Browsing by Author "Blanchard, Ian"
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- ItemOpen AccessA Retrospective Cohort Study of Health Service Utilization and Costs of People Experiencing Homelessness Following Community Paramedic Care(2021-09-22) Taplin, John G; Clement, Fiona; Barnabe, Cheryl; Cipriano, Lauren; Blanchard, Ian; Crowshoe, LyndenThe 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.
- ItemOpen AccessEmergency medical services response time and mortality in an urban setting: a retrospective cohort study(2009) Blanchard, Ian; Doig, Christopher J.
- ItemEmbargoImproving the Adoption of Transitions in Care Technology Between Emergency Medical Services and Emergency Departments: A Scoping Review(0024-01-08) Sterzer, Frances Ruth; Caird, Jeff; Bourdage, Joshua; Ellard, John; Blanchard, IanAbstract Background: Miscommunication during emergency care transitions between emergency medical services and emergency department personnel can lead to serious medical errors and adverse patient events. Although mobile technology has the potential to help, its global adoption within health systems remains limited. Objectives: This thesis sought to create an easily accessible repository of mobile software application features, motivations for use, and barriers that hinder the adoption of this technology. The primary goal was to support research, design, and development and improve the adoption of this critical technology. Design: The scoping review methodology was employed to explore the literature broadly. Searches were conducted in eight academic databases, including Academic Search Complete, APA PsycINFO, CINAHL Plus, the Cochrane Library, MEDLINE, Science Direct, Scopus, and Web of Science. Additionally, eight preprint databases were searched, along with Google Play Apps, Apple’s App Store, and Google, to identify available documents published between 2012-2023. This strategy provided access to the most current information on emerging technology, especially those adapted for pandemic management. Author, reference, and app searches were conducted to trace the evolution and development of products. Results: The document identification process was outlined using an adapted PRISMA flow chart, resulting in the inclusion of 38 academic and non-academic documents. The review revealed twelve distinct transitions in care software applications, primarily from the U.S. (61.8%), Australia (11.8%), Japan (11.8%), Brazil (8.8%), China (2.9%), and Saudi Arabia (2.9%). Pulsara, e-Bridge, Twiage, Join, and CrashHelp were the most prominently investigated applications. The review also highlighted diverse research approaches, stakeholders' perspectives, and insights into design features, motivations, and adoption barriers. Conclusions: This research introduces a novel approach to promoting transition in care software application adoption. It has resulted in an adoption model and a comprehensive strategy encompassing various key aspects. A common theme is the need to establish a robust support system involving stakeholders, along with flexible, region-specific solutions. Collaboration between emergency practitioners is consistently emphasized, underscoring the importance of holistic tools and strategies for success. This work underscores the potential of technology and human collaboration to save lives.
- ItemOpen AccessMulti-centre implementation of an Educational program to improve the Cardiac Arrest diagnostic accuracy of ambulance Telecommunicators and survival outcomes for sudden cardiac arrest victims: the EduCATe study design and methodology(2021-03-04) Vaillancourt, Christian; Charette, Manya; Naidoo, Sarika; Taljaard, Monica; Church, Matthew; Hodges, Stephanie; Leduc, Shannon; Christenson, Jim; Cheskes, Sheldon; Dainty, Katie; Feldman, Michael; Goldstein, Judah; Tallon, John; Helmer, Jennie; Sibley, Aaron; Spidel, Matthew; Blanchard, Ian; Garland, Jim; Cyr, Kathryn; Brehaut, Jamie; Dorian, Paul; Lacroix, Colette; Zambon, Sandra; Thiruganasambandamoorthy, VenkateshAbstract Background Sudden cardiac death remains a leading cause of mortality in Canada, resulting in more than 35,000 deaths annually. Most cardiac arrest victims collapse in their own home (85% of the time) and 50% are witnessed by a family member or bystander. Survivors have a quality of life similar to the general population, but the overall survival rate for out-of-hospital cardiac arrest (OHCA) rarely exceeds 8%. Victims are almost four times more likely to survive when receiving bystander CPR, but bystander CPR rates have remained low in Canada over the past decade, not exceeding 15–25% until recently. Telecommunication-assisted CPR instructions have been shown to significantly increase bystander CPR rates, but agonal breathing may be misinterpreted as a sign of life by 9–1-1 callers and telecommunicators, and is responsible for as much as 50% of missed OHCA diagnoses. We sought to improve the ability and speed with which ambulance telecommunicators can recognize OHCA over the phone, initiate timely CPR instructions, and improve survival. Methods In this multi-center national study, we will implement and evaluate an educational program developed for ambulance telecommunicators using a multiple baseline interrupted time-series design. We will compare outcomes 12 months before and after the implementation of a 20-min theory-based educational video addressing barriers to recognition of OHCA while in the presence of agonal breathing. Participating Canadian sites demonstrated prior ability to collect standardized data on OHCA. Data will be collected from eligible 9–1-1 recordings, paramedic documentation and hospital medical records. Eligible cases will include suspected or confirmed OHCA of presumed cardiac origin in patients of any age with attempted resuscitation. Discussion The ability of telecommunication-assisted CPR instructions to improve bystander CPR and survival rates for OHCA victims is undeniable. The ability of telecommunicators to recognize OHCA over the phone is unequivocally impeded by relative lack of training on agonal breathing, and reluctance to initiate CPR instructions when in doubt. Our pilot data suggests the potential impact of this project will be to increase absolute OHCA recognition and bystander CPR rates by at least 10%, and absolute out-of-hospital cardiac arrest survival by 5% or more. Trial registration Prospectively registered on March 28, 2019 at ClinicalTrials.gov identifier: NCT03894059 .
- ItemOpen AccessOptimally Linking Prehospital and Health System Data: The Association between Emergency Medical Services Offload Time, Response Time and Mortality(2020-01-14) Blanchard, Ian; Doig, Christopher James; Lang, Eddy S.; Dean, Stafford R.; Hagel, Brent Edward; Niven, Daniel J.; Williamson, Tyler S.INTRODUCTION: Delays in offloading Emergency Medical Services (EMS) patients in the hospital may impact timely response to emergencies, but no published studies are available. Little research has been conducted on the potential for bias when EMS data are linked to health system outcome and on the optimal EMS response time for survival of critically injured or ill patients. METHODS: Three years of EMS data from a large urban system were used to create hourly estimates of median hospital time and response time, and linked to health system outcome. Multivariable modelling and descriptive statistics were used to: 1. Explore the association between paramedic hospital time and response time while controlling for the effects of system volume, time of day, and season; 2. Describe the linkage rate between the standard strategy and one designed to optimize linkage; and 3. Explore the association between response time and mortality in critically injured or ill patients who did not experience an out-of-hospital cardiac arrest while controlling for age and sex. RESULTS: Depending on the time of day, there was between a one and three minute increase in predicted median response time when the system was experiencing a median hospital time of 90 minutes, during the winter in heavy system volume, compared to a 30 minute median hospital time, during the summer in light system volume. The optimized strategy increased the linkage rate from 88% to 97.1%, and reduced linkage failure in key clinical sub-groups. There was no significant association between response time and mortality except in one secondary analysis subgroup, which suggested longer response decreased mortality. CONCLUSIONS: There is an association between EMS hospital time and response time, but the relationship is complex and influenced by system level factors such as time of day, volume and season. An optimized strategy for linking EMS data to health system outcome improved the linkage rate and reduced the potential for bias. No consistent association between response time and mortality could be demonstrated. These analyses underscore the importance of research quality linked EMS data in the development of knowledge for EMS and paramedic practice.