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Background: Novel hospital diversion strategies are needed to support a growing number of patients with dementia living in the community. One promising model is community paramedicine (CP), which deploys paramedics to the home, who consult with a physician to coordinate treatment and assess disposition. While evidence suggests CP can manage many patients without escalation to the emergency department (ED), no studies have evaluated optimal CP utilization for patients with dementia. Therefore, we compare the use and outcomes of CP for homebound patients with and without dementia. Methods: This retrospective cohort study examines 251 homebound patients receiving home‐based primary care, who utilized a physician‐led CP service between March 2017 and May 2022. Linked electronic health record data included patient demographics, clinical characteristics, and CP encounter details. Dementia status and CP outcomes, including rates of ED transport, over‐transport (i.e., transported, but not hospitalized), and under‐transport (i.e., not transported, but ED visit within 3 days), were determined via chart review. Using logistic regression, we modeled the association of dementia status with over‐ and under‐transport, adjusting for age, sex, and chief complaint. Results: Fifty‐three percent of CP patients had dementia. Their most common chief complaints were dyspnea (24.3%), altered mental status (17.9%), and generalized weakness (9.8%). We found no significant difference in ED transport rates by dementia status (25.4 vs. 22.8%, p = 0.54). Dementia diagnosis was associated with lower rates of over‐transport (OR = 0.21, p = 0.03, CI [0.05, 0.85]) and comparable rates of under‐transport (OR = 0.70, p = 0.47, CI [0.27, 1.83]) in adjusted models. Conclusions: CP has effectively managed a diverse population of homebound patients with dementia cared for via home‐based primary care. Future work should examine potential cost savings and use of CP in dementia care across geographic and healthcare settings. See related article by Kim et al. in this issue. [ABSTRACT FROM AUTHOR]

The varied, atypical manifestations of geriatric syndromes make knowledge transfer the ability to extend knowledge from one context to another a particularly relevant concept. The authors hypothesized that multiple, contrasting short cases, by facilitating knowledge transfer, would improve knowledge more than a single long case in geriatric medicine. The authors’ objective was to assess the impact of two instructional methods (a single long case vs. contrasting short cases) on knowledge and knowledge retention among 3rd-year medical students on their Internal Medicine-Geriatrics Clerkship. They participated in the curriculum which consisted of four weekly mandatory sessions covering five content areas based on a systematic needs assessment. Instructional method alternated by month. Knowledge and knowledge retention were measured using an online multiple-choice question test administered before, immediately after, and one year following the curriculum. Students also completed a demographic survey prior to the curriculum and an evaluation of the curriculum following the curriculum. There was significant improvement in test scores from pre- to postcurriculum in both groups that persisted one year after the experience with no significant differences between the two groups. The two case-based instructional methods resulted in significant and enduring knowledge improvement, but one method was not better than the other. [ABSTRACT FROM PUBLISHER]