Community Paramedicine Demonstration Projects
فجوات الرعاية
Community Paramedicine Demonstration Projects
Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care
authors
Kenneth W. Kizer, MD, MPH Distinguished Professor, UC Davis School of Medicine (Department of Emergency Medicine) and Betty Irene Moore School of Nursing; Director, Institute for Population Health Improvement, UC Davis Health System
Karen Shore, PhD Senior Policy Analyst, Institute for Population Health Improvement, UC Davis Health System
Aimee Moulin, MD Assistant Professor, Department of Emergency Medicine, UC Davis School of Medicine
Report prepared for the California HealthCare Foundation and California Emergency Medical Services Authority in partial fulfillment of the Leveraging EMS Assets and Community Paramedicine Project funded by the California HealthCare Foundation (Grant Number 17119, Regents of the University of California).
July 2013
محتويات
مقدمة[عدل]
Introduction
Community paramedicine (CP) is a new and evolving model of community-based health care in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations.1
CP programs have been independently developed in a number of states and countries, and thus are varied in nature. These programs typically have been designed to address specific local problems and to take advantage of locally developed collaborations between and among emergency medical services (EMS) and other health care and social service providers. Interest in this model of care has grown substantially in recent years in the belief that it may improve access to and quality of care while also reducing costs.
Historically, EMS has focused on providing emergency treatment for persons suffering acute medical problems in community settings, while transporting such persons to a hospital emergency department (ED), and when needed, in the ED until care is taken over by hospital staff. EMS personnel also have been utilized to transport ill or injured persons between hospitals.
The inherent nature of emergency care makes it more expensive than many other types of health care services. EMS systems and hospital EDs must be prepared to handle a wide array of routine and unusual problems that occur unexpectedly and often require a rapid response with specialized skills and equipment because the problems are serious and sometimes life threatening. Consequently, the fixed costs associated with operating and maintaining emergency care services are high.
As concern about rising health care costs has grown in recent years, increased efforts have been directed at ensuring that expensive emergency care resources are optimally utilized. Also, because the overwhelming majority of EMS systems rely on fire departments and other publicly funded agencies to provide at least some services, and because most local governments are under significant financial strain, local EMS providers have increasingly sought to secure additional sources of financial support. Early experiences with CP programs suggest that they may lead to more optimal use of EMS assets and offer some potential for diversification of the EMS funding base. In particular, CP programs may result in:
1. More appropriate use of emergency care services[عدل]
Perhaps the best demonstrated benefit of CP programs has been in getting persons who have accessed the EMS system, but do not have a medically emergent condition, to more appropriate destinations than a hospital ED. This may yield financial savings and, in some cases, improve the coordination and continuity of care.
2. Increased access to primary care for medically underserved populations[عدل]
Some CP programs have provided solutions to primary care problems that were otherwise not being well addressed. For example, some CP programs provide short-term (e.g., within 72 hours of discharge) follow-up home visits for patients who have just been discharged from a hospital or ED until other providers are able to provide the home visits or other follow-up care. Such follow-up care may help prevent ED or hospital readmissions.
3. Enhanced opportunities for EMS personnel skills development and maintenance[عدل]
CP programs aimed at providing primary care for medically underserved populations may also provide opportunities for EMS personnel in low-call-volume settings (e.g., rural areas) to further develop patient assessment skills, as well as more frequently utilize their basic skills. This helps them maintain their skills and expand their clinical experience.
خاتمة[عدل]
Recognizing the widening gap between the demand for health care services and California’s supply of health care workers, and of the need for health care resources to be optimally utilized, including providers working as much as possible at the top of their skills, the California HealthCare Foundation and California Emergency Medical Services Authority (EMSA) asked the Institute for Population Health Improvement (IPHI), University of California Davis Health System, to assess the feasibility of developing community paramedicine programs in California.2 They asked IPHI to explore whether use of paramedics in expanded roles might be a practical option for California communities to consider when addressing health care needs in coming years.
This report provides a brief history of EMS systems and paramedicine in California, a broad overview of the development of community paramedicine in other states and countries, a summary of current perspectives on CP in the state based on interviews with key stakeholders, and a discussion of the barriers to implementing CP programs in California. We conclude the report with several recommendations for further exploration of the role of community paramedicine in California.
