Browsing by Author "Miramonti, Charles"

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    Effect of introducing the mucosal atomization device for fentanyl use in out-of-hospital pediatric trauma patients
    (Cambridge Journals, 2013-10) O'Donnell, Daniel; Schafer, Luke; Stevens, Andrew; Weinstein, Elizabeth; Miramonti, Charles; Kozak, Mary Ann
    Background: Pain associated with pediatric trauma is often under-assessed and undertreated in the out-of-hospital setting. Administering an opioid such as fentanyl via the intranasal route is a safe and efficacious alternative to traditional routes of analgesic delivery and could potentially improve pain management in pediatric trauma patients. Objective: The study sought to examine the effect of introducing the mucosal atomization device (MAD) on analgesia administration as an alternative to intravenous fentanyl delivery in pediatric trauma patients. The hypothesis for the study is that the introduction of the MAD would increase the administration of fentanyl in pediatric trauma patients. Methods: The research utilized a 2-group design (pre-MAD and post-MAD) to study 946 pediatric trauma patients (age ,16) transported by a large, urban EMS agency to one of eight hospitals in Marion County, which is located in Indianapolis Indiana. Two emergency medicine physicians independently determined whether the patient met criteria for pain medication receipt and a third reviewer resolved any disagreements. A comparison of the rates of fentanyl administration in both groups was then conducted. Results: There was no statistically significant difference in the rate of fentanyl administration between the pre-MAD (30.4%) and post-MAD groups (37.8%) (P5.238). A subgroup analysis showed that age and mechanism of injury were stronger predictors of fentanyl administration. Conclusion: Contrary to the hypothesis, the addition of the MAD device did not increase fentanyl administration rates in pediatric trauma patients. Future research is needed to address the barriers to analgesia administration in pediatric trauma patients.
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    Limited Data to Support Improved Outcomes after Community Paramedicine Intervention: A Systematic Review
    (Elsevier, 2019) Pang, Peter S.; Litzau, Megan; Liao, Mark; Herron, Jennifer; Weinstein, Elizabeth; Weaver, Christopher; O'Donnell, Dan; Miramonti, Charles; Emergency Medicine, School of Medicine
    Background Community paramedicine (CP) leverages trained emergency medical services personnel outside of emergency response as an innovative model of health care delivery. Often used to bridge local gaps in healthcare delivery, the CP model has existed for decades. Recently, the number of programs has increased. However, the level of robust data to support this model is less well known. Objective To describe the evidence supporting community paramedicine practice. Data sources OVID, PubMed, SCOPUS, EMBASE, Google Scholar-WorldCat, OpenGrey. Study appraisal and synthesis methods Three people independently reviewed each abstract and subsequently eligible manuscript using prespecified criteria. A narrative synthesis of the findings from the included studies, structured around the type of intervention, target population characteristics, type of outcome and intervention content is presented. Results A total of 1098 titles/abstracts were identified. Of these 21 manuscripts met our eligibility criteria for full manuscript review. After full manuscript review, only 6 ultimately met all eligibility criteria. Given the heterogeneity of study design and outcomes, we report a description of each study. Overall, this review suggests CP is effective at reducing acute care utilization. Limitations The small number of available manuscripts, combined with the lack of robust study designs (only one randomized controlled trial) limits our findings. Conclusions Initial studies suggest benefits of the CP model; however, notable evidence gaps remain.
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    Mobile integrated health to reduce post-discharge acute care visits: A pilot study
    (Elsevier, 2018) Siddle, Jennica; Pang, Peter S.; Weaver, Christopher; Weinstein, Elizabeth; O'Donnell, Daniel; Arkins, Thomas P.; Miramonti, Charles; Emergency Medicine, School of Medicine
    Background Mobile Integrated Health (MIH) leverages specially trained paramedics outside of emergency response to bridge gaps in local health care delivery. Study objective To evaluate the efficacy of a MIH led transitional care strategy to reduce acute care utilization. Methods This was a retrospective cohort analysis of a quality improvement pilot of patient patients from an urban, single county EMS, MIH transitional care initiative. We utilized a paramedic/social worker (or social care coordinator) dyad to provide in home assessments, medication review, care coordination, and improve access to care. The primary outcome compared acute care utilization (ED visits, observation stays, inpatient visits) 90 days before MIH intervention to 90 days after. Results Of the 203 patients seen by MIH teams, inpatient utilization decreased significantly from 140 hospitalizations pre-MIH to 26 post-MIH (83% reduction, p = 0.00). ED and observation stays, however, increased numerically, but neither was significant. (ED 18 to 19 stays, p = 0.98; observation stays 95 to 106, p = 0.30) Primary care visits increased 15% (p = 0.11). Conclusion In this pilot before/after study, MIH significantly reduces acute care hospitalizations.