Community Paramedicine/Mobile

Integrated HealthcareSurvey Summary

Prepared October 2013

What are Community Paramedicine (CP) & Mobile Integrated Healthcare (MIHC) Programs CP/MIHC programs use EMS practitioners and other

healthcare providers in an expanded role to increase patient access to primary and preventative care, within the medical home model.

CP/MIHC programs work to decrease the use of emergency departments, decrease healthcare costs, and increase improved patient outcomes.

The introduction of CP/MIHC programs within EMS agencies is a top trend in emergency medical care.

Why the CP survey was conducted

To better understand the extent and characteristics of CP/MIHC programs across the country.

To have a basis for understanding the CP/MIHC trend – which helps all of us in EMS – so we can develop strategies and policies to support it.

CP survey participation

NAEMT joined with 16 other national EMS organizations to collect information about CP/MIHC programs.

NAEMT thanks the Community Paramedicine Committee for survey development 

Committee Chair: Matt Zavadsky, NAEMT Director

Committee Members: Rod Barrett, NAEMT Director Dr. Jeff Beeson, American College of Emergency Physicians Jim DeTienne, National Association of State EMS Officials Dr. James Dunford, National Association of EMS Physicians Troy Hagen, National EMS Management Association Dr. Paul Hinchey, NAEMT Medical Director Dr. Doug Kupas, National Association of EMS Physicians Scott Matin, NAEMT Director Connie Meyer, NAEMT Immediate Past President David Newton, National Association of EMS Educators Mark Rector, International Academies of Emergency Dispatch Gary Wingrove, NAEMT Advocacy Committee

Appreciation to CP survey contributors

Joint National EMS Leadership Forum – assisted with survey development and distribution to their individual members.

Aaron Reinert, Chair of the National EMS Advisory Council – assisted in analyzing the survey data.

Gary Wingrove, a member of NAEMT’s Community Paramedicine Committee – developed the online map of CP programs.

Survey results at-a-glance

3,781 total responses were received – primarily from EMS practitioners, EMS managers, medical directors, and CP/MIHC program administrators.

Total responses were evenly dispersed across all types of EMS delivery models.

Survey results identified 232 unique CP/MIHC programs (6% of responses).

566 respondents (15%) indicated that their EMS agencies were in the process of developing a CP/MIHC program.

Details of the CP survey summary

The summary presents information on the 232 CP/MIHC programs reported by respondents.

The summary reports only on responses received. Several respondents did not complete all of the questions in the survey.

On some questions, respondents were able to select more than one response, or didn’t select any, which caused the percentage total to not equal 100%.

States reporting CP/MIHC programs in place

Respondents from 44 states, plus the District of Columbia and Puerto Rico, reported programs.

(One respondent, representing an ambulance company, indicated programs in multiple states.)

Programs represented — all delivery models

17%

15%

15%22%

12%

11%8%

Public, municipal

Public, hospital

Public, fire-based

Public,county or regional

Private,non-profit

Private, for profit

Volunteer

Population served by CP/MIHC programs

Less than 50,000: 40%

50,000 – 100,000: 16%

100,001 – 500,000: 22%

More than 500,000: 22%

Less than 10,000: 51%

10,000 – 50,000: 29%

More than 50,000: 20%

Annual call volume of CP/MIHC programs

Size of area served for CP/MIHC programs

Less than 250 sq. miles: 46%

250 – 1,000 sq. miles: 32%

More than 1,000 sq. miles: 22%

Population density of CP/MIHC programs

Super Rural

Rural

Suburban

Urban

5%

34%

31%

30%

Catalyst for starting a CP/MIHC program

Combat repeat users

Other

Other healthcare stakeholders

Other CP programs

Community assessment

Gap analysis of health needs

1%

7%

20%

30%

66%

68%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Participants in initial CP/MIHC program assessment

Other

Home health

Public health

Other EMS services

Hospital

Medical Director

7%

21%

41%

44%

77%

77%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Time CP/MIHC program has been in operation

Less than 1 year: 42%

1 – 3 years: 23%

More than 3 years: 35%

CP/MIHC program models

911 Nurse Triage

See and refer to alternate destination after assessment

Primary care/physician extender model

Readmission avoidance

Frequent EMS User

8%

24%

28%

46%

66%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Comparing program type to population density

Across all population densities, the “Frequent EMS User” was selected as the most common program model.

“Primary care/physician extender” was selected as the second-most common model for programs in super rural areas.

“Readmission avoidance” was selected as the second-most common model for programs in rural, suburban and urban areas.

Comparing program type by delivery model

“Frequent EMS User” was selected as the most common model for all types of private programs, as well as public-county, public-fire, and volunteer programs.

“Readmission avoidance” was selected as the most common model for public-hospital programs.

“Primary care/physician extender” was selected as the second-most common model for private-for profit programs.

“Readmission avoidance” was selected as the second-most common model for private-non profit and public-county programs.

Vehicles used to deliver services

Ambulance: 65%

SUV: 51%

Car: 18%

Fire Truck: 17%

POV: 3%

Other: (UTV, Medevac helicopter, golf cart,

crew boat, non-medical transport helicopter)

5%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Equipment used to deliver services

IStat or other point-of-care testing

Lab-value device

Scale

Patient education materials

29%

31%

41%

84%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Program operations

Can providers transport patients as needed?

Does program operate on a 24/7 basis?

Does program make house calls?

YES : 65% NO : 35%

YES : 65% NO : 35%

YES : 84% NO : 13%

CP/MIHC program funding sources

Medicaid fee schedule/free during pilot

Fee for referral

Grant

Fee for service

Self-funded

1%

5%

33%

42%

53%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

CP/MIHC practitioner deployment per patient

52%34%

6%

3%5%

One

Two

More than four

Three

Four

Organizations partnering in program implementation

Hospitals: 83%

Physician organizations: 47%

Other EMS agencies: 45%

Public health agencies: 42%

Home health organizations: 42%

Primary care facilities: 40%

Law enforcement agencies: 31%

Mental health care facilities: 27%

Nursing homes: 25%

None: 6%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Types of program collaboration with partners

Provides patient care: 72%

Coordinates patient services:

69%

Provides personnel: 44%

Provides oversight: 24%

Provides funding: 7%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Who provides medical direction for the CP/MIHC program

64%

30%

6%MultipleDirectors

SingleDirector

Committee

Average number of hours per week of medical direction

Less than 10: 66%

10: 17%

More than 10: 17%

Responsibilities of the Medical Director

Alternate dispositions/outcomes

Development/approval of care plans

On-line consultation

Protocol development/approval

47%

54%

62%

93%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Who approves clinical protocols for the program

Medical Director: 85%

Agency: 39%

State: 27%

Hospital: 24%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Responsibility for the overall management of the program

EMS Director/Chief/Manager: 73%

Medical Director: 24%

Other: 3%

Program implementation

Is there a defined process for adding new services to the program?

Is there a formal strategic plan that guides the overall direction and operation of the program?

YES : 53% NO : 47%

YES : 74% NO : 26%

Program implementation (continued)

Does the program have additional policies related to patient confidentiality?

Does the program have separate or additional liability coverage for the CP/MIHC services provided?

YES : 76% NO : 24%

YES : 35% NO : 65%

Who participates in providing patient care

Physician Assistants

Nurse Practitioners

Physicians

Nurses

AEMTs

EMTs

Paramedics

12%

12%

21%

24%

25%

54%

94%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

33%

15%17%

7%

28%

Total full-time program employees

One

Three

Less than OneFour or more

Two

CP/MIHC practitioner qualifications

No specific requirements

College degree

College-based CP training

Personality profile

Interviews

Advanced

Field experience

3%

16%

30%

35%

50%

51%

82%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

Specific training provided to CP/MIHC practitioners

No specific

Community relations

Patient relations

Clinical

13%

51%

57%

78%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

CP/MIHC practitioners

Are practitioners paid a higher rate than traditional roles?

Do practitioners have an advanced scope of practice?

Do practitioners wear different uniforms than those worn by traditional providers?

YES : 37% NO : 63%

YES : 11% NO : 89%

YES : 33% NO : 67%

CP/MIHC program data

Is program data being collected?

Is data collection based upon NEMSIS?

Are records integrated with other health information exchanges?

YES : 74% NO : 26%

YES : 40% NO : 60%

YES : 53% NO : 47%

How program data is collected

Data mining

Separate database

ePCR

29%

45%

66%

Respondents were able to select more than one response, resulting in a percentage total greater than 100%.

What program data is collected

Ongoing surveillance: 81%

Program outcomes: 92%

CP Survey Summary Conclusions

NAEMT’s Community Paramedicine/Mobile Integrated Healthcare Committee will continue to study this issue and bring additional information to members.

A follow-up survey is being developed to discover more information about CP/MIHC programs being implemented.

Visit the CP/MIHC page on www.naemt.org to learn more about this subject and how it is changing the role of EMS in healthcare delivery.

www.naemt.org1-800-346-2368 / info@naemt.org

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