Development of a Community Paramedicine Program in the City of Tonawanda Author: Kimberly R. Renda,...
1
Development of a Community Paramedicine Program in the City of Tonawanda Author: Kimberly R. Renda, MPA · Advisor: Dr. Scott Roberts, Health, Nutrition, and Dietetics The medical industry is coming off of major changes in healthcare, including the Affordable Care Act of 2010 (ACA). With enhanced Government involvement in healthcare nationwide, WNY also has private companies running major health insurances, as well as ambulance services, combined with nonprofit run hospitals. Healthcare costs have been increasing, and specific underserved target populations, such as poor, inner-city residents, rural residents, and elderly residents, are causing high costs and misuse of the 911 and emergency system. Community Paramedicine programs, a form of Mobile Integrated Healthcare (MIH), have been developed to fill these healthcare gaps. Community Paramedicine expands the scope of practice for Emergency Medical Technicians and Paramedics and allows these providers to reach underserved populations and provide them with underutilized resources. The published data and statistics on current healthcare trends tell the story and answer the questions – the existing system is not working. According to a report by the National Conference of State Legislatures (2015), between 14 and 27% of all emergency room visits are for non-emergent conditions, and could take place in a different setting, such as a doctor’s office or after-hours clinic, and could result in a potential cost savings of $4.4 billion annually. Return emergency room customers, or “frequent fliers,” as they are called, account for about 4.5 to 8% of all emergency room patients, yet also account for 21 to 28% of all visits. Also, studies suggest that 10 to 40% of EMS (ambulance) responses are for non-emergent situations. In a report from the Institute of Medicine (Beck et al., 2012) estimates that 30% of the United States annual healthcare budget, or $750 billion dollars, goes to unnecessary services, inefficient delivery, excessive administration costs, and prevention failures. In the same report, the authors note that in the current American healthcare system, specialized providers offer limited care to patients who often possess co-morbid conditions. Restricted hours of operation and a lack of communication between providers often leaves patients who are experiencing issues related to their chronic conditions to be referred to the Emergency Room, even when the ER is not suited to A Community Paramedicine program implemented in Erie County will be a cost effective option for both hospitals and insurance providers to reduce non- emergent 911 transports, ER visits, and hospital readmissions, while improving care for target populations who are considered to be at-risk and/or possess chronic and comorbid conditions. The purpose of this study is to examine Community Paramedicine as an effective and efficient part of healthcare reform. In Erie County, a mixture of public, private, and nonprofit organizations are involved in healthcare; however, disparities in the system make care expensive and inaccessible. Community Paramedicine programs in places such as Pennsylvania, Minnesota, Washington, and Michigan are demonstrating success in improving the quality of care, reducing emergency transports and hospital visits for non-emergent and/or chronic conditions, and reducing overall costs. This study will utilize a parallel mixed methods design to investigate whether there are advantages for the City of Tonawanda to adopt a Community Paramedicine program. Null Hypothesis Literature Review Introduction – Purpose Statement Beck, E., Craig, A., Beeson, J., Bourn, S., Goodloe, J., Moy, H. P., . . . White, L. (2012). Mobile Integrated Healthcare Practice: A Healthcare Delivery Strategy to Improve Access, Outcomes, and Value. Chicago, Illinois. National Conference of State Legislatures. (2015). Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders. Washington, DC: Retrieved from http://www.ncsl.org/research/health. Trozzo, S. (2013). Paramedic program aims to cut ER visits. Pittsburgh Post-Gazette. September 5, 2013 References Sample Selection The sample selection will consist of two groups. Semi-structured interviews will be conducted with key policymakers and stakeholders in the City of Tonawanda (politicians, fire department, DeGraff hospital, etc.). Quantitative data will be collected from the City of Tonawanda Fire Department via their EMS providers which will be comprised of data from 911 callers that would also normally go to Quality Improvement for review. The sample selection from the City of Tonawanda will be a cluster sampling, due to geographical location (only those located in the 14150 zip code within the City of Tonawanda) and will be collected over a period of time by the Fire Department. Research Design and Instrumentation This study will utilize interviews, questionnaires, and data collection from a local agency (City of Tonawanda Fire Department) as a case study. This convergent parallel mixed methods design will compare the opinions of decision-makers about the necessity for a Community Paramedicine program with the 911 calls. Interviews will be semi-structured and in-person when possible. The quantitative data will come as a result of collection from 911 calls in the City of Tonawanda. The Fire Department will provide information that does not violate HIPAA laws, including: •Age of the patient •Race of the patient •Patient’s chronic conditions/medical history •Does the patient live in designated low- income housing? •Does the patient live alone? •What was the condition? •Emergency room transport? A rating scale will be constructed from these data, which will be used to assess whether the condition could have been (or was) treated through Community Paramedicine. The results of the qualitative and quantitative data will be compared for congruency in support (interviews) and need (Fire Department data). Scholars note the existing system is based on what the patient perceives their condition to be, and allows them to determine the level of care provided, regardless of suitability and cost. If a patient with a Urinary Tract Infection deems their condition emergent, they can call 911 and have an ambulance take them to the ER, where they will receive an antibiotic and be sent home, continued cost and strain on the emergency system. A MIH system will respect a patient’s right to be seen by a practitioner, but also ensure the patient is seen by the right practitioner at the right time and in the right setting. One example of a MIH program that has already been implemented is Pittsburgh’s CONNECT program (Trozzo, 2013), which came about as a grassroots effort from residents from the Congress of Neighboring Communities, who recognized there were difficulties supporting their local ambulance services. As changes in healthcare reform accelerated, residents realized stakeholders such as The University of Pittsburgh Medical Center and Highmark may want to get involved with local EMS agencies. The Community Paramedics in Pittsburgh act as patient advocates, assist patients by filling prescriptions and complying with provider orders, and helping patients get to appointments. They focus on treating patients with chronic conditions and conditions that often result in readmissions, such as asthma, diabetes, and Congestive Heart Failure. Referrals for the program can come from area hospitals, insurance payers, and the local EMS agencies that have regular interactions with these patients. Community Paramedics work closely with Primary Care Providers and social service agencies to ensure patients are receiving proper, coordinated care. The goals of Pittsburgh’s program are to reduce misuse of the emergency system and ERs, make better use of EMS resources, improve collaboration among agencies, and provide better care and follow-up for patients. While healthcare is an ever evolving field, EMS has historically been unable to keep up with changes and growth, leaving providers with limited scopes of practice and unable to effectively and efficiently treat patients. However, with new regulations and standards from the ACA, agencies are beginning to revolutionize the way they view emergency and at home care. Utilizing a patient- centered approach, WNY agencies can better monitor target populations to reduce misuse of the emergency system, lower cost, improve care, and free up resources. However, new programs cannot succeed and sustain without significant collaboration across sectors and among agencies. Changes will have to be made in the NYS laws to allow for services to be provided and paid, but the literature has shown that progress has been made in filling healthcare gaps with Community Paramedicine. Hypothesis Photos by: Kimberly R. Renda Prima ry Care Emergen cy Care Community Paramedic ine Community Paramedicine will not be a cost effective option for insurance providers and hospitals in reducing unnecessary hospital admissions and 911 transports, and will not improve care.
-
Upload
mervin-perkins -
Category
Documents
-
view
214 -
download
1
Transcript of Development of a Community Paramedicine Program in the City of Tonawanda Author: Kimberly R. Renda,...
Development of a Community Paramedicine Program in the City of Tonawanda
Author: Kimberly R. Renda, MPA · Advisor: Dr. Scott Roberts, Health, Nutrition, and Dietetics
The medical industry is coming off of major changes in healthcare, including the Affordable Care Act of 2010 (ACA). With enhanced Government involvement in healthcare nationwide, WNY also has private companies running major health insurances, as well as ambulance services, combined with nonprofit run hospitals. Healthcare costs have been increasing, and specific underserved target populations, such as poor, inner-city residents, rural residents, and elderly residents, are causing high costs and misuse of the 911 and emergency system. Community Paramedicine programs, a form of Mobile Integrated Healthcare (MIH), have been developed to fill these healthcare gaps. Community Paramedicine expands the scope of practice for Emergency Medical Technicians and Paramedics and allows these providers to reach underserved populations and provide them with underutilized resources. The published data and statistics on current healthcare trends tell the story and answer the questions – the existing system is not working. According to a report by the National Conference of State Legislatures (2015), between 14 and 27% of all emergency room visits are for non-emergent conditions, and could take place in a different setting, such as a doctor’s office or after-hours clinic, and could result in a potential cost savings of $4.4 billion annually. Return emergency room customers, or “frequent fliers,” as they are called, account for about 4.5 to 8% of all emergency room patients, yet also account for 21 to 28% of all visits. Also, studies suggest that 10 to 40% of EMS (ambulance) responses are for non-emergent situations. In a report from the Institute of Medicine (Beck et al., 2012) estimates that 30% of the United States annual healthcare budget, or $750 billion dollars, goes to unnecessary services, inefficient delivery, excessive administration costs, and prevention failures. In the same report, the authors note that in the current American healthcare system, specialized providers offer limited care to patients who often possess co-morbid conditions. Restricted hours of operation and a lack of communication between providers often leaves patients who are experiencing issues related to their chronic conditions to be referred to the Emergency Room, even when the ER is not suited to serve their needs. MIH programs, such as CP, are intended to serve patients in their home for acute care, chronic care, and prevention services. In theory, a high quality and sustainable MIH/CP program will be patient- and community-centered, focusing on the needs of those being served and linking them to proper services through technology, communication, and information exchange. It will also continue to function under the oversight of a Medical Director, provide 24-hour service, and utilize collaborations with other medical and multidisciplinary providers.
A Community Paramedicine program implemented in Erie County will be a cost effective option for both hospitals and insurance providers to reduce non-emergent 911 transports, ER visits, and hospital readmissions, while improving care for target populations who are considered to be at-risk and/or possess chronic and comorbid conditions.
The purpose of this study is to examine Community Paramedicine as an effective and efficient part of healthcare reform. In Erie County, a mixture of public, private, and nonprofit organizations are involved in healthcare; however, disparities in the system make care expensive and inaccessible. Community Paramedicine programs in places such as Pennsylvania, Minnesota, Washington, and Michigan are demonstrating success in improving the quality of care, reducing emergency transports and hospital visits for non-emergent and/or chronic conditions, and reducing overall costs. This study will utilize a parallel mixed methods design to investigate whether there are advantages for the City of Tonawanda to adopt a Community Paramedicine program.
Null Hypothesis
Literature Review
Introduction – Purpose Statement
Beck, E., Craig, A., Beeson, J., Bourn, S., Goodloe, J., Moy, H. P., . . . White, L. (2012). Mobile Integrated Healthcare Practice: A Healthcare Delivery Strategy to Improve Access, Outcomes, and Value. Chicago, Illinois.
National Conference of State Legislatures. (2015). Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders. Washington, DC: Retrieved from http://www.ncsl.org/research/health.
Trozzo, S. (2013). Paramedic program aims to cut ER visits. Pittsburgh Post-Gazette. September 5, 2013
References
Sample Selection
The sample selection will consist of two groups. Semi-structured interviews will be conducted with key policymakers and stakeholders in the City of Tonawanda (politicians, fire department, DeGraff hospital, etc.). Quantitative data will be collected from the City of Tonawanda Fire Department via their EMS providers which will be comprised of data from 911 callers that would also normally go to Quality Improvement for review. The sample selection from the City of Tonawanda will be a cluster sampling, due to geographical location (only those located in the 14150 zip code within the City of Tonawanda) and will be collected over a period of time by the Fire Department.
Research Design and Instrumentation This study will utilize interviews, questionnaires, and data collection from a local agency (City of Tonawanda Fire Department) as a case study. This convergent parallel mixed methods design will compare the opinions of decision-makers about the necessity for a Community Paramedicine program with the 911 calls. Interviews will be semi-structured and in-person when possible.
The quantitative data will come as a result of collection from 911 calls in the City of Tonawanda. The Fire Department will provide information that does not violate HIPAA laws, including:
• Age of the patient• Race of the patient• Patient’s chronic conditions/medical history• Does the patient live in designated low-income housing?• Does the patient live alone?• What was the condition?• Emergency room transport?
A rating scale will be constructed from these data, which will be used to assess whether the condition could have been (or was) treated through Community Paramedicine.
The results of the qualitative and quantitative data will be compared for congruency in support (interviews) and need (Fire Department data).
Scholars note the existing system is based on what the patient perceives their condition to be, and allows them to determine the level of care provided, regardless of suitability and cost. If a patient with a Urinary Tract Infection deems their condition emergent, they can call 911 and have an ambulance take them to the ER, where they will receive an antibiotic and be sent home, continued cost and strain on the emergency system. A MIH system will respect a patient’s right to be seen by a practitioner, but also ensure the patient is seen by the right practitioner at the right time and in the right setting. One example of a MIH program that has already been implemented is Pittsburgh’s CONNECT program (Trozzo, 2013), which came about as a grassroots effort from residents from the Congress of Neighboring Communities, who recognized there were difficulties supporting their local ambulance services. As changes in healthcare reform accelerated, residents realized stakeholders such as The University of Pittsburgh Medical Center and Highmark may want to get involved with local EMS agencies. The Community Paramedics in Pittsburgh act as patient advocates, assist patients by filling prescriptions and complying with provider orders, and helping patients get to appointments. They focus on treating patients with chronic conditions and conditions that often result in readmissions, such as asthma, diabetes, and Congestive Heart Failure. Referrals for the program can come from area hospitals, insurance payers, and the local EMS agencies that have regular interactions with these patients. Community Paramedics work closely with Primary Care Providers and social service agencies to ensure patients are receiving proper, coordinated care. The goals of Pittsburgh’s program are to reduce misuse of the emergency system and ERs, make better use of EMS resources, improve collaboration among agencies, and provide better care and follow-up for patients. While healthcare is an ever evolving field, EMS has historically been unable to keep up with changes and growth, leaving providers with limited scopes of practice and unable to effectively and efficiently treat patients. However, with new regulations and standards from the ACA, agencies are beginning to revolutionize the way they view emergency and at home care. Utilizing a patient-centered approach, WNY agencies can better monitor target populations to reduce misuse of the emergency system, lower cost, improve care, and free up resources. However, new programs cannot succeed and sustain without significant collaboration across sectors and among agencies. Changes will have to be made in the NYS laws to allow for services to be provided and paid, but the literature has shown that progress has been made in filling healthcare gaps with Community Paramedicine.
Hypothesis
Photos by: Kimberly R. Renda
Primary Care
Emergency Care
Community Paramedicine
Community Paramedicine will not be a cost effective option for insurance providers and hospitals in reducing unnecessary hospital admissions and 911 transports, and will not improve care.
