Indicators of paramedic service use by community dwelling older adults
Bibliographic record
Abstract
Introduction: Home care clients represent a patient group that may be served through community paramedicine (CP) programs. The Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale was recently validated to identify levels of risk for use of emergency care among this population. This study investigates whether frail home care clients that were identified as being at higher risk based on their DIVERT scores were more likely to use paramedic services to access the emergency department within 90 days of assessment when compared to clients that had lower DIVERT scores. Methods: A retrospective cohort study was conducted using regularly collected administrative data. Home care assessment data were supplemented with data on emergency department (ED) visits. Arrival by ambulance was modelled to control for DIVERT scores as well as several social and demographic variables. Results: Within the cohort, approximately 40% of individuals visited an ED within 90 days of a home care assessment and almost half of all individuals visited an ED more than once within a year. About two-thirds of clients that visited an ED in the 90 days following assessment used an ambulance for transportation. DIVERT scores were predictive of this use with highest scores indicating 4.15 times higher odds of paramedic service use (95% CI 3.60-4.78 Conclusion: DIVERT was not developed to consider means of transportation to the ED. The results indicate that it can be used to identify frail community dwelling older adults that are likely to use paramedic services to take them to the ED. Further investigation of aspects of social isolation, carer resiliency, time of use, and characteristics associated with ED discharge are warranted. Frequent ambulance use among this population suggests that collaboration between care providers may provide opportunities to prevent unnecessary ED visits by these individuals.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".