Systematic Review of Community Paramedicine and EMS Mobile Integrated Health Care Interventions in the United States

Abstract

Emergency medical services (EMS) in the United States are frequently used for nonurgent medical needs. Use of 911 and the emergency department (ED) for primary care-treatable conditions is expensive, inefficient, and undesirable for patients and providers. The objective is to describe the outcomes from community paramedicine (CP) and mobile integrated health care (MIH) interventions related to the Quadruple Aim. Three electronic databases were searched for peer-review literature on CP-MIH interventions in the United States. Eight articles reporting data from 7 interventions were included. Four studies reported high levels of patient satisfaction, and only 3 measured health outcomes. No study reported provider satisfaction measures. Reducing ED and inpatient utilization were the most common study outcomes, and programs generally were successful at reducing utilization. With reduced utilization, costs should be reduced; however, most studies did not quantify savings. Future studies should conduct economic analyses that not only compare the intervention to traditional EMS services, but also measure potential cost savings to the EMS agencies running the intervention. Most cost savings from reduced utilization will be to insurance companies and patients, but more efficient use of EMS agencies' resources could lead to cost savings that could offset intervention implementation costs. The other 3 aims (health, patient satisfaction, and provider satisfaction) were reported inconsistently in these studies and need to be addressed further. Given the small number of heterogeneous studies reviewed, the potential for CP-MIH interventions to comprehensively address the Quadruple Aim is still unclear, and more research on these programs is needed.

Community paramedics treat high acuity conditions in the home: a prospective observational study

“…32 33 Lastly, a recent review of eight CP studies in the USA showed promise for decreased ED and hospital utilisation, but commented on lack of quantification of impact on cost of care across studies. 34 Propagation of the CP model is currently limited by several factors. First, as noted above, in-home care provided by paramedics and other EMS responders that does not culminate in hospital transport is not traditionally reimbursed, which has implications for policy-makers.…”

Approaches for Improving Health Equity: The Effect of The Gainesville Community Resource Paramedic Program on Reducing Emergency Department Utilization

“…As communities have searched for innovative strategies to break the cycle of poor health and high demand on community services, the community paramedicine (CP) model has emerged nationwide as a promising evidence-based approach (O'Meara 2014). The CP model seeks to improve health outcomes, system costs, patient quality, and utilization e ciency within established emergency medical services (EMS) infrastructure (Gregg, 2019). In CP programs, Fire Rescue or EMS departments utilize front-line paramedics in collaboration with interdisciplinary partners such as physicians and social workers to address the needs of these vulnerable patients with complex medical and social needs.…”

“…In a more recent review, studies that only included care coordination showed none or mixed results (Iovan, 2020). In a scoping review of studies in CP, only four of the eight identi ed studies included social support services outside of healthcare and none were speci cally focused on providing care that meaningfully addressed social determinants (Gregg, 2019). While comprehensive improvements to primary care delivery emerging alongside value-based payment programs may help in improving frequent ED usage, CP has the potential to help address upstream needs while integrating seamlessly into current health care delivery.…”

How to Screen Suitable Service Improve Community Health Care Services by University Students in Taiwan

“…After 20 years, ideals regarding the participation and autonomous management of communities are no longer limited to the comprehensive community development policies [ 23 ]. Programs implemented by departments related to environmental protection, internal affairs, agriculture, culture, policing, economy, commerce, health, and social affairs also focus on community residents to facilitate bottom-up operation, promote spontaneity, as well as transform communities and create local atmospheres according to residents’ actual needs [ 24 , 25 , 26 , 27 , 28 ].…”