The following is a summary of “Mobile integrated health-community paramedicine programs’ effect on emergency department visits: An exploratory meta-analysis,” published in the April 2023 issue of Emergency Medicine by Lurie, et al.

Mobile Integrated Health Community Paramedicine (MIH-CP) programs aimed to increase healthcare access and reduce Emergency Department (ED) and Emergency Medical Services (EMS) usage. However, previous systematic reviews of MIH-CP have reported inconsistent interventions and effect sizes, with a high prevalence of biased methods. Therefore, for a study, researchers sought to conduct a meta-analysis of MIH-CP’s effect on ED visits and to evaluate how study design influenced reported effect sizes. They hypothesized that biased methods would result in larger reported effect sizes.

From January 1, 2000, to July 24, 2021, they examined the databases of Pubmed, Embase, CINAHL, and Scopus for peer-reviewed MIH-CP literature. The National Association of Emergency Medical Technicians definition was followed, ED visits were reported, and an MIH-CP related intervention and outcome were all present in all full-text English studies. By analyzing the reported data, they determined risk ratios for each included study. To look for factors affecting the observed effect size, they ran tests for heterogeneity, a moderator analysis, and random-effects and cumulative meta-analyses on the data from ED visits.

Of the 16 studies that reported ED to visit data, 12 were included in the meta-analysis. All studies were observational; 3 used matched controls, 6 used pre-post controls, and 3 did not have controls. Seven studies used diversion/triage as the intervention, while 5 studies used health education/home primary care services. The pooled risk ratio for the data set was 0.56 (95% CI 0.42–0.74). Cumulative meta-analysis showed that, as of 2018, MIH-CP programs began consistently reducing ED visits. Significant heterogeneity was seen among studies, with I-squared >90%. Moderator analysis revealed reduced heterogeneity for matched-control studies.

In conclusion, they found that MIH-CP programs were associated with a reduced risk of ED visits. The study design did not significantly influence effect size, but it did impact heterogeneity. They recommended that future studies use high levels of control to produce reliable data with lower heterogeneity.

Reference: sciencedirect.com/science/article/abs/pii/S0735675722007847