Community Paramedic Programs in the United States
Community paramedic programs are now operating in about 20 states.[13] They have been found beneficial in addressing the social determinants of health[14] (Table 1) and domains of healthcare quality (Table 2).[15]
Table 1. Social Determinants of Health[14]
| Economic stability |
| Education |
| Health and healthcare |
| Neighborhood and built environment |
| Social and community context |
Table 2. Domains of Healthcare Quality[15]
| Safe |
| Effective |
| Patient-centered |
| Timely |
| Efficient |
| Equitable |
Community paramedic programs in rural areas are designed to address chronic disease management and to fill currents gaps in the healthcare system.[16,17] In British Columbia, Canada, community paramedics in a rural setting provide preventive health measures and health promotion activities.[18] Community paramedic programs have been associated with fewer emergency department admissions, EMS transports,[19] and hospital admissions, as well as improved quality of life and healthcare outcomes in patients with chronic medical conditions.[20,21,22,23,24]
Consumers of community paramedic programs have been satisfied with community paramedicine and say that these programs give them a feeling of empowerment in their healthcare and a greater sense of security and support.[25] Community paramedic programs also increase patient referrals to needed home care services.[19]
From the EMS agency perspective, community paramedic programs may be useful as a way to use light-duty EMS providers.[23] Table 3 lists a sampling of community paramedic programs and their services.
Table 3. Summary of a Selection of Community Paramedic Programs
| Program | Services | Goals | Outcomes |
|---|---|---|---|
| CONNECT Community Paramedicine,[26] Pittsburgh, PA |
In-home medication reconciliation Coordinate medical care plan with primary providers, specialists, and hospitals Accompany patients to provider visits Assess for social isolation Assess for changes in activities of daily living Coordinate with social service agencies Navigate patients to social support Assess housing, utilities, food security, and other social determinants of health needs |
Prevent hospital admissions and readmissions Reduce emergency department visits and 911 calls Address social determinants of health |
Saved $1.8 million in healthcare costs Reduced COPD patient readmission rates Reduced emergency department visits and 911 calls for superusers Provided support for chronic pain patients Helped veterans receive benefits |
| Mount Sinai Community Paramedicine, New York, NY |
In-home urgent visits for exacerbations of chronic conditions with in-home treatment Telemedicine consultation with affiliated program physicians and coordination with primary care providers |
Prevent hospital readmissions Reduce 911 calls and emergency department visits |
No data published |
| Northwell Health Community Paramedicine,[28,29,30] New York, NY |
In-home urgent visits for exacerbations of chronic conditions with in-home treatment Telemedicine or telephone consultation with affiliated program physicians and coordination with primary care providers In-home fall risk assessment Disease management education |
Prevent hospital readmissions Reduce 911 calls and emergency department visits |
78% of patients seen by a community paramedic were treated at home; only nine of these were seen in an emergency department within 24 hours Admission rate for those transported by a community paramedic was higher than for a patient transported by traditional means 90% of those who used the community paramedic service stated they would have used traditional 911 if they didn't have a community paramedic option |
| Medstar Mobile Healthcare,[31] Fort Worth, TX |
Routine home visits to high utilizers of the emergency department or 911 to provide disease management education and refer to resources Home visits for patients at risk for 30-day readmission to provide patient and family education and coordinate with primary care provider, coordinate in-home medical care and PCP appointment Post-ED discharge home visits to facilitate observation avoidance and to coordinate primary care follow-up Coordinate with home healthcare services |
Improve patient outcome Improve the health of the population Reduce costs |
Reduced ambulance transports by 60% for enrolled patients and 74% for superusers 52% reduction in readmissions for a high-risk readmission cohort |
| Montgomery County Hospital District Community Paramedicine,[32] Montgomery County, TX |
Comprehensive physical, mental and social home assessment Develop a care plan Coordinate care, manage healthcare communication, and refer to support services and resources |
Reduce 911 EMS utilization | 60% of enrolled patients have shown a reduction in 911 use |
COPD = chronic obstructive pulmonary disease; ED = emergency department; EMS = emergency medical services; PCP = primary care physician
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Community Paramedics: Redefining EMS - Medscape - Feb 07, 2018.
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