Baltimore mheath pilot aims to reduce emergency callouts
February 19, 2019
The University of Maryland Medical Center is working with the city of Baltimore on a two-year pilot to deploy an mhealth delivery model in selected areas.
The Mobile Integrated Healthcare – Community Paramedicine (MIH-CP) community-based programme will support the health of individuals through a comprehensive, free, multidisciplinary care model for patients that provides care outside the hospital setting, and which is designed to reduce health disparities, decrease emergency department visits and prevent hospital readmissions.
“Mobile Integrated Healthcare is patient centred and incorporates a holistic approach focused on the improvement of patient outcomes,” said Mohan Suntha, chief executive officer of the University of Maryland Medical Center. “Our goal is to meet the health care needs of our community members and to improve health disparities for west Baltimore residents."
The project is designed to provide effective and efficient care to patients outside the hospital. Paramedics and nurses with advanced training can function outside traditional emergency response and transport roles, and instead assist in maintaining individuals’ health at their homes while also providing convenient, unscheduled care access. This programme has been successfully implemented in areas across the country and has improved healthcare access for underserved populations and reduced costs.
Social and economic factors, weaknesses in primary care infrastructure and lack of access to treatment for chronic conditions contribute to a high rate of potentially avoidable health care use and emergency medical service (EMS) responses in west Baltimore. More than 80% of Baltimore City Fire Department (BCFD) 911 responses are for EMS incidents, presenting a significant strain to the system. Further, it is estimated nationally that 15% of persons transported to emergency rooms could be treated safely in non-urgent settings. This statistic is likely higher in west Baltimore given the challenges to health care access, lower health literacy and the complexity of chronic diseases.
“This innovative new partnership with the University of Maryland Medical Center offers the potential to transform the health prospects of those in our community most at risk,” said mayor Catherine Pugh. “Through this integrated mobile healthcare delivery model, we will reduce the burden on emergency medical personnel and on emergency rooms across our city, while still providing superior care to our underserved citizens.”
The two-year pilot programme employs trained paramedics and nurses to provide community-based care through two types of initiatives: minor definitive care now and transitional health support. Initial goals are to improve coordination of medical, behavioural and social services; enhance existing health care systems and resources; help fill the resource gaps within the local community; and improve quality of care while reducing avoidable cost.
MIH-CP will improve patient care by offering ways patients can better manage their health, developing stronger partnerships with the community and providing patients with the opportunity to receive medical care at home.
The minor definitive care now programme is focused on pre-hospital health care delivery. After responding to a 911 call, BCFD EMS personnel determine if the patient is appropriate for on-site evaluation and definitive care by a paramedic-nurse practitioner team. With an estimated 32% of patient calls qualifying for this service, BCFD anticipates nearly $1.4m a year in cost avoidance by appropriately reducing patient transport while delivering quality care on-scene. UMMC will experience cost savings of approximately $520,000 a year. Baltimore 911 response times will be reduced and over 2000 patients per year will avoid the emergency department. The financial savings estimates are based on modelling.
Additionally, a greater quality of care at a lower cost to both the patient and Baltimore city will be rendered.
After placing a 911 call and before going to the emergency room, the patient will be informed of the services and have the ability to opt in. A paramedic-nurse practitioner team will determine if a patient is appropriate for on-site evaluation and definitive care, geared towards low acuity patients. The team will arrange follow-up with appropriate care providers; this will hopefully eliminate the need for transport. After being evaluated, patients still have the option to request to be taken to the emergency department if they choose.
Transitional health support improves the transition of care from the hospital to the home, specifically targeting individuals with chronic diseases requiring frequent hospitalisation, particularly those covered by Medicare – an estimated 2000 patients served by UMMC.
In coordination with BCFD, UMMC will identify 50 of these patients at discharge and link them with a community paramedic nurse team. This team will deliver follow-up care and assist with chronic disease management for 30 days, including facilitating care coordination. This programme will save BCFD nearly $300,000 a year by reducing transports; decrease avoidable costs for UMMC by $3.5m a year; and, eliminate approximately 450 or more EMS calls per year by providing alternatives for patients who are historically high-using patients of the 911 system.
It will also allow the community paramedicine team to follow 50 patients who opt-in; the team will conduct follow-up home assessments during the first 30 days after patients have been discharged from the hospital. The 30-day follow-up care includes arranging outpatient clinic follow-up with the patient, and providing secondary support such as transportation, social resources and education. It provides patients with additional education about chronic disease management for the patient by the advanced paramedic team. And it may provide certain medications to be administered to the patient at home.
During the two-year pilot, data will be collected and analysed to understand outcomes of patients, cost savings, patient satisfaction and the potential scalability across the city and state. It is anticipated that it will dramatically change health care delivery to the citizens of Baltimore.