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How mobile integrated health is evolving to meet a patient need

Patient safety methods and lessons learned need to be applied to the evolving subspecialty of community paramedicine


Mobile Integrated Health Care also known as Community Paramedicine is an evolving specialty of EMS. MIH began in order to fill the gaps and niches in a communities health needs by EMS providers.

The MIH programs developing today vary widely. However, there are some common denominators such as population health management, readmission avoidance and transportation to alternative destinations. These programs ultimately seek to bring about better management of specific patient populations that occur across the healthcare continuum. In addition, there is an emphasis in MIH regarding how EMS providers can partner with organizations to find savings in health care dollars.

According to the National Association of EMTs the goal is to lower costs, improve the lives of patients and enable EMS practitioners — including EMTs, paramedics and community paramedics — to use their skills and resources to help solve the problems facing healthcare systems and communities. Examples of MIH programs already implemented include:

  • Community Paramedicine programs, which send paramedics with additional training and education into patients’ homes or into the community to do patient education and extend primary care in areas that have a shortage of primary care and other basic health resources.
  • Nurse triage to provide non-urgent 911 callers with advice, or providing assistance connected with alternative health care resources such as primary care, urgent care or mental health services.
  • Post-hospital discharge follow-up by EMTs, paramedics or community paramedics to ensure patients with conditions such as congestive heart failure, COPD and diabetes have the tools and information they need to manage their condition at home and avoid preventable readmissions.
  • Transporting patients to alternative destinations — such as primary care offices, urgent care, and mental health or detox facilities — instead of the emergency department.

Available lessons from MIH programs
The Center for Patient Safety intends to work in partnership with MIH programs for greater safety as well as serve as a resource to minimize risk. One of the benefits of participating with a Patient Safety Organization is the ability to share adverse events, near misses and unsafe conditions. This sharing enables learning that benefits all providers.

There are many lessons we can learn from available, seasoned MIH programs. Over the past 10 years, CPS has supported patient safety across the healthcare continuum, including hospitals, physician offices and other providers. Some of this experience and data allows for many lessons learned about falls, infections, wound complications and medication reconciliation just to name a few.

According to the fact sheet from the California Emergency Medical Services Authority "Community Paramedics are not independent practitioners; they work under clear medical control of a physician, receiving direction and supervision to ensure patient safety. The Community Paramedic training program builds upon the training and skill sets of experienced paramedics. Additional training in patient assessment, clinical skills and familiarity with the other health care providers and social services available in a local community will all be a part of the required training, and will lead to a more integrated approach to health care delivery."

Kathy Wire, JD, MBA, CPHRM, Project Manager for CPS states, "Historically, EMS providers stabilized a patient for transport and moved them to a hospital, where Emergency Department staff took over the patient’s care. Even in that limited role, EMS services have struggled to get information about the quality and safety of their care — they didn’t have any knowledge of what happened after the transfer. With the growth of Mobile Integrated Health Care, they will be working as parts of teams, managing patients without transport in a physician or APN-managed framework or working with the patient’s broader medical support system to determine the right destination for care. Now, they need to address the safety of their own care and also function as part of a safe team. As reimbursement for all providers drives this transition, EMS must evaluate outcomes of care and avoid the injuries and unreliability that accompany weak safety systems."

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