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EMS Community Paramedicine and Mobile Integrated Health
Summary / Explanation
Community paramedicine (CP) and mobile integrated health (MIH) are healthcare delivery models designed to fill gaps in the outpatient setting. CP and MIH support the current infrastructure by bringing patient-centered services directly to the home. These programs focus on reducing hospital admissions, emergency department visits, and healthcare costs while expanding access to care, particularly in underserved communities or for patients lacking viable transportation.[1][2][3] CP and MIH programs leverage the skills of emergency medical services (EMS) clinicians in collaboration with other healthcare professionals.[4][5][6]
While increasing the role of EMS clinicians beyond emergency response has been considered since the 1990s, the widespread implementation of CP and MIH has gained momentum in several countries worldwide.[6][4][7][8] The goals and functions of MIH and CP programs vary widely based on the needs of each community they serve. Training for community paramedics is also variable, depending on local needs.[2][4]
Community Paramedicine
Community paramedicine redefines the traditional role of EMS clinicians by enabling them to provide additional healthcare services within the community.[3][4] This model primarily addresses non-urgent healthcare needs and aims to ease the strain on emergency departments by providing an alternative pathway for healthcare access.[1][2][5][7][9] Despite its growing recognition, a 2023 study revealed that only 1.5% of EMS clinicians currently work in a CP or MIH capacity.[10] Several barriers limit the widespread adoption of CP. Funding and reimbursement remain major hurdles, as most EMS services are not compensated for non-transport services, such as home visits from community paramedics. Regulatory restrictions, which vary by state, may also inhibit the expansion of paramedics' scope of practice. Integrating a community paramedic from an EMS service into a hospital network or healthcare system is complex and can result in inefficiencies.[8] Additionally, some departments may have to work against a culture in which community paramedicine is considered less exciting or a less critical role.[11] This mirrors similar concerns when firefighters are pressed into EMS roles.
Mobile Integrated Health
Mobile integrated health (MIH) expands on the principles of community paramedicine by integrating a broader range of healthcare services and teams of interprofessional providers.[3][4] The approach focuses on comprehensive, patient-centered care through a coordinated physician-led team of healthcare professionals, including community paramedics, nurses, advanced practice clinicians, social workers, mental health workers, and other specialists.[5][12]
Essential CP and MIH Services
Health monitoring and preventative care: Community paramedics perform regular home visits to monitor chronic health conditions such as diabetes, hypertension, and congestive heart failure. These visits often involve monitoring vital signs, weight, medication adherence, and assisting with follow-up appointments.[1][3][4][13] Visits may be arranged after discharge from the hospital or as part of an ongoing program for at-risk individuals or patients who frequently seek treatment in emergency departments. Visits by the community paramedic can also identify worsening health issues before they become emergencies, reducing ED visits and hospital readmissions.[2][3][12]
Emergency department diversion and triage: Community paramedics assess patients for urgent or emergency conditions and utilize established protocols to manage or triage nonemergency cases, reducing unnecessary ED visits.[1][2][12] For example, established protocols (or "standing orders") could allow community paramedics to treat minor injuries or illnesses at home or refer patients to alternative care sites such as primary care, urgent care, mental health facilities, or substance use disorder care. Studies have shown reduced ED utilization and overall healthcare costs in areas implementing MIH or CP programs.[2][5][9][14]
Health education and support: Educating patients on managing their health conditions, using medications properly, and recognizing early warning signs of deterioration is likely one of the most important CP/MIH functions. Patients better educated about their disease and treatment are more likely to comply with their treatment plan.[15][16] EMS personnel can also perform home safety assessments (eg, evaluating fall risk) and connect patients with social services and support groups to address social determinants of health.[1][13]
In-home care: MIH extends in-home care beyond what is typically offered in primary care offices or CP. Services may include preventative medicine, chronic disease management, and mental health services.[1][7][9][13] Additionally, some MIH programs provide in-home care that would typically be provided in the ED or hospital, such as ongoing infusion therapies, wound care, or even dialysis. When appropriate, providing care in a patient's home may reduce hospitalization risk factors, such as delirium, functional decline, and infections. Reducing hospitalization also improves patient satisfaction.[5][12][13]
Telehealth and remote monitoring: MIH can leverage technology to provide immediate consultations and remote monitoring of devices in real-time. Telehealth consultations at home or in an ambulance allow patients to connect virtually with physicians and healthcare providers, which may assist in destination guidance and prehospital management. At the same time, remote monitoring devices enable tracking vital signs and health status.[12][17][18] Several commercial devices monitor cardiac function, alerting patients with CHF to the need for medication changes to prevent the progression of volume overload.[19]
Community partnerships: MIH programs may collaborate with local healthcare providers, social services, and community organizations to address the comprehensive needs of patients and improve access to care. This includes connecting patients with resources such as housing assistance, food programs, and transportation services.[5][6]
Conclusion
Community paramedicine and mobile integrated health represent transformative approaches to healthcare delivery. Although these concepts have been considered for decades, the aging population and overall strain on healthcare systems necessitate a change in the current method of healthcare delivery. By expanding the role of EMS clinicians, integrating healthcare services, and incorporating telehealth services, the CP and MIH models can improve access to care, enhance health outcomes, reduce costs, and improve patient satisfaction. As healthcare systems continue to evolve, CP and MIH programs are likely to play an increasingly important role in meeting the needs of diverse patient populations and addressing the challenges encountered by traditional care models.
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References
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