Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept

doi:10.1016/j.annemergmed.2015.06.005

Annals of Emergency Medicine

Volume 67, Issue 3, March 2016, Pages 361-366

https://doi.org/10.1016/j.annemergmed.2015.06.005 Get rights and content

Mobile integrated health care and community paramedicine are models of health care delivery that use emergency medical services (EMS) personnel to fill gaps in local health care infrastructure. Community paramedics may perform in an expanded role and require additional training in the management of chronic disease, communication skills, and cultural sensitivity, whereas other models use all levels of EMS personnel without additional training. Currently, there are few studies of the efficacy, safety, and cost-effectiveness of mobile integrated health care and community paramedicine programs. Observations from existing program data suggest that these systems may prevent congestive heart failure readmissions, reduce EMS frequent-user transports, and reduce emergency department visits. Additional studies are needed to support the clinical and economic benefit of mobile integrated health care and community paramedicine.

Introduction

“Mobile integrated health care and community paramedicine” is the current term for a new model of community-based health care delivery that primarily uses emergency medical services (EMS) personnel and systems.¹ Mobile integrated health care and community paramedicine programs address wellness, prevention, care for the chronically ill, postdischarge care, social support networks, and increasing medical compliance for a local population. The model’s providers, often called community paramedics if trained at that level, perform assessments and interventions on an outpatient basis but usually do not provide acute transport.¹ First conceived of in programs attempting to expand access to services for underserved rural populations, the delivery system is one potential way to improve health system engagement with the community.

Section snippets

Data Sources

To our knowledge, there are few published peer-reviewed scientific descriptions of mobile integrated health care and community paramedicine. We identified information on it through a comprehensive search of the PubMed literature database, using the following key words: “MIH/CP,” “mobile integrated health care,” “community paramedicine,” “community paramedic,” and “home health care.” White papers and consensus conference proceedings published by the National Association of State EMS Officials

History of Mobile Integrated Health Care and Community Paramedicine

The first well-studied mobile integrated health care and community paramedicine programs in the United States were designed to address rural health care needs. Compared with residents in urban communities, rural community residents tend to have insufficient access to health care and exhibit worse health outcomes.² There are fewer physicians and higher rates of tobacco use, infant and adolescent mortality, self-reported adult obesity, and substance abuse.3, 4 Injuries sustained in rural areas

Outcomes of Mobile Integrated Health Care and Community Paramedicine Projects

There have been few data published on the safety, cost-effectiveness, and feasibility of mobile integrated health care and community paramedicine programs.¹⁵ Outcomes data will likely result from existing and pilot programs, many of which have specifically integrated evaluation components.

Most data on mobile integrated health care and community paramedicine clinical outcomes and cost-effectiveness originate from the MedStar Mobile Health Program in Dallas and Fort Worth, TX.¹⁶ MedStar’s efforts

Training for Mobile Integrated Health Care and Community Paramedicine Providers

Mobile integrated health care and community paramedicine represents an expansion in the standard scope of practice for community paramedicine providers compared with personnel who perform only treatment centered on acute transport. Depending on the specific needs of the population being served and existing resources available in the community, some programs provide significant additional training for community paramedicine providers and thereby expand their scope of practice, whereas others do

Mobile Integrated Health Care and Community Paramedicine Program Design

Nearly 2 decades of experience with both successful and failed mobile integrated health care and community paramedicine initiatives have allowed experts to form consensus about requirements for successful program implementation, even in the absence of validated national benchmarks or norms.²⁹ Most experts suggest the following:

1.
Successful mobile integrated health care and community paramedicine program implementation requires a comprehensive assessment of local health care needs before program

Future Directions

Although the definition and scope of mobile integrated health care and community paramedicine has been markedly refined since the publication of the National Consensus Conference on Community Paramedicine in 2013,¹² the main hurdle to the progression of mobile integrated health care and community paramedicine as a recognized health care discipline is the lack of safety, efficacy, and long-term outcomes data. Community paramedicine providers will have to demonstrate to government and private

References (39)

National Association of Emergency Medical Technicians. Vision statement on mobile integrated healthcare (MIH) and...
M. Eberhardt et al.
Urban and Rural Health Chartbook
(2001)
M.J. O'Grady et al.
Essential research issues in rural health: the state rural health directors' perspective
Policy Anal Brief W Ser
(2002)
Rural Emergency Medical Services—Special Report
(1989)
T. Pasko et al.
Physician Characteristics and Distribution in the US: 2000-2001 Edition
(2000)
M. Hauswald et al.
Expanded emergency medical services: the failure of an experimental community health program
Prehosp Emerg Care
(2005)
T.D. Rowley
Solving the paramedic paradox
Rural Health News
(2001)
United States Department of Transportation, National Highway Traffic Safety Administration, United States Department of...
United States Department of Health & Human Services, Health Resources & Services Administration, Office of Rural Health...

Joint Committee on Rural Emergency Care, National Association of State Emergency Medical Services Officials, National...

D.G. Patterson et al.

National Consensus Conference on Community Paramedicine: Summary of an Expert Meeting

(2013)

E. Beck et al.

Mobile integrated healthcare practice: a healthcare delivery strategy to improve access, outcomes, and value

Modern Healthc

(2013)

J. Goodwin

Finding a new seat at the healthcare table

EMS World

(2013)

Pearson KB, Gale JA, Shaler G. Community Paramedicine in Rural Areas: State and Local Findings and the Role of the...

United States Department of Health & Human Services, Agency for Healthcare Research and Quality, AHRQ Health Care...

Program overview—high utilizer 9-1-1/emergency department patients. MedStar Mobile Healthcare; 2014. Available at:...

Medstar high utilizer economic report thru February 2015. MedStar Mobile Healthcare; 2015. Available at:...

MedStar CHF program overview. MedStar Mobile Healthcare; 2014. Available at:...

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: Supervising editor: Henry E. Wang, MD, MS

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Emergency medical services/conceptsMobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept

Introduction

Section snippets

Data Sources

History of Mobile Integrated Health Care and Community Paramedicine

Outcomes of Mobile Integrated Health Care and Community Paramedicine Projects

Training for Mobile Integrated Health Care and Community Paramedicine Providers

Mobile Integrated Health Care and Community Paramedicine Program Design

Future Directions

Urban and Rural Health Chartbook

Essential research issues in rural health: the state rural health directors' perspective

Policy Anal Brief W Ser

Rural Emergency Medical Services—Special Report

Physician Characteristics and Distribution in the US: 2000-2001 Edition

Expanded emergency medical services: the failure of an experimental community health program

Prehosp Emerg Care

Solving the paramedic paradox

Rural Health News

National Consensus Conference on Community Paramedicine: Summary of an Expert Meeting

Mobile integrated healthcare practice: a healthcare delivery strategy to improve access, outcomes, and value

Modern Healthc

Finding a new seat at the healthcare table

EMS World

Emergency medical services/concepts
Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept