A Retrospective Cohort Study of Health Service Utilization and Costs of People Experiencing Homelessness Following Community Paramedic Care
Bibliographic record
Abstract
The City Centre Team (CCT) is a community paramedic program that delivers care to people experiencing homelessness in Calgary, Canada. This study compares the rates and characteristics of health service utilization and the associated costs of patients interacting with the service by linking multiple administrative databases (including hospitalizations, emergency department and urgent care centre visits, emergency medical services (EMS) events, physician claims, and pharmaceutical dispensations) in a pre-post retrospective cohort study. The primary outcome is the difference in ambulatory care sensitive condition-related hospitalizations in the year preceding the initial CCT visit and in the following year. Secondary outcomes are the differences between periods of all-cause hospitalizations, emergency department and urgent care centre visits, EMS events, physician claims, pharmaceutical dispensations, and costs. In the post-period, CCT patients had increased ambulatory care sensitive condition-related hospitalizations and associated costs compared to the pre-period. Except for all-cause hospitalizations, there was increased utilization and costs of health services between periods, with significant increases in community-based care in those that were previously underserved. The study characterizes and shows the impact on health service utilization in the initial 18-months of a community paramedic program directed at people experiencing homelessness. These findings inform decision-makers of a health service that can be developed in response to the complex health needs of an underserved population using community paramedics.
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".