Mobile Integrated Healthcare and Community Paramedicine

Team: Janet Coffman (UCSF), Alicia LaFrance (UCSF)

 

According to a survey conducted by the National Association of Emergency Medical Technicians (NAEMT) in 2014, more than 100 emergency medical services (EMS) agencies in 33 states and the District of Columbia have implemented mobile integrated healthcare and community paramedicine (MIH-CP) initiatives. MIH-CP is a new model of care in which emergency medical technicians and paramedics (EMT-Ps) are trained to deliver a broader range of services than simply emergency response and transportation to emergency departments.

 

Key Questions

  • What are the services that MIH-CP programs provide to persons at risk for needing home health care or nursing home placement?
  • How do EMT-Ps interact with health professionals providing home health and skilled nursing services?
  • What is the impact of these programs on risk factors for home health and nursing home use, such as hospital readmissions and falls?


Report

Janet Coffman, MPP, PhD and Alicia LaFrance, MSW, MPH of the UCSF Center for Health Professions have just released their report, Mobile Integrated Health Care - Community Paramedicine: A Resource for Community-dwelling People at Risk for Needing Long-Term Care. The report presents the findings of a landscape analysis on this new model of care that trains paramedics to deliver a broader range of services than traditional emergency response and transport of people to emergency departments. The authors also reviewed four geographically and organizationally distinct examples of MIH-CP programs that serve both elder citizens and younger persons with chronic illness or recent hospitalizations who currently need or who are at risk for receiving long-term care.

Community paramedic roles range from delivering services over a series of prescheduled visits to providing acute care on an as-needed basis. Training is combines coursework with clinical supervision by physicians and experienced CPs. The authors found that MIH-CP programs serving the targeted populations are housed in three types of agencies: fire departments, hospitals, and privately owned emergency medicine service providers. Programs partner with hospices, home health agencies, hospitals, and social services organizations to deliver a variety of services. Sources of payment also varied among grants, contracts with health plans, and a variety of insurance plans, along with the agency’s own resources.

Although the authors found little published literature reviewing outcomes of MIH-CP programs, the case studies achieved improvements in a variety of outcomes including increases in medication adherence and patient satisfaction, reductions in transports to emergency departments, fewer hospital admissions, and successful linkage to social services. Programs report that cost savings have also been achieved.

Coffman and LaFrance conclude that a growing body of evidence, and the experience of the programs highlighted in the report suggest that MIH-CP are filling important gaps in a fragmented healthcare delivery system for patients who need long-term care.

For questions, contact: Janet Coffman, PhD, MPP, Associate Professor, UCSF, janet.coffman@ucsf.edu