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Community Integrated Paramedicine This Session Will Discuss and Describe What Encompasses Community Integrated Paramedicine

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Community Integrated Paramedicine This Session Will Discuss and Describe What Encompasses Community Integrated Paramedicine Community Integrated Paramedicine This session will discuss and describe what encompasses Community Integrated Paramedicine. At the end of this presentation participants will be able to describe Community Integrated Paramedicine, identify its potential benefits in a rural setting, and describe how it helps achieve the triple aim. What’s in a name? Community Paramedicine (CP) Michigan Terminology Advanced Care Practitioner Mobile Integrated Health (MIH) Community Integrated Paramedicine Community Integrated Paramedics Integrated Care Paramedics Community Paramedic Community Care Paramedics licensure, 300+ hours of Community Care EMT education, interfaces with the 9-1-1- system CP-MIH Mobile Integrated Health no licensure, 10+ hours of education, partner/follow up only Focusing in on CIP 30,000-Foot View: International 10,000-Foot View: National 1,000-Foot View: Michigan Close-up View: Programs Future View: You? This Photo by Unknown Author is licensed under CC BY Change your perspective EMS is a qualified and under utilized resource in the healthcare system Capacity to help change the landscape of healthcare Can assist existing entities to fill gaps No duplication No competition Retrieved from https://www.pinterest.com/pin/486599934732040325/ The 30,000-Foot View Positives Canada Curriculum (North Central EMS Institute International UK ‘national curriculum’ Australia Varying models (including rural) Nova Scotia Challenges Switzerland Communication & Marketing New Zealand Data (apples to oranges) Ontario, Canada Over 3,000 square miles/100,00 people Observational ethnographic study 1) Improved health monitoring and primary health care access close to home 2) Improved sense of security and support for vulnerable residents 3) Improved education and empowerment for better health management (Martin, O’Meara & Farmer, 2016) International Roundtable on Communityhttp://www.ircp.info/ Paramedicine The 10,000-Foot View National National Positives Some form of CP-MIH in Program success over half of the states (33) Curriculum efforts No state reports zero Rural models for activity Michigan Varying degrees of Challenges regulation Not all successes Legislation (lessons learned) State Data Many lack coordination within their own state. Language/consistency Community Paramedicine in rural South Carolina Abbeville County Frequent ED utilizers with one or more of the following: hypertension, diabetes, chronic heart failure, asthma, chronic obstructive pulmonary disease Rural community with inadequate access to health care, poor health behaviors and an increasingly aging population Educated participants and connected them to resources for primary care Decreased ED visits by 58.7% and inpatient visits by 68.8% (Bennett, Yuen & Merrell, 2018) National Rural Health Conference Conversations 1996 Agenda for the Future didn’t adequately address rural 2004 Rural and Frontier EMS Agenda for the Future EMS 2050: people-centered EMS systems 1. Sustainable and Efficient 2. Reliable and Prepared 3. Socially Equitable 4. Adaptable and Innovative 5. Inherently Safe and Effective 6. Integrated and Seamless Rural and Frontier Emergency Medical Services Tactical Plan Rural and Frontier EMS Tactical Plan Three Year National Tactical Plan 12 general areas, narrowed to 5 broad goals for achievability 1. Integration of Health Services 2. Legislation/Integration of Clinical Care and Transportation Decisions/Resources 3. System Finance 4. Human and Education Resources 5. Public Information, Education and Relations Integration Push for collaboration between rural CAH and EMS Addressing unmet health needs in rural areas Financial discussion Where is a patient’s first point of contact for your healthcare system? ED’s are rarely a financial gain in a CAH Who delivers your ED patients? 9-1-1 will ALWAYS get you a response Unintended consequences – used as a taxi, get into the ED quicker card, primary care. Georgia Pilot Program Rural Community Care Coordination Community Paramedics Trained and Functioned as Care Coordinators Toolkit (not yet available) Cost Analysis Templates Legal Guidelines for EMS Directors Reviewed and constructed in a collaborative effort Attorneys Accountants Medical Michigan Statute • PA 386 (almost 700 pages), Section 209. • Defines roles and processes Why can’t we • Licensure just copy what • Ceiling and Floor Medical Control Authority other states do? • Michigan – determined by geography • Other states - each agency has it’s own Medical Director Is Different Better? • Safety and resources • Challenges for duplicating other states • Easier for collaboration The1,000-Foot View 11 pilot programs Positives Michigan The first began in Vision 2014 Resources Workgroups that Plan meet monthly MDHHS – CIP tab Michigan Health Endowment Fund Negatives 1 FTE – 2 years Data Grants for programs 816 Licensed EMS 213 agencies Michigan agencies are ALS Specific 28,600 licensed 9,000 providers Paramedics 83 counties 59 Medical Control 37 are rural Authorities Michigan EMS Medical Control Authorities 1 Keweenaw, Houghton 2 Baraga 3 Marquette, Alger 4 Schoolcraft 5 Luce 6 Eastern UP 7 Gogebic, Ontonagon, Iron 8 Dickinson 9 Bay Area 10 Delta 11 Northern Michigan 12 Northwest Regional 13 North East Michigan 14 Otsego 15 North Central 16 Ogemaw 17 Iosco 18 Manistee 19 Mason 20 Lake, Mecosta 21 Clare 22 Midland, Gladwin 23 Arenac 24 Oceana 25 Newaygo 26 Isabella 27 Bay County 28 Muskegon 29 Montcalm 30 Gratiot 31 Saginaw, Tuscola 32 Huron 33 Sanilac 34 Ottawa 35 Kent 36 Ionia 37 Tri-County 38 Shiawassee 39 Genesee 40 Lapeer 41 St. Clair 42 Allegan 43 Barry 44 Washtenaw, Livingston 45 Oakland 46 Macomb 47 Van Buren 48 Kalamazoo 49 Calhoun 50 Jackson 51 H.E.M.S. 52 Detroit East 53 Berrien 54 Cass 55 St. Joseph 56 Branch 57 Hillsdale 58 Lenawee 59 Monroe The Close-Up View 11 Pilot Programs in Michigan Mobile Integrated Health - 5 Community Paramedic - 6 Medstar Paramedic Program Clinton Area Ambulance Service Authority Remote Specialist Visiting Provider (RSVP) (Bloomfield Fire Department and Star Jackson Community Ambulance EMS) (EHP) Life EMS/Tandem365 Huron Valley Ambulance (EHP) Superior EMS Promed New CP Programs – 8 Livingston EMS 2018 Grant Recipients Hayes Green Beach What current programs are doing Accompanying Community Health Workers on initial and follow up home visits & connect client with PCP Follow up with discharged ED and surgical patients to reduce readmissions or ED utilization for primary care (wound care, medication reconciliation, care plan compliance) Follow up for clients of transport services (not allowed to cross the threshold) when concerns for home safety Discharge follow up: pneumonia, CHF, COPD and providing medical assessment, appointment assistance, PICC/PEG/Urinary catheter assessment. What current programs are doing Assist PCP in monitoring chronic health patients Decrease hospice patient ED use when hospice isn’t available Welfare checks as prompted by central dispatch/law enforcement CHF/COPD/pneumonia/diabetes - patients who were in the ED 2 or more times in 12 months Telemedicine for Remote Specialize Visiting Physicians (RSVP) EMS algorithm to dispatch CP with ALS, treat in place, arrange for follow up (26 Alpha/Omega – sick no priority symptoms) Promed Ambulance - Muskegon Focus: Post discharge follow up for strokes Referrals: Case management (Mercy Health Partners Matter of Balance Instructors ADL/memory aids (notebooks) Visual/coloring books for impairment explanation Resources/physical, mental, emotional rehabilitation Program began June 21, 2016 CVA/TIA Diagnosis (June-June) 2015/2016 Inpatient readmissions: 56% (N-1378) 2016/2017 Inpatient readmissions: 13% (N-1847) Clinton Area Ambulance Service Authority Focus: Community 1 Patient 2016: 48 ambulance transports and 65 Emergency Department visits Quarter 1 2017: 0 and 0 Medstar Macomb Focus: COPD/CHF patients Referrals: Case Management (HFHS) Post discharge support, QTR 1 2017: readmission prevention, PCP engagement Reduced readmissions of enrolled patients from >20% to 3% First in the state Following Narcan deployment in the field Medstar Phone/text/meet Opiate Services offered Follow-up • Harm Reduction/Safer Use programs • Narcan/Needles Pilot • Immunizations/Vaccinations • Oral health assessment and referrals for Program free care • Rehab – right now if today is the day • FAN and HNH experienced people Emergent Health Partners (EHP) Focus: ER Diversion Education Dispatch/Triage Volume (850 CP contacts per quarter) Resources Medical Directors are extremely engaged Protocols 3 vehicles (2 HVA, 1 JCA) Organization and leadership Payer partnerships BCBS Core Competency Scope and Role Home Safety Medication Reconciliation/Medication Diversion Social Determinants Cultural Competencies Communications Home Medical Devices Patient Movement Provider Safety Clinical – case management/what/where to ask if you don’t know The call Team members Telemedicine Documentation Transfer of Information Disease COPD/Asthma CHF Pneumonia Hip/Knee Arthroplasty Diabetes Hypertension Sepsis Neurological Conditions (Stroke) Substance Use Disorders Behavioral Health/Mental Health Cardiac (not on list) Each disease includes: Monitoring and management Patient education Acute vs. chronic Care plan Common meds/med rec Meds administered by CP POC testing Lab values Specific ADLs/home safety/DMA Physician involvement/protocol Call/Documentation
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