# Understanding Frequent EMS Users in the D.C. Health Care System: Evidence from Medicaid Claims Data

> **NIH AHRQ R36** · UNIV OF MARYLAND, COLLEGE PARK · 2021 · $19,268

## Abstract

PROJECT ABSTRACT
Frequent users of emergency medical services (EMS), or EMS “super-users”, present a burden to local EMS
systems and the broader health care system by contributing to emergency department (ED) overcrowding and
inefficient hospital use. Due to limitations in existing national-level data sources and the high level of
heterogeneity in local- and state-level EMS systems, EMS use is an under-researched area of the health
services literature. Current knowledge is limited and understood in the context of ED and inpatient utilization.
Applying a behavioral-ecological framework, this innovative multi-methods study seeks to provide an improved
understanding of the relationship between frequent EMS use and the broader health care system. In doing so,
the study team hopes to identify possible context-specific factors that could lead to reductions in frequent EMS
use, more appropriate use of health care resources, and lower costs. The central hypothesis is that there is
substantial variation in health care resource use, costs, and outpatient network connectivity relating to specific
characteristics of the EMS super-user population and longitudinal patterns of frequent EMS use. The study will
use Medicaid claims data over a 6-year period (FY2014-19) from the District of Columbia (DC), which is
chosen for its high per-capita EMS call volume and low uninsured rate. Individual characteristics, health care
utilization, and Medicaid costs for adult EMS users will be assessed using regression analyses of de-identified
claims data (Aims 1 and 2). Outpatient provider network connectivity will be explored using a network analysis
approach applied to claims-derived shared-patient provider networks (Aim 3). This research is especially
timely, since the Affordable Care Act has encouraged the testing of innovative payment and service-delivery
models, such as Mobile Integrated Health-Community Paramedicine, alternative destination programs, and
collaborations at various EMS agencies nationwide. Study findings are expected to provide actionable, context-
specific insights that can guide Medicaid-driven efforts to improve care efficiency for EMS super-users in urban
settings. Further, the study will provide a useful example of how disparate methods applied to administrative
claims data can be leveraged to promote population health. The study builds on the PI's methods training,
research, and professional experience in care coordination for vulnerable populations, and is a collaborative
effort between DC’s Medicaid agency and Fire/EMS Department. Supported by the research team’s expertise
in health economics, health services research, econometrics, network analysis, as well as experience in
working with EMS, hospital, outpatient health care systems, and community partners, the proposed study will
help advance the PI's career goal of bridging the research-practice divide as an independent health services
researcher.

## Key facts

- **NIH application ID:** 10337734
- **Project number:** 1R36HS027717-01A1
- **Recipient organization:** UNIV OF MARYLAND, COLLEGE PARK
- **Principal Investigator:** Aitalohi Amaize
- **Activity code:** R36 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2021
- **Award amount:** $19,268
- **Award type:** 1
- **Project period:** 2021-09-01 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10337734

## Citation

> US National Institutes of Health, RePORTER application 10337734, Understanding Frequent EMS Users in the D.C. Health Care System: Evidence from Medicaid Claims Data (1R36HS027717-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10337734. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*