Effect of the CP@clinic program (Community Paramedicine at Clinic program) on health care utilization from administrative data during and after the intervention: a cluster-randomized controlled trial
- 1Department of Family Medicine, McMaster University , , ,
- 2Department of Health Research Methods, Evidence, and Impact, McMaster University , , ,
Abstract
Introduction
The study objective was to compare the effects of the Community Paramedicine at Clinic (CP@clinic) program versus usual care on building-level health service utilization during a 12-month trial period and 12 months post-trial.Methods
This study employed a longitudinal, repeated cross-sectional design within a cluster-randomized controlled trial (RCT). It involved 30 apartment buildings across five Ontario communities, housing low-income older adults. Buildings were paired and randomized to receive either the CP@clinic intervention or continuing with usual care. Data was derived from ICES-maintained administrative health databases, linked using unique identifiers. The sample included all residents aged 55 + in the study postal codes from the Ontario Health Insurance Plan (OHIP) Registered Persons Database (RPDB), excluding those aged 120+, ineligible for OHIP, and those with no health care encounters within 7 years. The primary health care utilization outcome was emergency department visits by ambulance and other outcomes included hospital admissions and primary care visits.Results
CP@clinic buildings showed significantly lower hospital admission rates during both the 12-month RCT period (adjusted incidence rate ratio [aIRR]: 0.75 [0.61,0.91]) and the 12-month post-RCT period [aIRR: 0.82 (0.70,0.96)] compared to usual care buildings. Primary care visits were lower in CP@clinic buildings during the RCT (aIRR: 0.93 [0.88,0.99]) but higher in the post-RCT period (aIRR: 1.05 [1.00,1.10]). No significant differences were found in emergency department visits or the number of days admitted between groups in either period.Discussion
CP@clinic was linked to a sustained reduction in hospital admissions and an increase in primary care visits beyond the RCT time period, reflecting a shift from reactive to preventive care among older adults residing in social housing. The lasting impact beyond the RCT period suggests that the CP@clinic Program can improve health system efficiency, primary care access, and reduce health inequities in vulnerable populations.Trial registration
ClinicalTrials.gov, Identifier: NCT02152891.
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BibTeX
@article{agarwal2026effect,
title = {{Effect of the CP@clinic program (Community Paramedicine at Clinic program) on health care utilization from administrative data during and after the intervention: a cluster-randomized controlled trial}},
author = {Gina Agarwal and Melissa Pirrie and Manasvi Sai Vanama and Zheng Jing Hu and J. Michael Paterson and Lehana Thabane and Ricardo Angeles and Francine Marzanek},
journal = {Frontiers in health services},
year = {2026},
month = oct,
doi = {10.3389/frhs.2026.1939050},
url = {https://europepmc.org/article/PMC/PMC13716780},
note = {CC BY},
}
RIS
TY - JOUR
TI - Effect of the CP@clinic program (Community Paramedicine at Clinic program) on health care utilization from administrative data during and after the intervention: a cluster-randomized controlled trial
AU - Gina Agarwal
AU - Melissa Pirrie
AU - Manasvi Sai Vanama
AU - Zheng Jing Hu
AU - J. Michael Paterson
AU - Lehana Thabane
AU - Ricardo Angeles
AU - Francine Marzanek
PY - 2026
DA - 2026/10/15
JO - Frontiers in health services
DO - 10.3389/frhs.2026.1939050
UR - https://europepmc.org/article/PMC/PMC13716780
AB - Introduction The study objective was to compare the effects of the Community Paramedicine at Clinic (CP@clinic) program versus usual care on building-level health service utilization during a 12-month trial period and 12 months post-trial.Methods This study employed a longitudinal, repeated cross-sectional design within a cluster-randomized controlled trial (RCT). It involved 30 apartment buildings across five Ontario communities, housing low-income older adults. Buildings were paired and randomized to receive either the CP@clinic intervention or continuing with usual care. Data was derived from ICES-maintained administrative health databases, linked using unique identifiers. The sample included all residents aged 55 + in the study postal codes from the Ontario Health Insurance Plan (OHIP) Registered Persons Database (RPDB), excluding those aged 120+, ineligible for OHIP, and those with no health care encounters within 7 years. The primary health care utilization outcome was emergency department visits by ambulance and other outcomes included hospital admissions and primary care visits.Results CP@clinic buildings showed significantly lower hospital admission rates during both the 12-month RCT period (adjusted incidence rate ratio [aIRR]: 0.75 [0.61,0.91]) and the 12-month post-RCT period [aIRR: 0.82 (0.70,0.96)] compared to usual care buildings. Primary care visits were lower in CP@clinic buildings during the RCT (aIRR: 0.93 [0.88,0.99]) but higher in the post-RCT period (aIRR: 1.05 [1.00,1.10]). No significant differences were found in emergency department visits or the number of days admitted between groups in either period.Discussion CP@clinic was linked to a sustained reduction in hospital admissions and an increase in primary care visits beyond the RCT time period, reflecting a shift from reactive to preventive care among older adults residing in social housing. The lasting impact beyond the RCT period suggests that the CP@clinic Program can improve health system efficiency, primary care access, and reduce health inequities in vulnerable populations.Trial registration ClinicalTrials.gov, Identifier: NCT02152891.
SN - 2813-0146
ER -