680 Impacts of a mobile paramedicine home visit program after emergency department evaluation for hypertensive crisis

Document Type

Conference Proceeding

Publication Date

5-13-2024

Publication Title

Acad Emerg Med

Abstract

Background and Objectives: Most patients evaluated in the emergency department for hypertensive crisis continue to have uncontrolled hypertension months after the index encounter. Linkage to primary care and medication adherence are some of many barriers to hypertension control. Mobile paramedicine home visit programs can serve as a bridge between the ED and primary care follow up. Our objective in this study was to evaluate the association of a mobile integrated health (MIH) visit after ED encounters for hypertensive crisis with repeat ED encounters. Methods: This is a retrospective cohort study of adults ?18?years who were evaluated in the emergency department for hypertensive crisis, defined as a blood pressure (BP) >180/110?mm?Hg between March 2022 and October 2023. We excluded patients that required an inpatient admission or died in the ED. Clinicians could order an MIH home visit at their discretion to occur within 3?days after discharge, and each visit included evaluation by a paramedic tied to primary care virtual management as needed. We compared patients with a MIH visit to those receiving usual care alone. The primary outcome was ED revisits within 30?days. Analysis included multivariable logistic regression (adjusting for sex, age, and comorbid heart failure) to assess the relationship between an MIH intervention and return ED visits within 30?days. Results: A total of 552 patients were included, 69 who had an MIH visit and 483 patients without a MIH visit. Patients in the study were 69.9% Black, 54.7% female, had a mean age of 64.2?±?15.4?years, and a mean systolic BP (SBP) of 190?±?23?mm?Hg. Comorbid conditions were common, including chronic kidney disease (40.8%), diabetes mellitus (44.4%), and heart failure (55%). There were 40 (7.2%) patients with repeat ED encounters within 30-days, 7 (10.1%) in the MIH cohort and 33 (6.8%) in the usual care cohort. These encounters had a mean SBP of 161?±?31?mm?Hg in the MIH cohort and 166?±?28?mm?Hg in the usual care cohort. In adjusted analysis, those in the MIH cohort did not have a statistically different rate of 30-day ED revisits (OR 1.7, 95% CI 0.72–4.17) or 30-day hospitalizations (OR 0.42, 95% CI 0.05–3.21). Conclusion: An MIH visit was not associated with a decrease in 30-day ED revisits for patients with hypertensive crisis in this analysis. Future analyses with greater statistical power are indicated to test the impact of MIH interventions.

Volume

31

Issue

S1

First Page

8-401

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