Evaluation of California’s Community Paramedicine Pilot Program
Community paramedicine, also known as mobile integrated health, is an innovative model of care that is being implemented throughout the United States. From 2014 to 2020, the California Emergency Medical Services Authority sponsored a Health Workforce 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.
On September 25, 2020, California’s governor signed AB 1544, a bill that authorizes local emergency medical services agencies to develop community paramedicine or triage to alternate destination programs in accordance with regulations that EMSA will develop. When AB 1544 went into effect on January 1, 2021, responsibility for the 14 pilot sites that were in operation was transferred from OSHPD to EMSA. These pilot projects will continue to operate as they have in the past pending EMSA’s adoption of regulations to implement AB 1544.
Healthforce Center at UCSF conducted 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. Seven updates to the report have been released that reflect new data from the pilot projects. The latest update to the report, which was released in February 2021, presents findings from the time the initial group of pilot projects began enrolling patients (June 2015 to October 2015) through September 2020. Under the pilot, community paramedics provide:
- Short-term follow-up care after hospital discharge for people with chronic conditions
- Case management services for frequent users of the emergency medical services system
- Directly observed therapy for people with tuberculosis
- Collaboration with hospice nurses to reduce unwanted transports of hospice patients to an emergency department
- 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, social workers, and outreach 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. The post-discharge, frequent 911 users, tuberculosis, hospice, alternate destination – mental health projects, and alternate destination – sobering center have improved patients’ well-being. In most cases, they have yielded savings for payers and other parts of the health care system. The seventh concept, alternate destination – urgent care, shows potential but further research involving a larger volume of patients is needed to draw definitive conclusions.