Community paramedicine is working to improve the effectiveness and efficiency of healthcare delivery by partnering specially trained paramedics with other healthcare providers.
The California Emergency Medical Services Authority https://emsa.ca.gov/community_paramedicine is sponsoring pilot projects where specially trained paramedics perform duties beyond their traditional roles of responding to 911 calls, transporting patients to emergency departments, and performing inter-facility transfers.
The California’s Community Paramedicine program has initiated six pilot projects with several new duties. For example, community paramedics and hospitals are collaborating to reduce the number of avoidable readmissions. After a patient is released from the hospital for treatment for a chronic condition, the patient is called or visited in their home by a community paramedic during the first week at home.
Paramedics so often have to deal with frequent emergency medical services users which can include frequent 911 users, or emergency department visitors or both. The first step in this pilot is to identify why the person needs to use emergency medical service resources on a frequent basis. If necessary, the paramedic will link patients to appropriate non-emergency service providers to reduce the dependence on EMS agencies and emergency departments for care.
Sometimes some patients don’t always need to go to the emergency department for mental health issues. Paramedics in responding to 911 calls can evaluate patients that have mental health needs. If the person does not have an immediate mental health need, then the paramedic can provide transport directly to a mental health crisis center.
Another pilot enables paramedics to offer patients with acute alcohol intoxication but with no other acute medical or mental health needs, transport to a sobering center instead of going to an emergency department. So far, the sobering center has cared for over 50,000 people since it opened in 2003. Preliminary findings suggests that this pilot project is benefiting patients and the healthcare system.
Today, community paramedics are able to collaborate with local public health officials to provide Directly Observed Therapy (DOT) to patients with TB. The paramedics dispense medications and then make sure that the patients are taking the medications.
Another study deals with 911 hospice calls. Community paramedics are now collaborating with hospice agency nurses, patients, and family members to treat patients in their homes instead of transporting them to the emergency department.
The Healthforce Center at UCSF https://healthforce.ucsf.edu is conducting an evaluation of the pilot programs. In November 2017, the Healthforce Center released the report “Evaluation of California’s Community Paramedicine Pilot Program” In May 2018, findings were presented from the first 25 months of the pilot project.
The evaluation found that community paramedics are collaborating successfully with physicians, nurses, behavioral health professionals, and social workers to fill gaps in the health and social services safety net. All of the post-discharge patients, frequent 911 users, tuberculosis, hospice, and mental health projects in operation for 21 or more months have improved the patents’ well-being. In most cases, the pilot program has yielded savings for payers and other parts of the healthcare system.
Go to https://emsa.ca.gov/community_paramedicine for more information on the pilot program.