on patients’ risk of falls in the home. For example, structural hazards which would require home renovation or significant financial expenditure were omitted. This resulted in the 11 item list shown in Fig. 1 . The discharge comprehension assessment (DCA) is a structured conversation between the EMT and the patient (and their caregiver, when present in the ambulance) that occurs during the routine transportation encounter (beginning from the patient’s hospital bed to assisting them into their home). The checklist was developed utilizing Coleman’s four “pillars” of a patient-centered transition of care: medication self-management, use and maintenance of a patient-centered record, primary care and specialist follow-up, and knowledge of red flags.[ 14 ] In this Coleman study, nurses, social workers, or other transitional coaches were sent to the home post-discharge to address the pillars; however, this service is not feasible in all communities or for all patients, due to workforce or financial constraints. This inspired the creation of the DCA as part of the Transport PLUS intervention to provide increased transitional care efforts to patients who might not receive a home visit. Our adapted checklist assesses the patient’s understanding of and access to medications, follow-up appointments, transportation, and self-care instructions (Fig. 2 ). EMT Training EMT training sessions for the assessments were administered to optimize effectiveness and inter-rater reliability. This training included a one-hour didactic session (offered either in-person or through an online module), as well as a one-hour practical component that included two simulations of obtaining consent and administering the Transport PLUS intervention. Training was iterative and EMT feedback was used in continually refining its development. The didactic training included, in addition to the checklists, the importance of patient comprehension of discharge instructions and how to review sample discharge paperwork while completing the DCA checklist. Samples of actual discharge paperwork given to patients/caregivers upon discharge were used for this purpose. Pre and post testing was administered, and participation in the intervention required a post-test score of 85%. The Transport PLUS intervention Administration and Outcome Measures To determine the feasibility of Transport PLUS , patient acceptance of the Transport PLUS intervention and accuracy of the EMT assessment were assessed. Data was collected on the frequency of fall hazards identified, fall hazard removal or correction, EMT-identified deficiencies in discharge comprehension, and correction or reinforcement to discharge comprehension. Clinical outcomes measured included 3-day and 30-day readmission. Secondary outcomes include patient-reported helpfulness of the intervention, qualitative focus group results, and CHW home visit to validate EMT assessments. Transport PLUS was performed for all patients that accepted the intervention, and all completed checklists were collected. Patients were asked verbally for permission to make a 4-week follow-up phone call, during which patients were asked to self-report the presence of fall hazards in their home and if previously identified hazards by the EMTs had been removed or addressed. Finally, after the study was completed, some additional patient feedback was obtained in the form of a focus group to qualitatively assess patient response to the intervention. Patients were asked questions about their comfort with the intervention, prompted for concerns with the program, and given the opportunity to provide any additional feedback. A limited number of randomly selected patients were given the option for a follow-up visit with a community health worker (CHW), who was also trained in identifying home fall hazards. Each CHW judged the validity of the initial EMT assessment of reported fall hazards. Aggregate percentages of overall removal of fall hazards were collected to validate patient self-reported data and the EMT’s initial assessment. Finally, a review of the electronic health record was performed to yield readmission or ED revisit at 3- and 30-days post-intervention. This study was reviewed and approved by the Institutional Review Board of the Icahn School of Medicine at Mount Sinai. Results The Transport PLUS Program trained a total of 103 EMTs, all of whom successfully completed the course and were eligible to deliver the Transport PLUS intervention. 439 encounters were made where patients were offered the Transport PLUS Intervention. These encounters consisted of 327 unique patients. Unique patients are considered for demographic data, whereas all other results are reported relative to total encounters. Demographic information is provided in Table 1 . Table 1 Patient Demographics (n = 326) Count Percent Age (years) 65–69 38 12% 70–79 78 24% 80–89 131 40% 90–99 73 22% > 100 6 2% Sex F 214 66% M 112 34% Race White 119 37% Black 94 29% Hispanic 66 20% Asian 7 2% Native American 1 0% Unavailable 39 12% Insurance Private 135 41% Medicare 317 97% Medicaid 182 56% Dual Eligible 178 55% The first outcome of interest is patient acceptability of the intervention, which is reported separately for DCA and FSA. DCA was accepted in 404 patient encounters (92.03%). FSA was accepted in 323 patient encounters (73.58%). Among these, 3 returned checklists were only partially completed, whereas the remaining FSA and all DCA checklists were completed in full. EMTs identified a total of 2,117 fall hazards over the course of the study. Of these, 1,094 unique hazards were identified. (If in a given encounter there were multiple hazards of the same type identified (e.g. throw rugs), all are counted in total hazard statistics reported, but would only count as one unique identification.) Four-week follow-up phone surveys then yielded hazard removal rates as reported by the patient. Phone surveyors were able to reach patients regarding 316 encounters. When asked about hazards documented by the EMT, patients denied or disagreed with the presence of the hazard in 34% of cases. Of the hazards which were acknowledged by the patient, the overall removal rate was 40% Statistical data for fall hazards and follow-up call data per hazard are reported in Table 2 and Table 3 , respectively. Table 2 Fall Hazards Unique (n = 1,094) Average 3.398 Median 3 Max 10 Total (n = 2,117) Average 6.570 Median 6 Max 30 Table 3 Hazard Removal Upon Follow Up Phone Call Clutter Throw rugs Carpet frayed, torn or folded Wires or cords as fall hazard Poor lighting poses fall hazard Nightlights absent Low Toilet Lack of Grab-Bars Lack of Non-Slip Bath-Mat High reach for supplies Walkway fall hazard Total Removals 11 17 6 13 14 13 20 38 30 25 13 200 Hazard Remains Present 8 22 15 30 52 58 13 55 29 17 6 305 Hazard Denial 9 20 14 35 27 36 16 68 16 9 9 259 Refused to answer 22 21 21 21 21 22 21 21 21 24 21 236 Percent of Removals among Hazards Acknowledged 58% 44% 29% 30% 21% 18% 61% 41% 51% 60% 68% 40% Patient-reported data on hazard removal was validated during home visits by CHWs. 40 such CHW assessments were performed. Among this group, 85.7% of hazards which were self-reported as removed were confirmed to have actually been removed. DCA results revealed 94 (23%) patients who accepted the DCA had at least one area of DCA deficiency. Data reported on each of the six deficiencies individually is reported in Table 4 . Of note, among the 260 total categorical deficiencies found, EMTs were able to reinforce the discharge plan and correct comprehension deficiency with the patient in 199 cases (76.5%). The follow-up survey also found that 90.2% of patients who accepted the Transport PLUS intervention and answered the survey question stated that they found the intervention to be helpful. 3-day and 30-day ED revisits and hospital readmissions are categorized by the origin of the initial transport home and reported in Table 5 . Table 4 Discharge Comprehension(n = 404) Q1: Instructions Q2: Red Flags Q3: Fill Rx Q4: Med Changes Q5: Follow Up Q6: Who to Call complete awareness and capability 363 354 375 358 362 352 partial awareness, plan reinforced 30 40 21 35 33 40 partial or no awareness, unable to correct 11 10 8 11 9 12 Table 5 Returns and Readmission(n = 386) Return ED Visit Return Admission # % # % Transported Home from ED (n = 136) 3 day 10 7.35% 7 5.15% 30 day 38 27.94% 23 16.91% Transported Home from Inpatient (n = 250) 3 day 13 5.20% 10 4.00% 30 day 75 30.00% 52 20.80% Table 5 caption Revisit and readmission rates reported here are among only those patients who accepted at least one component of the intervention (DCA, FSA, or both), and excludes two patients whose charts were inaccessible for patient privacy. Focus group feedback at the conclusion of the study yielded a few notable constructive comments. Some patients expressed discomfort in the assessment of their living space; the cabinet search for high-reach items felt particularly intrusive. Some EMTs expressed concern about the additional time in the home that the intervention took. These concerns are further addressed in the discussion. Discussion The results demonstrate that patients are highly amenable to the Transport Plus intervention and overwhelmingly found it helpful. EMTs found the intervention feasible to incorporate into their workflow. The preliminary data on return ED visits and readmission confirm that this is a high-risk population. It is a reasonable hypothesis that future studies involving more rigorous methods such as a randomized controlled trial may find a causal relationship between interventions associated with transport home and readmission reduction given the significant rates of deficiency correction in both the FSA and DCA. This hypothesis would be consistent with previous findings that discharge comprehension issues and post-discharge falls are highly prevalent, that both are linked to readmission, and that patients transported home by ambulance are known to be at high risk for readmission.[ 3 , 4 , 6 ] Several challenges pertaining to the feasibility of the Transport PLUS intervention were identified and addressed during this pilot study. Training was initially in-person but the program experienced high EMS staff turnover rates, leading to a need for online training. Our experience was consistent with EMS literature which has found high EMT turnover to be a national phenomenon with one longitudinal study finding a mean annual turnover rate in EMS agencies of 10.7%.[ 15 ] This problem remains unresolved and has been further exacerbated by the global pandemic. Therefore, any training program associated with ambulance personnel must prepare for frequent turnover and be able to provide rapid training to new EMS staff. Resource-related challenges were also faced in delivering the program. Supervisors were responsible for maintaining fidelity of the program. These supervisors were a limited resource and could only periodically observe visits. It was also envisioned that EMS dispatch would be able to determine when a patient might be eligible and prioritize dispatch of a Transport PLUS capable unit. In practice, this was challenging to implement given the numerous other responsibilities that took precedence, such as call acuity, response time, and resource management. Lastly, the checklists were paper forms that needed to be carefully handled and delivered, a problem which was avoided in further study by digitization of the checklists. Focus group results indicated concerns related to intrusive searches regarding high-reach items in cabinets, as well as concerns from EMTs over the additional minutes spent on the scene. The former was used to inform modifications to the intervention, such as replacing the request for cabinet search with a less obtrusive question asking patients to report if they had any high-reach items of need. EMS operational data was also reviewed to address time concerns and no notable disruptions to call response were observed due to the additional time spent at the patient’s home. Our findings were limited by a lack of a comparison group. As the intervention was funded as a demonstration project, it was offered to all qualifying patients with trained providers capable of providing the intervention. Another limitation of the study is that it was limited to patients being discharged from a single urban hospital and the results may not be generalizable to other patient populations. We can, however, compare Transport PLUS to similar EMS-based interventions in existing literature. Infinger et al. recently reported the development of a reliable survey of environmental risk factors for elderly patients in the prehospital setting. Their content validation procedure ultimately yielded a 9-item checklist with high demonstrated interrater reliability. Notable similarities to the list deployed here in the FSA include walkway trip hazards, rugs, clutter, and adequate lighting. Notable inclusions in their tool, which were absent in our intervention, are furniture, slippery floors, and stair condition.[ 16 ] It may be worth adjusting the Transport PLUS checklist in future iterations to accommodate these important areas of concern. Transport PLUS is yet another step in developing the emerging field of Community Paramedicine/Mobile Integrated Healthcare (CP/MIH,) which aims to reduce emergency utilization of EMS through early recognition and intervention. A randomized control trial conducted by Agarwal et al. deployed community paramedicine using validated tools and compared utilization between buildings that received the intervention, termed CP@clinic, and those receiving usual care. Their intervention resulted in a 19% reduction in relative EMS call volume.[ 17 ] In yet another study, CP/MIH for a Medicare Advantage population was found to save 2.4 million and result in a 2.97 million (USD) return on investment, further highlighting reduced utilization.[ 18 ] These findings add credence to the importance of prevention and education that can be uniquely and effectively administered by EMS providers. A randomized control trial is currently underway evaluating, as primary outcomes, falls occurring in the following three months and 3-day and 30-day readmission rates for the Transport PLUS intervention.[ 19 ] Conclusions This study demonstrated the feasibility of the Transport PLUS intervention and high acceptability to both patients and EMS providers. Widespread implementation of such an intervention could be readily achieved through the dissemination of existing materials to more providers utilizing the training process reported here. The Transport PLUS intervention would be easily scalable and inexpensive to administer. The findings from this pilot study also identified a number of opportunities for improvement to be implemented prior to a future randomized control trial. Further study involving more widespread implementation should also be completed to evaluate generalizability and long-term outcomes pertaining to healthcare utilization. Abbreviations CHW (Community Health Worker) CP (Community Paramedicine) DCA (Discharge Comprehension Assessment) ED (Emergency Department) EMT (Emergency Medical Technician) FSA (Fall Safety Assessment) MIH (Mobile Integrated Healthcare) Declarations Ethics Approval and Consent to Participate: This study was approved by the Institutional Review Board at Mount Sinai Hospital (ID: STUDY-12-00969) Consent for Publication: Not Applicable Availability of Data and Materials: The datasets generated and analyzed during this study are available from the corresponding author on a reasonable request. Competing Interests: The authors declare they have no competing interests. Funding: Funding for this research was provided by the Center for Medicare and Medicaid Innovation (CMMI) and played no role in the design of the study, data collection/analysis/interpretation, or writing of the manuscript. Author’s Contributions: KM was responsible for the overall design of the study, implementation of the study protocol and analysis of the results. LR obtained funding and assisted KM in study implementation. SKY was a major contributor in writing the manuscript. SKY and HC analyzed and interpreted patient data for discharge comprehension, fall hazards, follow-up calls readmission, and community health worker responses. HN, KG, DG, NT, AS and UH analyzed and interpreted focus group data. All authors read and approved the final manuscript. Acknowledgments: Not Applicable References National Hospital Ambulatory Medical Care Survey. 2016 Emergency Department Summary Tables. 2016;38. Mather M, Jacobsen LA, Ard KMP. www.prb.org Population Bulletin. Popul Bull. 2015;23. Hill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Oliver D, et al. Evaluation of the Sustained Effect of Inpatient Falls Prevention Education and Predictors of Falls After Hospital Discharge—Follow-up to a Randomized Controlled Trial. J Gerontol Ser A. 2011;66A:1001–12. Munjal KG, Shastry S, Chapin H, Tan N, Misra A, Greenberg E, et al. Retrospective Cohort Study of Rates of Return Emergency Department Visits Among Patients Transported Home by Ambulance. J Emerg Med. 2020;59:147–52. Important Facts about Falls | Home and Recreational Safety | CDC Injury Center [Internet]. 2019 [cited 2021 Dec 5]. Available from: https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html . Engel KG, Heisler M, Smith DM, Robinson CH, Forman JH, Ubel PA. Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand? Ann Emerg Med. 2009;53:454–61.e15. Albrecht JS, Gruber-Baldini AL, Hirshon JM, Brown CH, Goldberg R, Rosenberg JH, et al. Hospital discharge instructions: comprehension and compliance among older adults. J Gen Intern Med. 2014;29:1491–8. Gershon RRM, Dailey M, Magda LA, Riley HEM, Conolly J, Silver A. Safety in the Home Healthcare Sector: Development of a New Household Safety Checklist. J Patient Saf. 2012;8:51–9. Sorcinelli A, Shaw L, Freeman A, Cooper K. Evaluating the safe living guide: a home hazard checklist for seniors. Can J Aging Rev Can Vieil. 2007;26:127–37. Wyman JF, Croghan CF, Nachreiner NM, Gross CR, Stock HH, Talley K, et al. Effectiveness of education and individualized counseling in reducing environmental hazards in the homes of community-dwelling older women. J Am Geriatr Soc. 2007;55:1548–56. Gill TM, Williams CS, Robison JT, Tinetti ME. A population-based study of environmental hazards in the homes of older persons. Am J Public Health. 1999;89:553–6. Centers for Disease Control & Prevention. Check for Safety: A Home Fall Prevention Checklist for Older Adults [Internet]. CDC Foundation; 2005 [cited 2013 Jan 14]. Available from: http://www.cdc.gov/homeandrecreationalsafety/pubs/English/booklet_Eng_desktop-a.pdf . Machiko Tomita. Home Safety Self Assessment Tool (HSSAT) v.3 [Internet]. Occupational Therapy Geriatric Group, Department of Rehabilitation Science, University at Buffalo; 03/012011 [cited 2013 Nov 4]. Available from: https://www2.tompkinscountyny.gov/files2/cofa/documents/hssat_v3.pdf . Coleman EA, Parry C, Chalmers S, Min S-J. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822–8. Patterson PD, Jones CB, Hubble MW, Carr M, Weaver MD, Engberg J, et al. The longitudinal study of turnover and the cost of turnover in EMS. Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2010;14:209–21. Infinger A, Dowbiggin P, Seymour R, Wally M, Karunakar M, Caprio A, et al. Development of a Content Valid and Reliable Prehospital Environmental Falls Risk Assessment Tool for Older Adults. 24: Prehosp Emerg Care. Taylor & Francis; 2020. pp. 349–54. Agarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, et al. Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial. Prehosp Emerg Care. Taylor & Francis; 2019;23:pp. 718–29. Roeper B, Mocko J, O’Connor LM, Zhou J, Castillo D, Beck EH. Mobile Integrated Healthcare Intervention and Impact Analysis with a Medicare Advantage Population. Popul Health Manag. Mary Ann Liebert, Inc., publishers; 2018;21:349–56. Icahn School of Medicine at Mount Sinai. Randomized Controlled Trial Evaluating Efficacy of EMS Providers Performing Discharge Comprehension and Home Fall Hazard Assessments [Internet]. clinicaltrials.gov; 2020 Jan. Report No.: NCT03046771. Available from: https://clinicaltrials.gov/ct2/show/NCT03046771 . Supplementary Files ConsortChecklist.doc Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Minor revision 26 May, 2022 Reviews received at journal 18 Apr, 2022 Reviewers invited by journal 11 Apr, 2022 Editor assigned by journal 07 Apr, 2022 Editor invited by journal 06 Apr, 2022 Submission checks completed at journal 05 Apr, 2022 First submitted to journal 15 Mar, 2022 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1453848","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research","associatedPublications":[],"authors":[{"id":96329927,"identity":"34955f07-d474-4b1b-8401-b578f3969b3a","order_by":0,"name":"Kevin G Munjal","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kevin","middleName":"G","lastName":"Munjal","suffix":""},{"id":96329928,"identity":"15cf29a5-f138-4424-95e2-b23358cb36f0","order_by":1,"name":"Sai Kaushik Yeturu","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0002-7567-2835","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Sai","middleName":"Kaushik","lastName":"Yeturu","suffix":""},{"id":96329929,"identity":"ba5d1537-7dcf-49a2-b9f5-f7ab2e9ef26c","order_by":2,"name":"Hugh H Chapin","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hugh","middleName":"H","lastName":"Chapin","suffix":""},{"id":96329930,"identity":"15f96f45-ef41-4825-aea7-6c0d3309d051","order_by":3,"name":"Nadir Tan","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nadir","middleName":"","lastName":"Tan","suffix":""},{"id":96329931,"identity":"ec753d9f-5e77-4ac0-af19-a44ad3a1a407","order_by":4,"name":"Diana Gregoriou","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Diana","middleName":"","lastName":"Gregoriou","suffix":""},{"id":96329932,"identity":"3dd23386-9554-4450-8c75-0c1a4a6243d3","order_by":5,"name":"Daniela Garcia","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Daniela","middleName":"","lastName":"Garcia","suffix":""},{"id":96329933,"identity":"d39cc079-095d-4f1a-875f-459368cc0ef0","order_by":6,"name":"Corita Grudzen","email":"","orcid":"","institution":"New York University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Corita","middleName":"","lastName":"Grudzen","suffix":""},{"id":96329934,"identity":"571d0e87-8a1c-4a04-bc96-1960996265c8","order_by":7,"name":"Ula Hwang","email":"","orcid":"","institution":"Yale School of Medicine: Yale University School of Medicine","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ula","middleName":"","lastName":"Hwang","suffix":""},{"id":96329935,"identity":"f0bcc3ca-37c9-47b9-9509-e88edcb65e64","order_by":8,"name":"Barbara Morano","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Barbara","middleName":"","lastName":"Morano","suffix":""},{"id":96329936,"identity":"a08d6c1e-8f9a-4ec4-9299-e58d15207b53","order_by":9,"name":"Hayley Neher","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hayley","middleName":"","lastName":"Neher","suffix":""},{"id":96329937,"identity":"a363d18a-d179-45fe-89d0-3be394106195","order_by":10,"name":"Ksenia Gorbenko","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ksenia","middleName":"","lastName":"Gorbenko","suffix":""},{"id":96329938,"identity":"59f86a03-405d-405c-9fe0-d53bad62bc31","order_by":11,"name":"Glen Youngblood","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Glen","middleName":"","lastName":"Youngblood","suffix":""},{"id":96329939,"identity":"60fb3cc8-2e95-4888-9e1e-084a034b1f0a","order_by":12,"name":"Anjali Misra","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Anjali","middleName":"","lastName":"Misra","suffix":""},{"id":96329940,"identity":"afb2b5f3-b366-4f8a-bf5d-5821ccddb4f1","order_by":13,"name":"Stayley Dietrich","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Stayley","middleName":"","lastName":"Dietrich","suffix":""},{"id":96329941,"identity":"1928cbcd-aeca-4c4a-897c-4fa2efbf4bfb","order_by":14,"name":"Cyndi Gonzalez","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cyndi","middleName":"","lastName":"Gonzalez","suffix":""},{"id":96329942,"identity":"82328a43-1d13-496b-b03c-6ff0a0a66fd3","order_by":15,"name":"Giselle Appel","email":"","orcid":"","institution":"SKMC: Thomas Jefferson University Sidney Kimmel Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Giselle","middleName":"","lastName":"Appel","suffix":""},{"id":96329943,"identity":"642e81ba-a4c8-4697-ae6f-54e728d37c41","order_by":16,"name":"Erica Jacobs","email":"","orcid":"","institution":"George Washington University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Erica","middleName":"","lastName":"Jacobs","suffix":""},{"id":96329944,"identity":"3a2723f1-52e1-4458-a499-957716122ac4","order_by":17,"name":"Albert Siu","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Albert","middleName":"","lastName":"Siu","suffix":""},{"id":96329945,"identity":"b28202c1-53b8-4b74-8620-445ca991643e","order_by":18,"name":"Lynne D Richardson","email":"","orcid":"","institution":"Icahn School of Medicine at Mount Sinai","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lynne","middleName":"D","lastName":"Richardson","suffix":""}],"badges":[],"createdAt":"2022-03-15 11:22:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1453848/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1453848/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":20075994,"identity":"4b96a987-ccf0-4f4e-b6dc-4b112807dc0c","added_by":"auto","created_at":"2022-04-07 16:20:05","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":156907,"visible":true,"origin":"","legend":"\u003cp\u003eFall Safety Assessment Checklist\u003c/p\u003e","description":"","filename":"Figure1FallSafetyAssessment.png","url":"https://assets-eu.researchsquare.com/files/rs-1453848/v1/8dcaa8f1d5be54a62156510f.png"},{"id":20075996,"identity":"c1de5c5c-7546-455d-8b65-133cbd08f76c","added_by":"auto","created_at":"2022-04-07 16:20:05","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":322268,"visible":true,"origin":"","legend":"\u003cp\u003eDischarge Comprehension Assessment Checklist\u003c/p\u003e","description":"","filename":"Figure2DischargeComprehensionAssessment.png","url":"https://assets-eu.researchsquare.com/files/rs-1453848/v1/54f83af857ac4fea85509bc7.png"},{"id":20075998,"identity":"5340dfc9-0341-4643-9878-cf00e16e08ba","added_by":"auto","created_at":"2022-04-07 16:20:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":481389,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1453848/v1/c111ce73-81d0-4609-aa88-4de738aafd52.pdf"},{"id":20075995,"identity":"e284fa39-1783-4c0d-9157-f726933a1953","added_by":"auto","created_at":"2022-04-07 16:20:05","extension":"doc","order_by":6,"title":"","display":"","copyAsset":false,"role":"supplement","size":223744,"visible":true,"origin":"","legend":"","description":"","filename":"ConsortChecklist.doc","url":"https://assets-eu.researchsquare.com/files/rs-1453848/v1/2b7599b54abc1040b63b257c.doc"}],"financialInterests":"","formattedTitle":"Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study","fulltext":[{"header":"Key Messages Regarding Feasibility","content":"\u003cp\u003e1) What uncertainties existed regarding the feasibility?\u003c/p\u003e\n\u003cp\u003ePrior to this pilot study, \u003cem\u003eTransport PLUS \u003c/em\u003ewas a novel intervention that had not previously been implemented or attempted.\u0026nbsp; It was unknown whether prehospital providers could be easily trained and whether the intervention could be operationalized within an EMS agency.\u0026nbsp; There was also uncertainty regarding the prehospital providers\u0026rsquo; capacity to accurately complete the assessment and whether patients would be amenable to receiving the intervention, particularly if they would be accepting of EMS providers performing the discharge comprehension assessment and in-home fall safety assessments. Specific items to be included in the relevant surveys and the training format/ delivery also required development and feedback.\u003c/p\u003e\n\u003cp\u003e2) What are the key feasibility findings?\u003c/p\u003e\n\u003cp\u003eTraining providers using a combination of in-person practical and online didactic training was feasible and effective. To address high provider turnover, the study team developed online asynchronous learning tools; however, the in-person practical remained necessary to ensure competency and fidelity of the intervention. Dispatch was found to be capable of assigning appropriate units when patients were eligible. Patients were highly amenable to the intervention, though with some reservations on specific items of the Fall Safety Assessment. Community Health Worker validation resulted in high reliability of reported findings. Finally, paper checklists utilized in this study were difficult to integrate into the patient\u0026rsquo;s electron health records.\u003c/p\u003e\n\u003cp\u003e3) What are the implications of the feasibility findings for the design of the main study?\u003c/p\u003e\n\u003cp\u003eThese positive feasibility findings of patient acceptance and provider capacity provided sufficient basis with which to design a subsequent randomized control trial to further evaluate the intervention. The feasibility findings directly informed improvements to the checklist and to the training program to be used in the main study. Items of the fall safety assessment, particularly high-reach items in cabinets, were modified in the main study to be a question as opposed to a visual survey, thereby addressing patient and provider concerns about discomfort in searching patient home cabinets. The checklists utilized in the interventions were also digitized, resolving the troubles of transmitting data from the intervention by paper.\u003c/p\u003e"},{"header":"Background","content":"\u003cp\u003eAdults aged 65 and older accounted for approximately 23\u0026nbsp;million emergency department (ED) visits in the United States in 2016,[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] a number expected to continue to grow as the population of adults in this age group is anticipated to double over the next 40 years.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] These patients are especially vulnerable following a hospitalization, which is often associated with functional decline. One study demonstrated that 40% of adults aged 60 or older will face a fall in the 6 months following a hospitalization, and over half of these result in injury.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] It is also known that older adult patients face a statistically significant increased risk of 30-day readmission to the emergency department (ED) when transported home by ambulance.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] The frequent and diverse utilization of healthcare services by the elderly requires attention to risks in transition of care and lapses of patient education, particularly as they transition from hospital environment to home. Two key risks are addressed in this demonstration: falls in the home and comprehension of discharge instructions.\u003c/p\u003e \u003cp\u003eOlder adults face a variety of comorbidities and serious risk of injury due to falls which may result in hip fractures, head injuries, and other serious trauma. The fall-related mortality rate for older adults increased by 30% from 2007 to 2016. The same report indicates that falls among the elderly are not only serious, but also a costly public health concern, comprising 50\u0026nbsp;billion USD in 2015 healthcare spending with Medicare and Medicaid covering 75% of those costs.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] \u003cem\u003eTransport PLUS\u003c/em\u003e offers a unique opportunity to deliver an in-home fall prevention intervention targeted to high-risk patients transported home by ambulance following hospital or ED discharge.\u003c/p\u003e \u003cp\u003eMeanwhile, patient discharge instructions are often dense with information and difficult for patients to comprehend. Competing priorities among patients, caregivers, and providers can contribute to confusion, and time pressures often leave little opportunity for the patient to obtain clarity before leaving the hospital. In one study of ED discharge instruction comprehension, at all ages, it was found that 78% of patients have a deficiency in their understanding of their own aftercare. More alarmingly, among this same cohort of patients, deficient comprehension was only recognized by the patient 20% of the time where it was demonstrated, highlighting that patients frequently are unaware when they fail to understand their aftercare.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Lack of comprehension in discharge care is prevalent outside of the ED as well, with adults 65 and older discharged from medical and surgical units demonstrating non-comprehension of recommended follow-up appointments (5%), medications (27%), exercise (48%) and diet (50%).[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] For patients transported home by ambulance, this is an opportunity to improve understanding of discharge instructions.\u003c/p\u003e \u003cp\u003eEmergency Medical Services (EMS), while still most commonly recognized for 9-1-1 emergency response, are already being utilized to transport patients home by ambulance. More can be accomplished by these medically trained professionals, and they have the capacity to directly improve the patient\u0026rsquo;s transition of care. EMS provides transportation of particularly vulnerable patients to their home setting from both hospital inpatient stays, as well as from the ED. As previously mentioned, among older patients, those transported home by ambulance are particularly vulnerable.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe evolving practice, often referred to as \u0026ldquo;community paramedicine\u0026rdquo; or \u0026ldquo;mobile integrated healthcare\u0026rdquo;, seeks to expand the role of emergency medical technicians (EMTs) and paramedics to help support patients\u0026rsquo; needs in the home and in the community. The intent of these programs is to prevent emergencies in the community, thereby decreasing the present burden on crowded emergency departments. \u003cem\u003eTransport PLUS\u003c/em\u003e, a collaboration between Mount Sinai Health System and partner commercial ambulance agencies, was designed to train and utilize EMTs as a valuable member of the continuum of high-quality healthcare delivery. EMTs were trained to perform a discharge comprehension assessment and a home fall safety assessment for patients over the age of 65 and their families or caregivers during routine transports to the home after being discharged from the ED or from inpatient units.\u003c/p\u003e \u003cp\u003eIn this paper, we describe the implementation of the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention and present the results of a feasibility study to evaluate whether EMTs were able to successfully perform the intervention and whether patients found the intervention helpful.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe \u003cem\u003eTransport PLUS\u003c/em\u003e Program is a novel EMS transition of care intervention that trains EMTs who are already transporting older adult patients (65\u0026thinsp;+\u0026thinsp;years in age) home from a single, urban academic hospital by ambulance. The study was conducted between November, 2013 and July, 2014. EMTs were trained to perform two simple interventions: a home fall safety assessment (FSA) and a discharge comprehension assessment (DCA). Patients transitioning to other hospitals, nursing homes, or any other institution providing formal post-discharge care were excluded from the study. Both the FSA and DCA were developed using a checklist developed through a comprehensive review of the literature and existing tools.\u003c/p\u003e \u003cp\u003e \u003cb\u003eDevelopment of the\u003c/b\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eTransport PLUS\u003c/span\u003e \u003cb\u003eintervention\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe home fall safety assessment (FSA) is a brief scan of the home or apartment for easily recognized fall hazards. The extensive literature search, which included publications from the fields of nursing and physical therapy, generated a long list of fall hazards potentially present in the home.[\u003cspan additionalcitationids=\"CR9 CR10 CR11 CR12\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Given that the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention was to be administered by EMTs, and not overly extend the amount of time the EMTs were spending in the home, we developed a simple, brief, and manageable checklist. The fall hazards selected for the checklist were those that are common, easily assessed with a high degree of inter-rater reliability, modifiable by the patient or their caregiver, and most likely to make an impact on patients\u0026rsquo; risk of falls in the home. For example, structural hazards which would require home renovation or significant financial expenditure were omitted. This resulted in the 11 item list shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e The discharge comprehension assessment (DCA) is a structured conversation between the EMT and the patient (and their caregiver, when present in the ambulance) that occurs during the routine transportation encounter (beginning from the patient\u0026rsquo;s hospital bed to assisting them into their home). The checklist was developed utilizing Coleman\u0026rsquo;s four \u0026ldquo;pillars\u0026rdquo; of a patient-centered transition of care: medication self-management, use and maintenance of a patient-centered record, primary care and specialist follow-up, and knowledge of red flags.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] In this Coleman study, nurses, social workers, or other transitional coaches were sent to the home post-discharge to address the pillars; however, this service is not feasible in all communities or for all patients, due to workforce or financial constraints. This inspired the creation of the DCA as part of the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention to provide increased transitional care efforts to patients who might not receive a home visit. Our adapted checklist assesses the patient\u0026rsquo;s understanding of and access to medications, follow-up appointments, transportation, and self-care instructions (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEMT Training\u003c/h2\u003e \u003cp\u003eEMT training sessions for the assessments were administered to optimize effectiveness and inter-rater reliability. This training included a one-hour didactic session (offered either in-person or through an online module), as well as a one-hour practical component that included two simulations of obtaining consent and administering the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention. Training was iterative and EMT feedback was used in continually refining its development. The didactic training included, in addition to the checklists, the importance of patient comprehension of discharge instructions and how to review sample discharge paperwork while completing the DCA checklist. Samples of actual discharge paperwork given to patients/caregivers upon discharge were used for this purpose. Pre and post testing was administered, and participation in the intervention required a post-test score of 85%.\u003c/p\u003e \u003cp\u003e \u003cb\u003eThe\u003c/b\u003e \u003cspan type=\"BoldItalic\" class=\"BoldItalic\" name=\"Emphasis\"\u003eTransport PLUS\u003c/span\u003e \u003cb\u003eintervention Administration and Outcome Measures\u003c/b\u003e\u003c/p\u003e \u003cp\u003eTo determine the feasibility of \u003cem\u003eTransport PLUS\u003c/em\u003e, patient acceptance of the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention and accuracy of the EMT assessment were assessed. Data was collected on the frequency of fall hazards identified, fall hazard removal or correction, EMT-identified deficiencies in discharge comprehension, and correction or reinforcement to discharge comprehension. Clinical outcomes measured included 3-day and 30-day readmission. Secondary outcomes include patient-reported helpfulness of the intervention, qualitative focus group results, and CHW home visit to validate EMT assessments.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTransport PLUS\u003c/em\u003e was performed for all patients that accepted the intervention, and all completed checklists were collected. Patients were asked verbally for permission to make a 4-week follow-up phone call, during which patients were asked to self-report the presence of fall hazards in their home and if previously identified hazards by the EMTs had been removed or addressed. Finally, after the study was completed, some additional patient feedback was obtained in the form of a focus group to qualitatively assess patient response to the intervention. Patients were asked questions about their comfort with the intervention, prompted for concerns with the program, and given the opportunity to provide any additional feedback.\u003c/p\u003e \u003cp\u003eA limited number of randomly selected patients were given the option for a follow-up visit with a community health worker (CHW), who was also trained in identifying home fall hazards. Each CHW judged the validity of the initial EMT assessment of reported fall hazards. Aggregate percentages of overall removal of fall hazards were collected to validate patient self-reported data and the EMT\u0026rsquo;s initial assessment. Finally, a review of the electronic health record was performed to yield readmission or ED revisit at 3- and 30-days post-intervention. This study was reviewed and approved by the Institutional Review Board of the Icahn School of Medicine at Mount Sinai.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe \u003cem\u003eTransport PLUS\u003c/em\u003e Program trained a total of 103 EMTs, all of whom successfully completed the course and were eligible to deliver the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention. 439 encounters were made where patients were offered the \u003cem\u003eTransport PLUS\u003c/em\u003e Intervention. These encounters consisted of 327 unique patients. Unique patients are considered for demographic data, whereas all other results are reported relative to total encounters. Demographic information is provided in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient Demographics (n\u0026thinsp;=\u0026thinsp;326)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u0026ndash;69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70\u0026ndash;79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80\u0026ndash;89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90\u0026ndash;99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e66%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eRace\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhite\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBlack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHispanic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAsian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNative American\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnavailable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eInsurance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedicare\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e317\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e97%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedicaid\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDual Eligible\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe first outcome of interest is patient acceptability of the intervention, which is reported separately for DCA and FSA. DCA was accepted in 404 patient encounters (92.03%). FSA was accepted in 323 patient encounters (73.58%). Among these, 3 returned checklists were only partially completed, whereas the remaining FSA and all DCA checklists were completed in full.\u003c/p\u003e \u003cp\u003eEMTs identified a total of 2,117 fall hazards over the course of the study. Of these, 1,094 unique hazards were identified. (If in a given encounter there were multiple hazards of the same type identified (e.g. throw rugs), all are counted in total hazard statistics reported, but would only count as one unique identification.) Four-week follow-up phone surveys then yielded hazard removal rates as reported by the patient. Phone surveyors were able to reach patients regarding 316 encounters. When asked about hazards documented by the EMT, patients denied or disagreed with the presence of the hazard in 34% of cases. Of the hazards which were acknowledged by the patient, the overall removal rate was 40% Statistical data for fall hazards and follow-up call data per hazard are reported in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFall Hazards\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eUnique (n\u0026thinsp;=\u0026thinsp;1,094)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.398\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;2,117)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMax\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e Hazard Removal Upon Follow Up Phone Call\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"14\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClutter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThrow rugs\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCarpet frayed, torn or folded\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eWires or cords as fall hazard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ePoor lighting poses fall hazard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eNightlights absent\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLow Toilet\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eLack of Grab-Bars\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLack of Non-Slip Bath-Mat\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eHigh reach for supplies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eWalkway fall hazard\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRemovals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHazard Remains Present\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHazard Denial\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRefused to answer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePercent of Removals among Hazards Acknowledged\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e18%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e41%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e51%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e60%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e68%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e40%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c14\" namest=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003ePatient-reported data on hazard removal was validated during home visits by CHWs. 40 such CHW assessments were performed. Among this group, 85.7% of hazards which were self-reported as removed were confirmed to have actually been removed.\u003c/p\u003e \u003cp\u003eDCA results revealed 94 (23%) patients who accepted the DCA had at least one area of DCA deficiency. Data reported on each of the six deficiencies individually is reported in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Of note, among the 260 total categorical deficiencies found, EMTs were able to reinforce the discharge plan and correct comprehension deficiency with the patient in 199 cases (76.5%). The follow-up survey also found that 90.2% of patients who accepted the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention and answered the survey question stated that they found the intervention to be helpful. 3-day and 30-day ED revisits and hospital readmissions are categorized by the origin of the initial transport home and reported in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDischarge Comprehension(n\u0026thinsp;=\u0026thinsp;404)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQ1: Instructions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eQ2: Red Flags\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eQ3: Fill Rx\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eQ4: Med Changes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eQ5: Follow Up\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eQ6: Who to Call\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ecomplete awareness and capability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e354\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e352\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartial awareness, plan reinforced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epartial or no awareness, unable to correct\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eReturns and Readmission(n\u0026thinsp;=\u0026thinsp;386)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eReturn ED Visit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eReturn Admission\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e#\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTransported Home from ED (n\u0026thinsp;=\u0026thinsp;136)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e5.15%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e27.94%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e16.91%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eTransported Home from Inpatient (n\u0026thinsp;=\u0026thinsp;250)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.00%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.00%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e20.80%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e caption\u003c/strong\u003e \n Revisit and readmission rates reported here are among only those patients who accepted at least one component of the intervention (DCA, FSA, or both), and excludes two patients whose charts were inaccessible for patient privacy.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eFocus group feedback at the conclusion of the study yielded a few notable constructive comments. Some patients expressed discomfort in the assessment of their living space; the cabinet search for high-reach items felt particularly intrusive. Some EMTs expressed concern about the additional time in the home that the intervention took. These concerns are further addressed in the discussion.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results demonstrate that patients are highly amenable to the Transport Plus intervention and overwhelmingly found it helpful. EMTs found the intervention feasible to incorporate into their workflow. The preliminary data on return ED visits and readmission confirm that this is a high-risk population. It is a reasonable hypothesis that future studies involving more rigorous methods such as a randomized controlled trial may find a causal relationship between interventions associated with transport home and readmission reduction given the significant rates of deficiency correction in both the FSA and DCA. This hypothesis would be consistent with previous findings that discharge comprehension issues and post-discharge falls are highly prevalent, that both are linked to readmission, and that patients transported home by ambulance are known to be at high risk for readmission.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSeveral challenges pertaining to the feasibility of the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention were identified and addressed during this pilot study. Training was initially in-person but the program experienced high EMS staff turnover rates, leading to a need for online training. Our experience was consistent with EMS literature which has found high EMT turnover to be a national phenomenon with one longitudinal study finding a mean annual turnover rate in EMS agencies of 10.7%.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] This problem remains unresolved and has been further exacerbated by the global pandemic. Therefore, any training program associated with ambulance personnel must prepare for frequent turnover and be able to provide rapid training to new EMS staff.\u003c/p\u003e \u003cp\u003eResource-related challenges were also faced in delivering the program. Supervisors were responsible for maintaining fidelity of the program. These supervisors were a limited resource and could only periodically observe visits. It was also envisioned that EMS dispatch would be able to determine when a patient might be eligible and prioritize dispatch of a \u003cem\u003eTransport PLUS\u003c/em\u003e capable unit. In practice, this was challenging to implement given the numerous other responsibilities that took precedence, such as call acuity, response time, and resource management. Lastly, the checklists were paper forms that needed to be carefully handled and delivered, a problem which was avoided in further study by digitization of the checklists.\u003c/p\u003e \u003cp\u003eFocus group results indicated concerns related to intrusive searches regarding high-reach items in cabinets, as well as concerns from EMTs over the additional minutes spent on the scene. The former was used to inform modifications to the intervention, such as replacing the request for cabinet search with a less obtrusive question asking patients to report if they had any high-reach items of need. EMS operational data was also reviewed to address time concerns and no notable disruptions to call response were observed due to the additional time spent at the patient\u0026rsquo;s home.\u003c/p\u003e \u003cp\u003eOur findings were limited by a lack of a comparison group. As the intervention was funded as a demonstration project, it was offered to all qualifying patients with trained providers capable of providing the intervention. Another limitation of the study is that it was limited to patients being discharged from a single urban hospital and the results may not be generalizable to other patient populations.\u003c/p\u003e \u003cp\u003eWe can, however, compare \u003cem\u003eTransport PLUS\u003c/em\u003e to similar EMS-based interventions in existing literature. Infinger et al. recently reported the development of a reliable survey of environmental risk factors for elderly patients in the prehospital setting. Their content validation procedure ultimately yielded a 9-item checklist with high demonstrated interrater reliability. Notable similarities to the list deployed here in the FSA include walkway trip hazards, rugs, clutter, and adequate lighting. Notable inclusions in their tool, which were absent in our intervention, are furniture, slippery floors, and stair condition.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] It may be worth adjusting the \u003cem\u003eTransport\u003c/em\u003e PLUS checklist in future iterations to accommodate these important areas of concern.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTransport PLUS\u003c/em\u003e is yet another step in developing the emerging field of Community Paramedicine/Mobile Integrated Healthcare (CP/MIH,) which aims to reduce emergency utilization of EMS through early recognition and intervention. A randomized control trial conducted by Agarwal et al. deployed community paramedicine using validated tools and compared utilization between buildings that received the intervention, termed CP@clinic, and those receiving usual care. Their intervention resulted in a 19% reduction in relative EMS call volume.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] In yet another study, CP/MIH for a Medicare Advantage population was found to save 2.4\u0026nbsp;million and result in a 2.97\u0026nbsp;million (USD) return on investment, further highlighting reduced utilization.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] These findings add credence to the importance of prevention and education that can be uniquely and effectively administered by EMS providers. A randomized control trial is currently underway evaluating, as primary outcomes, falls occurring in the following three months and 3-day and 30-day readmission rates for the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrated the feasibility of the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention and high acceptability to both patients and EMS providers. Widespread implementation of such an intervention could be readily achieved through the dissemination of existing materials to more providers utilizing the training process reported here. The \u003cem\u003eTransport PLUS\u003c/em\u003e intervention would be easily scalable and inexpensive to administer. The findings from this pilot study also identified a number of opportunities for improvement to be implemented prior to a future randomized control trial. Further study involving more widespread implementation should also be completed to evaluate generalizability and long-term outcomes pertaining to healthcare utilization.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCHW (Community Health Worker)\u003c/p\u003e\n\u003cp\u003eCP (Community Paramedicine)\u003c/p\u003e\n\u003cp\u003eDCA (Discharge Comprehension Assessment)\u003c/p\u003e\n\u003cp\u003eED (Emergency Department)\u003c/p\u003e\n\u003cp\u003eEMT (Emergency Medical Technician)\u003c/p\u003e\n\u003cp\u003eFSA (Fall Safety Assessment)\u003c/p\u003e\n\u003cp\u003eMIH (Mobile Integrated Healthcare)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval and Consent to Participate:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board at Mount Sinai Hospital (ID: STUDY-12-00969)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication:\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of Data and Materials:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during this study are available from the corresponding author on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this research was provided by the Center for Medicare and Medicaid Innovation (CMMI) and played no role in the design of the study, data collection/analysis/interpretation, or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contributions:\u0026nbsp;\u003c/strong\u003eKM was responsible for the overall design of the study, implementation of the study protocol and analysis of the results. LR obtained funding and assisted KM in study implementation. SKY was a major contributor in writing the manuscript. SKY and HC analyzed and interpreted patient data for discharge comprehension, fall hazards, follow-up calls readmission, and community health worker responses. HN, KG, DG, NT, AS and UH analyzed and interpreted focus group data. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNational Hospital Ambulatory Medical Care Survey. 2016 Emergency Department Summary Tables. 2016;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMather M, Jacobsen LA, Ard KMP. www.prb.org Population Bulletin. Popul Bull. 2015;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHill A-M, Hoffmann T, McPhail S, Beer C, Hill KD, Oliver D, et al. Evaluation of the Sustained Effect of Inpatient Falls Prevention Education and Predictors of Falls After Hospital Discharge\u0026mdash;Follow-up to a Randomized Controlled Trial. J Gerontol Ser A. 2011;66A:1001\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMunjal KG, Shastry S, Chapin H, Tan N, Misra A, Greenberg E, et al. Retrospective Cohort Study of Rates of Return Emergency Department Visits Among Patients Transported Home by Ambulance. J Emerg Med. 2020;59:147\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eImportant Facts about Falls | Home and Recreational Safety | CDC Injury Center [Internet]. 2019 [cited 2021 Dec 5]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html\u003c/span\u003e\u003cspan address=\"https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEngel KG, Heisler M, Smith DM, Robinson CH, Forman JH, Ubel PA. Patient Comprehension of Emergency Department Care and Instructions: Are Patients Aware of When They Do Not Understand? Ann Emerg Med. 2009;53:454\u0026ndash;61.e15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbrecht JS, Gruber-Baldini AL, Hirshon JM, Brown CH, Goldberg R, Rosenberg JH, et al. Hospital discharge instructions: comprehension and compliance among older adults. J Gen Intern Med. 2014;29:1491\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGershon RRM, Dailey M, Magda LA, Riley HEM, Conolly J, Silver A. Safety in the Home Healthcare Sector: Development of a New Household Safety Checklist. J Patient Saf. 2012;8:51\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSorcinelli A, Shaw L, Freeman A, Cooper K. Evaluating the safe living guide: a home hazard checklist for seniors. Can J Aging Rev Can Vieil. 2007;26:127\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWyman JF, Croghan CF, Nachreiner NM, Gross CR, Stock HH, Talley K, et al. Effectiveness of education and individualized counseling in reducing environmental hazards in the homes of community-dwelling older women. J Am Geriatr Soc. 2007;55:1548\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGill TM, Williams CS, Robison JT, Tinetti ME. A population-based study of environmental hazards in the homes of older persons. Am J Public Health. 1999;89:553\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCenters for Disease Control \u0026amp; Prevention. Check for Safety: A Home Fall Prevention Checklist for Older Adults [Internet]. CDC Foundation; 2005 [cited 2013 Jan 14]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://www.cdc.gov/homeandrecreationalsafety/pubs/English/booklet_Eng_desktop-a.pdf\u003c/span\u003e\u003cspan address=\"http://www.cdc.gov/homeandrecreationalsafety/pubs/English/booklet_Eng_desktop-a.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMachiko Tomita. Home Safety Self Assessment Tool (HSSAT) v.3 [Internet]. Occupational Therapy Geriatric Group, Department of Rehabilitation Science, University at Buffalo; 03/012011 [cited 2013 Nov 4]. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www2.tompkinscountyny.gov/files2/cofa/documents/hssat_v3.pdf\u003c/span\u003e\u003cspan address=\"https://www2.tompkinscountyny.gov/files2/cofa/documents/hssat_v3.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman EA, Parry C, Chalmers S, Min S-J. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med. 2006;166:1822\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatterson PD, Jones CB, Hubble MW, Carr M, Weaver MD, Engberg J, et al. The longitudinal study of turnover and the cost of turnover in EMS. Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 2010;14:209\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInfinger A, Dowbiggin P, Seymour R, Wally M, Karunakar M, Caprio A, et al. Development of a Content Valid and Reliable Prehospital Environmental Falls Risk Assessment Tool for Older Adults. 24: Prehosp Emerg Care. Taylor \u0026amp; Francis; 2020. pp.\u0026nbsp;349\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal G, Angeles R, Pirrie M, McLeod B, Marzanek F, Parascandalo J, et al. Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial. Prehosp Emerg Care. Taylor \u0026amp; Francis; 2019;23:pp.\u0026nbsp;718\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoeper B, Mocko J, O\u0026rsquo;Connor LM, Zhou J, Castillo D, Beck EH. Mobile Integrated Healthcare Intervention and Impact Analysis with a Medicare Advantage Population. Popul Health Manag. Mary Ann Liebert, Inc., publishers; 2018;21:349\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIcahn School of Medicine at Mount Sinai. Randomized Controlled Trial Evaluating Efficacy of EMS Providers Performing Discharge Comprehension and Home Fall Hazard Assessments [Internet]. clinicaltrials.gov; 2020 Jan. Report No.: NCT03046771. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://clinicaltrials.gov/ct2/show/NCT03046771\u003c/span\u003e\u003cspan address=\"https://clinicaltrials.gov/ct2/show/NCT03046771\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pilot-and-feasibility-studies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pafs","sideBox":"Learn more about [Pilot and Feasibility Studies](http://pilotfeasibilitystudies.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/PAFS/default.aspx","title":"Pilot and Feasibility Studies","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Emergency Medical Technicians, Prehospital Care, Community Paramedicine, Mobile Integrated Healthcare, Discharge Comprehension, Fall Safety, Emergency Medical Services, Readmissions, Transitions of Care","lastPublishedDoi":"10.21203/rs.3.rs-1453848/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1453848/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e The growing population of patients over the age of 65 faces particular vulnerability following discharge after hospitalization or an emergency room visit. Specific areas of concern include a high risk for falls and poor comprehension of discharge instructions. Emergency Medical Technicians (EMTs), who frequently transport these patients home from the hospital, are uniquely positioned to aid in mitigating transition of care risks and are both trained and utilized to do so using the \u003cem\u003eTransport\u003c/em\u003e \u003cem\u003ePLUS \u003c/em\u003eintervention. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Existing literature and focus groups of various stakeholders were utilized to develop two checklists: the Fall Safety Assessment (FSA) and the Discharge Comprehension Assessment (DCA). EMTs were trained to administer the intervention to eligible patients in the geriatric population.\u0026nbsp;Using data from the checklists, follow-up phone calls, and electronic health records, we measured the presence of hazards, removal of hazards, presence of discharge comprehension issues, and correction or reinforcement of comprehension.\u0026nbsp;These results were validated during home visits by community health workers (CHWs). Feasibility outcomes included patient acceptance of the \u003cem\u003eTransport PLUS\u003c/em\u003e intervention and accuracy of the EMT assessment.\u0026nbsp;Qualitative feedback via focus groups was also obtained.\u0026nbsp;Clinical outcomes measured included 3-day and 30-day readmission or ED revisit.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e 103 EMTs were trained to administer the intervention and participated in 439 patient encounters. The intervention was determined to be feasible, and patients were highly amenable to the intervention, as evidenced by a 92% and 74% acceptance rate of the DCA and FSA, respectively. The majority of patients also reported that they found the intervention helpful (90%), and self-reported removing 40% of fall hazards; 85% of such changes were validated by CHWs. Readmission/revisit rates are also reported.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The \u003cem\u003eTransport \u003c/em\u003ePLUS intervention is a feasible, easily implemented tool in preventative community paramedicine with high levels of patient acceptance. Further study is merited to determine the effectiveness of the intervention in reducing rates of readmission or revisit. A randomized control trial has since begun utilizing the knowledge gained within this study. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eTrial Registration: \u003c/strong\u003eNot Applicable\u003cstrong\u003e \u003c/strong\u003e\u003c/p\u003e","manuscriptTitle":"Feasibility of the Transport PLUS Intervention to Improve the Transitions of Care for Patients Transported Home by Ambulance: A Non-Randomized Pilot Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-04-07 16:20:03","doi":"10.21203/rs.3.rs-1453848/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Minor revision","date":"2022-05-26T10:50:02+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2022-04-18T15:27:44+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2022-04-11T16:47:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2022-04-07T18:34:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2022-04-06T23:00:00+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2022-04-05T14:35:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pilot and Feasibility Studies","date":"2022-03-15T07:21:43+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pilot-and-feasibility-studies","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pafs","sideBox":"Learn more about [Pilot and Feasibility Studies](http://pilotfeasibilitystudies.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/PAFS/default.aspx","title":"Pilot and Feasibility Studies","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"30324641-3229-45d3-8f69-b141ed7366b2","owner":[],"postedDate":"April 7th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2022-07-22T04:14:27+00:00","versionOfRecord":[],"versionCreatedAt":"2022-04-07 16:20:03","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1453848","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1453848","identity":"rs-1453848","version":["v1"]},"buildId":"-HB7Z8yhvgn0wM9Nzuekk","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}