Evaluation of California’s Community Paramedicine Pilot Program
Community paramedicine (CP), also known as mobile integrated health, is an innovative model of care that is being implemented throughout the United States. The California Emergency Medical Services Authority has sponsored a pilot project under which specially trained paramedics perform duties beyond their traditional roles of responding to 911 calls, transporting patients to emergency departments and performing inter-facility transfers. Healthforce Center at UCSF is conducting an evaluation of the pilot project that was funded by the California Health Care Foundation.
In January 2017, Healthforce Center released a report that presented findings from the evaluation for the first 16 months of the pilot project. In November 2017, Healthforce Center released an update to that report that presents findings from the first 25 months of the pilot project and in February 2018, it issued a report on findings from the first 28 months of the project. A report presenting findings from the first 34 months of the project was released in July 2018. The latest update to the report, which was released in February 2018, describes findings from the first 40 months of the project.
Under the pilot, community paramedics provide:
- Short-term follow-up care after hospital discharge for people with chronic conditions
- Case management services to frequent users of the emergency medical services (EMS) system
- Directly observed therapy for people with tuberculosis
- Collaboration with hospice nurses to reduce unwanted transports of hospice patients to an ED
- Transportation for people with mental health needs to mental health crisis centers
- Transportation for people who are acutely intoxicated to sobering centers
- Transportation for patients with low-acuity medical conditions to urgent care centers
The evaluation found that community paramedics are collaborating successfully with physicians, nurses, behavioral health professionals and social workers to fill gaps in the health and social services safety net. The evaluation has yielded consistent findings for six of the seven community paramedicine concepts tested. All of the post-discharge, frequent 911 users, tuberculosis, hospice, and alternate destination – mental health projects have been in operation for at least two and one half years and have improved patients’ well-being. In most cases, they have yielded savings for payers and other parts of the health care system. Findings regarding outcomes of a project testing the sixth concept, alternate destination – sobering center, suggest that this project is also benefitting patients and the health care system over the course of its first 14 months. The seventh concept, alternate destination – urgent care, shows potential but further research involving a larger volume of patients is needed to draw definitive conclusions.