What are Community Paramedicine

Report
Community
Paramedicine/Mobile
Integrated Healthcare
Survey 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%.
Community Paramedicine Programs
States Number
reporting
CP/MIHC
in place
of CP Programs
byprograms
State
20%
19
Indiana
15
Texas
14
Illinois
12
Virginia
11
North Carolina
10
Massachusetts, Pennsylvania
9
New York
8
Arizona, Florida, New Jersey
6
Alabama, Idaho, Minnesota
California, Connecticut, Kentucky,
Missouri, New Mexico, Ohio
(One respondent,
representing an
ambulance company,
indicated programs in
multiple states.)
5
Colorado, Georgia, Maine, Michigan,
Nevada, Oregon
4
3
New Hampshire, Oklahoma, Tennessee
Iowa, Louisiana, Maryland, Montana,
Puerto Rico, South Carolina,
South Dakota, Wisconsion, Wyoming
Alaska, Akansas, District of Columbia,
Hawaii, Mississippi, North Dakota,
Vermont, Washington
Respondents from
44 states, plus the
District of
Columbia and
Puerto Rico,
reported programs.
2
1
0
5
10
15
20
Programs represented — all delivery models
Public,
municipal
11%
Public,
hospital
Private,
for profit
Volunteer
8%
17%
15%
12%
22%
Public,
fire-based
Private,
non-profit
15%
Public,
county or regional
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%
Annual call volume of CP/MIHC programs
Less than 10,000: 51%
10,000 – 50,000: 29%
More than 50,000: 20%
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
30%
Urban
31%
Suburban
34%
Rural
Super Rural
5%
Catalyst for starting a CP/MIHC program
Gap analysis of health needs
68%
Community assessment
66%
30%
Other CP programs
Other healthcare stakeholders
20%
Other 7%
Combat repeat users
1%
Respondents were able to select more than one response, resulting
in a percentage total greater than 100%.
Participants in initial CP/MIHC program
assessment
Medical Director
77%
Hospital
77%
44%
Other EMS services
41%
Public health
Home health
21%
Other 7%
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
66%
Frequent EMS User
46%
Readmission avoidance
Primary care/physician
extender model
See and refer to alternate
destination after assessment
28%
24%
911 Nurse Triage 8%
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:
Other:
(UTV, Medevac helicopter, golf cart, crew
boat, non-medical transport helicopter)
Respondents were able to select more than one response, resulting
in a percentage total greater than 100%.
3%
5%
Equipment used to deliver services
84%
Patient education materials
Scale
41%
Lab-value device
31%
IStat or other point-of-care
testing
29%
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?
YES : 65%
NO : 35%
 Does program operate on a 24/7 basis?
YES : 65%
NO : 35%
 Does program make house calls?
YES : 84%
NO : 13%
CP/MIHC program funding sources
53%
Self-funded
42%
Fee for service
33%
Grant
Fee for referral 5%
Medicaid fee schedule/free
during pilot
1%
Respondents were able to select more than one response, resulting
in a percentage total greater than 100%.
CP/MIHC practitioner deployment per patient
More than four
Four
3%
Three
5%
6%
Two
52%
34%
One
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:
Respondents were able to select more than one response, resulting
in a percentage total greater than 100%.
6%
Types of program collaboration with partners
Provides patient care: 72%
Coordinates patient services: 69%
Provides personnel: 44%
Provides oversight: 24%
Provides funding:
Respondents were able to select more than one response, resulting
in a percentage total greater than 100%.
7%
Who provides medical direction for the
CP/MIHC program
Committee
Multiple
Directors
30%
6%
Single
Director
64%
Average number of hours per week
of medical direction
Less than 10: 66%
10: 17%
More than 10: 17%
Responsibilities of the Medical Director
93%
Protocol development/approval
On-line consultation
Development/approval of care
plans
Alternate
dispositions/outcomes
62%
54%
47%
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?
YES : 53%
NO : 47%
 Is there a formal strategic plan that guides the overall
direction and operation of the program?
YES : 74%
NO : 26%
Program implementation (continued)
 Does the program have additional policies related to
patient confidentiality?
YES : 76%
NO : 24%
 Does the program have separate or additional liability
coverage for the CP/MIHC services provided?
YES : 35%
NO : 65%
Who participates in providing patient care
94%
Paramedics
54%
EMTs
AEMTs
25%
Nurses
24%
Physicians
21%
Nurse Practitioners
12%
Physician Assistants
12%
Respondents were able to select more than one response, resulting
in a percentage total greater than 100%.
Total full-time program employees
Four or more
Less than One
28%
33%
7%
Three
17%
Two
15%
One
CP/MIHC practitioner qualifications
82%
Field experience
Advanced
51%
Interviews
50%
Personality profile
College-based CP training
35%
30%
College degree
16%
No specific requirements
3%
Respondents were able to select more than one response, resulting
in a percentage total greater than 100%.
Specific training provided to CP/MIHC
practitioners
78%
Clinical
57%
Patient relations
51%
Community relations
No specific
13%
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?
YES : 37%
NO : 63%
 Do practitioners have an advanced scope of practice?
YES : 11%
NO : 89%
 Do practitioners wear different uniforms than those
worn by traditional providers?
YES : 33%
NO : 67%
CP/MIHC program data
 Is program data being collected?
YES : 74%
NO : 26%
 Is data collection based upon NEMSIS?
YES : 40%
NO : 60%
 Are records integrated with other health information
exchanges?
YES : 53%
NO : 47%
How program data is collected
ePCR
Separate database
Data mining
66%
45%
29%
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.org
1-800-346-2368 / [email protected]
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www.twitter.com/NAEMT_

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