Excellence in EMS Integration Awards

Excellence in Public Information or Education

In 2019 the Richmond City Health District (RCHD) launched a new partnership and program with Richmond Ambulance Authority (RAA) called "First Responders for Recovery" to combat opioid abuse and help patients connect to recovery resources. The RCHD's Peer Recovery Specialist trains RAA's trains RAA Paramedics and EMTs on different methods they can use to encourage patients to sign a "First Responders for Recovery" release form. Within 48 hours RCHD’s Peer Recovery Specialist contacts the patient to try and get them into a recovery center.

Organization Description
The mission of the Richmond City Health District is to promote healthy living, protect the environment, prevent disease and prepare the city for disasters.

Date of Implementation: May 2019

Number and Demographics of Patients

Since launching RAA has obtained 228 signatures from patients interested in being contacted by RCHD's Peer Recovery Specialist as part of the program. The average age of the patients is 44.2. The minimum age is 23 with the maximum age being 86.

Outcomes / Utilization

While the goal of the program has been to provide better options for patients with opioid addiction and get those patients connected to recovery resources, the amount of man hours saved by potentially preventing repeat calls for the same patient suffering an overdose is an extremely valuable asset for RAA's EMS system. By potentially lowering the number of repeat calls for an overdose, RAA's first responders are available for other emergent calls.

Additional Information

• Richmond Ambulance Authority & Health District Announce Plan to Steer Opioid Users to Recovery 
• Richmond Groups Team Up to Fight the Opioid Epidemic 
• Program to Help People Find Addiction Recovery Resources Begins in Richmond 
• Opportunity to Offer Hope 

Leadership in Integrated Healthcare—Lifetime Achievement Award

Linda Frederiksen began employment at MEDIC EMS in 1995 as the Quality/Education Coordinator.  Prior to working at MEDIC, Linda worked as an Emergency Department Registered Nurse, holding Iowa and Illinois Nursing licenses and Illinois Trauma Nurse Specialist. She worked as an Emergency Medical Services Educator prior to coming to MEDIC and still continues to teach, holding several instructor certifications including ACLS, PALS, BLS, PHTLS and NRP.  A Nationally Registered Paramedic for twenty-five years, Linda is a critical care paramedic, holds a Bachelor of Science in Nursing from the University of Illinois, as well as a Masters’ degree in Public Administration from Drake University in Des Moines, Iowa.

Named the fourth Executive Director in the history of the company in 2004, Linda has a strong clinical background in Total Quality Management and Education, and holds an Emergency Medical Dispatcher-Quality Certification.  Linda is on the Board of Directors for the Iowa Emergency Medical Services Association, and has served as President, Vice-President, and Treasurer. As well as the Secretary and Treasurer of the Scott County Emergency Medical Services Association.

She is active on several boards and panels including the Eastern Iowa Community Colleges, Black Hawk College, University of Iowa Emergency Medical Services Learning Resource Center, Scott Emergency Communications Center Technical Advisory Committee and Board Ex-Officio and the Scott County High Utilizers Group to name a few.

Leadership in Integrated Healthcare, Distinguished Service

Montgomery County, Indiana  Project Swaddle:  In 2013, a small group of committed citizens and public servants in Montgomery County, Indiana recognized novel approaches were necessary to address the health challenges facing the local community. Like many rural communities, its residents are primarily White, Non-Hispanic individuals (92%) who speak English (95%), have a high school degree but somewhat limited college experience (89% high school degree; 18% college degree), have an average annual household income ($53,075), and were born in the US (97%). Montgomery County faces a set of challenges, which are shared by many other rural communities. High teen birth rates, substantial food insecurity, substance use during pregnancy, and limited access to obstetrics care contribute to poor health and well-being of children in Montgomery County. Additionally, poor mental health, limited access to mental and physical health care, high rates of substance use, and a range of factors influencing maternal health are key challenges to the health and well-being of the general community.    

In an effort to combat these issues, this coalition focused on developing sustainable, effective prevention and intervention strategies addressing the socioecological determinants of health. As a result of this coalition’s effort, the Montgomery County Mobile Integrated Healthcare-Community Paramedicine (MIH-CP) program was developed. The MIH-CP program uses trained community paramedics to deliver in-home services to patients under the supervision of a physician. The first MIH-CP initiative, funded by a grant from ISDH, proved to be an efficient and effective method for providing care and managing high-risk patients. During the chronic disease pilot program, there was a 98% reduction in ER and hospital visits among participants. The MIH-CP program was quickly expanded to accept patients with other chronic diseases. Additionally, the coalition also developed Project Swaddle, a community paramedicine program to provide in-home prenatal and postpartum services to women with high risk pregnancies.    

 The purpose of Project Swaddle is to empower women with the skills and environment needed to raise a healthy infant/child, while maintaining their own physical and mental health. The program currently provides the best available level of prenatal care, along with additional services to prepare women for motherhood. Throughout pregnancy and the 16 weeks following birth, community paramedics make regular in-home visits. During these visits, they and a community health worker partner to address the mother and infant’s clinical, behavioral, and environmental needs. While acting as a physician extender for regular prenatal care, and maternal and infant postpartum care, the community paramedics provide transportation assistance, safe sleep education (DOSE), abusive head trauma prevention education (Period of PURPLE Crying), home safety inspections, health and depression screenings, social service referrals, and guidance on coping tools. The community paramedics also provide a warm referral to partner services, including birthing education with a certified Lamaze instructor, lactation consultation, the Baby & Me Tobacco Free Program, and doula services.     

Community paramedics also include psychosocial assessments and interventions in their scope of care for pregnant and postnatal women. Their assessments take into account general statements of patient's feelings about self, degree of satisfaction in interpersonal relationships, clients' in-home relationships, most significant relationship, community activities, work or school relationships, and family cohesion, as well as any protective factors like hobbies, relaxation, leisure and rest distribution, and coping strategies for stress. Interventions, including support from a social worker, are available should the client self-report changes in personality, behavior, mood, feelings of anxiety or nervousness, feelings of depression, or use of medications or other techniques during times of anxiety. Screening for substance abuse or misuse is also critical. Community paramedics note any alcohol or drug use, including types and frequency, habits associated with use, such as sharing needles or driving under the influence, and also other types of potentially harmful substances, including caffeine, secondhand smoke, or poor nutritional quality. Unique to Project Swaddle is the ability to provide Medicated Assisted Treatment (MAT), under the direction of a physician, to pregnant and post-natal women.    

Patients enrolled in Project Swaddle also have access to telehealth equipment and monitoring (e.g., blood pressure monitoring, body weight assessment, glucose monitoring, physical activity tracking). In the event of an emergency, such as critically high blood pressure, the community paramedic receives automatic notification. If available, they are dispatched to the scene, where they evaluate and care for the patient on-site and determine the severity of the situation. In addition to providing telehealth monitoring and crisis response, the community paramedic is available to patients for questions and routine follow-up via secure text messaging and telephone.

Indiana must continue to address numerous challenges to reach its goal of improving mothers’ health and wellbeing, including unique demographic and environmental factors. Overall, a higher percentage of Indiana’s population is living in poverty or with a disability, compared to the overall US population. In contrast, a lower percentage of the population holds a Bachelor’s degree or lives in an urban area. These factors contribute to decreased access to appropriate healthcare, resulting in increased risk for poor maternal and infant health outcomes. Lack of access to obstetric care is another challenge facing Indiana’s women. According to 2018 data released by ISDH, Indiana is home to 86 birthing facilities. However, 35 out of the 92 counties are without a birthing hospital or an obstetrics and gynecology (OBGYN) provider, giving rise to inconsistent access to quality, timely, and specialized women’s healthcare during pregnancy and postpartum periods in those counties. This crisis continues to grow, as hospitals offering obstetric services continue to close their doors. Three hospitals have done so since the fall of 2017. A sustainable alternative to traditional clinic-based healthcare must continue to be developed.     

Community paramedicine and Project Swaddle offer one novel approach to address Indiana’s unique challenges. The goal of community paramedicine is to improve access to care and avoid effort duplication. While these services are often used to address access to care issues among older adults or individuals with chronic diseases, Montgomery County, Indiana discovered the principles of their thriving community paramedicine program could be adapted to a population of at-risk pregnant women and mothers. Project Swaddle currently provides the best available level of prenatal care, along with additional services to prepare women for motherhood.  

Although formal evaluation of this CPP has not yet been conducted, preliminary evaluation suggest women enrolled in the program have better than expected outcomes, as do their infants, compared to women not enrolled. Since CPPP implementation in Montgomery County, there have been lower NICU rates and length of hospital stays, fewer preterm births, and fewer child protective services removals than previously experienced among similar women in the community. We have conducted several case studies of the mothers enrolled in the program, which show consistent positive health outcomes for mothers and their infants. Additionally, women report improved social connections among friends and family, and increased community support through resources (e.g., connected to free car seat programs) and interpersonal relationships (e.g., relationship with paramedic).

Biography

Division Chief Paul Miller began his career on a paid on-call fire department in 1996 near Flint Michigan prior to accepting a full-time position in June of 1999 with the Crawfordsville Fire Department as a firefighter/EMT. In 2014 Chief Miller was appointed to the rank of Division Chief from Lieutenant where he continues to serve. Chief Miller has previously served as an adjunct instructor for Vincennes University & Ivy Technical College and is a regular featured speaker for many state and national conferences in addition to collaboratively constructing one of the most diverse community paramedicine programs in the country with many non-traditional partners.

Leadership in Integrated Healthcare, Distinguished ServiceNominated by Cyndy Stone, PatientCare EMS Solutions

As a certified paramedic, community paramedic and Director of Business Development / Community Paramedicine at Empress EMS (partner with PatientCare EMS Solutions), Hanan Cohen has served in the EMS Industry and Hospital Administration for over 30 years.  About 6 years ago, he started a quest to bring Mobile Integrated Health programs (Community Paramedicine (CP) to patients in the Bronx, NY and in Westchester County, NY.  Through his efforts, Empress EMS launched CP programs for both St. Barnabas Hospital in the Bronx and White Plains Hospital in White Plains, NY. These treat in place programs  primarily focus on reducing readmission of high-risk patients with chronic disease to the hospital and preventing the use of the emergency room for non-emergency issues.  This programs includes personal outreach to patients identified as higher risks and follow up with ER patients to help ensure that they do not return to the ER unnecessarily.     

The development and implementation of these programs helped to prepare the Empress team for what was to come with COVID-19, when the NY State Department of Health called on them to provide the first testing in homes for high-risk patients and in nursing homes during the peak of the outbreak.  In addition, Hanan worked with NYS DOH to open the first COVID-19 drive through testing facility in New Rochelle which became a model for other testing sites opening across the country.     

Hanan is a member of the American Ambulance Association National Corona Virus Workgroup, the Empress lead on the NYS DOH COVID-19 Task Force, a member of the NY Mobile Integrated HealthCare Alliance and a member of the AAA Payment Reform Committee.  His remarkable work in Mobile Integrated Health (MIH) was needed during the initial stages of the COVID-19 pandemic.  The well-established model along with the professional relationships developed through his work in MIH and CP created a clear recipe for operational success.  The stellar work, against many odds, during the crisis has become the focus of national attention.  He contracted the virus himself, although asymptomatic, and continued to lead during this effort while quarantined. He would be a worthy recipient of this prestigious award and a great example of how MIH leaders should lead from the front.

During the pilot phase of the Community Paramedic program developed by Hanan in partnership with other medical professionals,  metrics measured were decrease in Emergency Room utilization and decrease in readmissions, both of which were achieved.  Part of the success was Hanan and his teams efforts to follow-up by phone to those in the high risk category.    

During COVID-19, as the first agency to work with NYS Task Force to activate mobile testing in homes with high risk patients and nursing homes, the procedures were requested by the CDC and other states. Further, developing a consistent employee communication model to provide consistent and accurate information was key to keeping the Empress team motivated and properly informed.  This included but was not limited to frequent supervisor interaction, including supervisors or first wave of COVID-19 calls, daily debriefings, mobile app to maintain a consistent message and reliable information, email, internal Facebook with consistent messaging to ensure that staff were properly informed of protocol, procedure and that they knew they were critically important in ensuring a positive response to this crisis; proactive approaches to training and infection control procedures which were implemented prior to state and federal requirements which included producing videos and hand-outs on proper use of PPE; donning PPE prior to knocking on doors, stepping back after knocking, maintaining limited interactions; repeating screening questions, placing masks on every patient, and more.   

In addition, to follow up on the CP programs' successes, Empress called treat-at-home COVID-19 patients to answer questions, and further assess symptoms.  They delivered food and medications to patients without access, followed up with doctors on behalf of patients to ensure proper medications and home health equipment.  During the very early stages of the outbreak, decontamination was taking 2.5 - 3 hours per vehicle which was a major strain on the business and it's already over-worked employees through this crisis.  To provide relief, Empress hired approximately 20 employee family members and friends who had lost their jobs due to the pandemic.  This provided needed relief to the employees, income for struggling families and a sense that the company understood the challenges and cared about its employees.     Hanan, with his vast EMS and Hospital administration knowledge coupled with his extensive experience with community paramedicine and now with COVID-19 pandemic management have resulted in many requests to consult and speak on the topics.

Biography

Hanan is the Director of Business Development and Community Paramedicine at Empress EMS.  He is a paramedic and community paramedic with 30 years experience in EMS and Hospital Administration.  His major focus is on new program design to provide collaborative community health programs with hospitals in Westchester County, NY and New York City.

2020 Leadership In Integrated Healthcare Award, Research

Dr. Brad Cannell has led an effort with two universities to test methods to make it easier and more reliable for EMTs to identify potential victims of elder abuse and neglect.  Brad has been the principle investigator for two studies for the detection of elder abuse through emergency care technicians (DETECT) studies.  The first project was funded by a grant awarded by the National Institute of Justice, Office of Justice Programs, U.S. Department of Justice (DOJ), and was conducted through the University of North Texas Health Science Center.     

Results from the study have been published in JAMA - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765655     

A current study is being conducted through Dr. Cannell’s affiliation with the University of Texas and is funded through the National Institutes of Health (NIH).     

The mistreatment of the elderly is a serious and widespread public health problem with far-reaching implications, and often EMS may be the only ‘witness’ to the victimization.  Unfortunately, many EMTs are unaware of the subtle ways to detect elder abuse.  Dr. Cannell’s studies are helping determine the most effective ways EMTs can use tools and worksheets embedded into electronic patient care reports (ePCRs) to screen patients for potential elder abuse.   

MedStar has participated in both of these studies, and has implemented training and ePCR worksheets to support these studies.  In the most recent study, MedStar community paramedics conduct face-to-face interviews with patients screened as being at high risk for potential elder abuse to test the worksheets for accuracy in reporting.

The mean (SD) age of the 11 178 older adults included in this study was 76 (8) years (range, 65-105 years); there was no reported data on patient sex. A total of 18 080 reports of elder mistreatment were recorded. Medics within the study region reported more cases of elder mistreatment during the implementation of the screening tool (relative risk [RR], 4.14; 95% CI, 3.25-5.27). After adjusting for changes in the number of elder mistreatment reports in the comparison groups (ie, underlying changes in reporting trends), the number of reports to APS increased (RR, 3.03; 95% CI, 2.06-4.46). The occurrence of elder mistreatment was validated in 83% (95% CI, 75%-91%) of the reports investigated by APS during the periods when medics did not have access to the screening tool compared with 82% (95% CI, 77%-87%) during the periods when medics had access to the screening tool, indicating that there were no differences in the proportion of reports that resulted in a validated Adult Protective Services (APS) investigation.

Biography

Dr. Cannell received his PhD in Epidemiology, and Graduate Certificate in Gerontology, in 2013 from the University of Florida. He received his MPH with a concentration in Epidemiology from the University of Louisville in 2009, and his BA in Political Science and Marketing from the University of North Texas in 2005. During his doctoral studies, he was a Graduate Research Assistant for the Florida Office on Disability and Health, an affiliated scholar with the Claude D. Pepper Older Americans Independence Center, and a student-inducted member of the Delta Omega Honorary Society in Public Health. In 2016, Dr. Cannell received a Graduate Certificate in Predictive Analytics from the University of Maryland University College, and a Certificate in Big Data and Social Analytics from the Massachusetts Institute of Technology.   

Dr. Cannell’s research is broadly focused on healthy aging and health-related quality of life. Specifically, he has published research focusing on preservation of physical and cognitive function, living/aging with disability, and understanding/preventing elder abuse. Additionally, he has a strong background and training in epidemiologic methods, and predictive analytics. He has been principal or co-investigator on multiple trials and observational studies in community and healthcare settings. He is currently the principal investigator on the Detection of Elder abuse Through Emergency Care Technicians (DETECT) project.

Excellence in Value Demonstration or Research

Video or Telephone? A Natural Experiment on the Added Value of Video Communication in Community Paramedic Responses

Published peer reviewed research in Annuals of Emergency Medicine

Annals of Emergency Medicine, 09 Jun 2020, DOI: 10.1016/j.annemergmed.2020.04.026 PMID: 32534834

Organizations Involved

Northwell Health Center for EMS, Northwell Health Clinical Call Center, Northwell Health House Calls Program

Abstract

STUDY OBJECTIVE: The objective of this study was to determine the effect of video versus telephonic communication between community paramedics and online medical control physicians on odds of patient transport to a hospital emergency department (ED).

METHODS: This was a retrospective analysis of data from a telemedicine-capable community paramedicine program operating within an advanced illness management program that provides home-based primary care to approximately 2,000 housebound patients per year who have advanced medical illness, multiple chronic conditions, activities of daily living dependencies, and past-year hospitalizations. Primary outcome was difference in odds of ED transport between community paramedicine responses with video communication versus those with telephonic communication. Secondary outcomes were physicians' perception of whether video enhanced clinical evaluation and whether perceived enhancement affected ED transport.

RESULTS: Of 1,707 community paramedicine responses between 2015 and 2017, 899 (53%) successfully used video; 808 (47%) used telephonic communication. Overall, 290 patients (17%) were transported to a hospital ED. In the adjusted regression model, video availability was not associated with a significant difference in the odds of ED transport (odds ratio 0.80; 95% confidence interval 0.62 to 1.03). Online medical control physicians reported that video enhanced clinical evaluation 85% of the time, but this perception was not associated with odds of ED transport.

CONCLUSION: We found support that video is considered an enhancement by physicians overseeing a community paramedicine response but is not associated with a statistically significant difference in transport to the ED compared with telephonic communication in this nonrandom sample. These results have implications for new models of out-of-hospital care that allow patients to be evaluated and treated in the home.

Nominated by Matt Zavadsky, Medstar Mobile Healthcare

VITAS Healthcare of Fort Worth has partnered with MedStar Mobile Healthcare on a hospice revocation avoidance program since 2013.  

The partnership is designed to prevent hospice revocations and enhance the experience of patients and families enrolled in VITAS’s hospice program by providing a ‘safety net’ in the event of a hospice-related 9-1-1 activation for the enrolled patient.     

Patients/families at risk for a potential 9-1-1 activation are identified by VITAS and referred to MedStar for enrollment.    MedStar does an initial home visit for the family and patient to explain the goals of the partnership and explain what might typically happen in the event of a 9-1-1 call.     

Enrolled patients are flagged in MedStar’s computer aided dispatch system and if 9-1-1 is activated, in addition to the regular EMS response, a MedStar Community Paramedic co-responds to the call.  MedStar’s communications center also notifies the on-call VITAS Hospice nurse of the response.     

Once on scene, if the 9-1-1 activation is related to the patient’s hospice plan of care, the on-scene MedStar CP assists the patient and family with comfort measures, such as administration of medication from the patient’s ‘comfort pack’.  The VITAS on-call nurse is contacted by the CP for care coordination.  Typically, these patients are managed at home, without the need for an ambulance trip to the emergency room.  If, in the determination of the on scene MedStar CP, the VITAS nurse, and the family, the patient is not able to stay home, the VITAS nurse makes arrangements for the patient to be transferred to an in-patient hospice unit.   

VITAS also has the capability to access MedStar to request an episodic home visit for an enrolled hospice patient to do an assessment, treatment and communication with the VITAS nurse.   

This partnership has been profiled in numerous healthcare journals, and the Advisory Board Company.   

To date, 462 patients have been enrolled in this program, and 9-1-1 was activated for the patients 208 times.  Of these calls, only 108 resulted in a transport from the home, and 17 of these were transported to an in-patient hospice unit.   

Of the 462 patients referred who were at risk for revocation, only 89 (19.3%) experienced a revocation.

Nominated Organization Description
VITAS provides coordinated care and offers support to patients and their families with a range of options that corresponds to their specific needs. Guided by an individualized care plan, hospice care often begins with routine home care and includes a number of specialized services.      

VITAS offers several key services that support patients and their families as they provide hospice care at home. Our Telecare clinicians are available via phone 24/7/365 to answer questions and dispatch someone to the bedside, if necessary. Medical equipment and medications are delivered to the home a well, and respite care provides up to 5 days of Medicare-certified inpatient care for a hospice patient so that family members can take a break from their caregiving duties to relax, unwind, recharge, travel, recover from an illness or attend other events.

Date of Implementation: 2013

Number and Demographics of Patients

462 patients identified as at-risk for 9-1-1 activation and revocation of hospice status.

Outcomes / Utilization

To date, 462 patients have been enrolled in this program, and 9-1-1 was activated for the patients 208 times.  Of these calls, only 108 resulted in a transport from the home, and 17 of these were transported to an in-patient hospice unit.   

Of the 462 patients referred who were at risk for revocation, only 89 (19.3%) experienced a revocation.

Learn more

• Innovative Partnership Breaks Cycle of Rehospitalization
• Fort Worth Paramedics Take Detour to Save Hospice Patients an ER Trip 
• EMS World Home Health, Hospice, and EMS Team Up to Tackle the Triple Aim 
• Healthcare Innovation the Fort Worth Way 

Montgomery County Adult Protective Services (APS) and Montgomery County Fire and Rescue Services (MCFRS) have launched an innovative partnership to address the most vulnerable among our population. MCFRS is the highest single referrer of cases to APS annually. Patients referred to APS often have a variety of social and medical issues that lead to them calling 911 more frequently than an average resident. Previously, APS case managers would respond to these referrals on their own, but there was limited information flow between EMS and APS regarding case resolution or client needs. To increase the effectiveness of APS referrals, and better address the needs of high utilizers, the Mobile Integrated Health program was started within MCFRS in 2015. MIH partnered with APS and other sections of the Montgomery County Department of Health and Human Services to track EMS high utilizers and identify whether or not they were already receiving county interventions. In many cases, their case managers were unaware of how many 911 calls these clients were generating. Beginning in 2019, the partnership was taken one step further, and a Registered Nurse and Social Worker were added to the MIH team. Both of these positions are also part of the APS program. This cross-training has created a seamless collaboration in which APS and MIH field evaluations can occur simultaneously. The MIH/APS staff can address the needs of appropriate EMS high utilizers by identifying necessary interventions/resources, connecting them to community partners/programs, and diverting 911 calls that would otherwise be generated. These two staff positions also assist in the oversight of the community paramedics who regularly visit EMS high utilizers. Our partnership with APS has also enabled us to share educational information with our providers regarding appropriate APS referrals. In years past, EMS would make referrals but APS was unable to connect with the referring provider due to lack of contact information, misunderstanding of shift rotation, etc. Without a detailed conversation with the provider, APS would not necessarily be able to start an investigation. Once EMS and APS were able to collaborate on these referrals, APS had a consistent connection point which resulted in more APS assessments being performed when needed. MCFRS is proud to say that due to our improved communication and information sharing, 100% of all Fire/Rescue referred cases are deemed to be APS-appropriate and result in an investigation. Lastly, we are working together to explore the introduction of an assessment tool which would be embedded in ImageTrend eMeds report and would allow any clinician to do an immediate and rapid assessment for APS eligibility based on Maryland and Montgomery County criteria. That referral would then be tracked to ensure the clinician followed up directly with APS.

Organization Description
Adult Protective Services (APS) is a program that serves adults, 18 and over, who are in a situation of vulnerability and either at risk of, or experiencing, exploitation and harm.  They investigate situations of suspected abuse and provide professional services designed to protect the wellbeing of vulnerable adults. There are a variety of types of abuse and neglect that warrant a report being made to Adult Protective Services, and an APS intake worker will assess each situation and determine if it necessitates intervention by APS.

Date of Implementation
Original program was implemented in 2015. Program enhancements and cross-staffing began in earnest in November 2019

Number and Demographics of Patients
In FY20, APS received 4,955 referrals. Out of those, 971 were converted into investigations, for an investigation rate of 19.5%. In that same timeframe, MCFRS made 51 referrals to APS, and all 51 became investigations, for an investigation rate of 100%. MCFRS referrals accounted for 5% of all APS investigations in FY20.

Outcomes / Utilization
MCFRS MIH and APS now work collaboratively to address the needs of clients. We provide background information for APS caseworkers on their investigations, such as frequency of 911 calls to the client's home, or medical/hospitalization records through CRISP (Chesapeake Regional Information System for our Patients), a state-wide HIE sharing hospitalizations, EMS encounters, private practice visits, and prescription information.  Our cross-trained staff can simultaneously assess patients for APS and MIH enrollment, and refer patients to appropriate resources quickly and efficiently. They will also be incorporated in future revisions to our Mobile Crisis Response program, Crisis Now.

Supporting Docs
https://results4america.org/tools/case-study-montgomery-county/

2019 AIMHI EMS Integration Award
John Peter Smith Health Network

John Peter Smith Health Network partnered with MedStar Mobile Healthcare on a comprehensive approach to helping improve patient outcomes, enhance experience of care, and reduce healthcare expenditures for high utilizer patients and patients at risk for preventable readmissions. Since initiation of the program in 2013, 507 patients have graduated from the program.

The high-utilizer cohort experienced a 40.6% reduction in ED visits (507 less occurrences) and a 31.3% reduction in inpatient admissions (365 less occurrences). The readmission prevention cohort experienced an 83% reduction in expected readmissions (292 fewer occurrences).

About John Peter Smith Health Network

For more than 100 years, JPS Health Network has served the medical needs of Tarrant County families as the community’s public healthcare system. 

The Network operates the 573-bed John Peter Smith Hospital, providing emergency services and trauma care at Tarrant County’s only Level 1 Trauma Center. JPS operates more than 40 community and school-based health centers in the neighborhoods where our patients live. 

JPS has become a leading academic teaching hospital in innovative curricula, excellence in scholarly activity and evidence-based community-oriented research. Training is important to the mission of JPS in its efforts to meet the health care needs of Tarrant County. 

JPS Health Network is a $950 million, tax-supported health care system for Tarrant County in North Texas. 

JPS is anchored by John Peter Smith Hospital, which is a 573-bed acute care in Fort Worth, Texas. JPS has the only Level 1 Trauma Center in Tarrant County and the county’s only psychiatric emergency services site. JPS is also a certified Chest Pain Center, Certified Primary Stroke Center and an Accredited American College of Surgery Cancer Center. JPS has a Level lll Neonatal Intensive Care Center (NICU).  The network has more than one million patient encounters per year.

Number and Demographics of Patients

168 high utilizer patients and 339 readmission risk patients.

Outcomes

This program has saved estimated healthcare expenditures of $9 million in prevented ED visits and inpatient admissions.

2019 AIMHI EMS Innovation Award
Northern Nye County Hospital District

In April 2018, the Northern Nye County Hospital District entered into a professional services agreement with REMSA's Integrated Health Community Paramedic Program.  With the closure of it's only hospital in Tonopah Nevada, and a struggling EMS Volunteer system the Hospital District sought out services to provide a higher level of care to the citizens and visitors to Northern Nye Co. and specifically, the frontier town of Tonopah NV.     

Through innovation and collaboration, the Hospital District worked with REMSA to develop a program that would supplement the existing Nye Co. BLS Volunteer EMS system by co-responding an advanced life support Community Paramedic to all 911 requests for service.  The Community Paramedic can determine the most appropriate patient pathway including; attending to the advanced life support patient in the back of the Nye Co. Volunteer Ambulance during the approximate 2 hr. transport to the closest receiving hospital, initiating direct communication with an air medical resource, or initiating alternative destination transport to the local clinic for low acuity patients.  Additionally, the Community Paramedic operates under an expanded scope of practice, and has integrated into the local clinic with the ability to assist with treatment, and do telemedicine presentations to the trauma center approximately 4hrs. away in Reno NV.  In mid 2019, the program will begin a mobile telemedicine program during times of non clinic availability.  The program also provides in home Community Paramedic patient referral visits and consultation for numerous cases such as CHF, COPD, and medication compliance.  For non emergency services, The Northern Nye Co. Hospital District established 24/7 access to REMSA's dedicated Nurse Health Line number for medical assistance to residents within Northern Nye Co.     

The Northern Nye County Hospital District has been the driving force behind the program.  The goal of expanding the level of care, determining the most appropriate patient pathway, and eliminating long distance transports for those with low acuity emergencies, has proven to invigorate a depleted volunteer EMS System tired of 4 hour transports.  The dedication and willingness of the Northern Nye Co. Hospital District to apply innovation is truly improving emergency and non emergency healthcare to a frontier area struggling to keep their communities healthy and safe.  The nomination of the Northern Nye County Hospital District is truly deserved, and may ultimately pave the way for rural healthcare throughout the country.

About Northern Nye County Hospital District

The Northern Nye County Hospital District was established by the Board of Nye County Commissioners in May 2015 under the provisions of state law NRS 450.550 and including NRS 450.760 through Nye County Resolution No. 2015-17.   

The purpose of the District is to facilitate the provision of accessible health care services to the residents of and visitors to Northern Nye County. The Board of Trustees recognizes that the delivery of health care services is a dynamic process, and the District must utilize its limited available financial resources in the best and most efficient manner possible.

Date of Implementation

• 1/1/18 Nurse Health Line
• 4/16/18 Community Paramedic Program implemented

Number and Demographics of Patients

Since the launch of Community Paramedics on April 16, 2018 to December 31, 2018 the program has remained in service 24 hours per day 7 days a week without interruption.  There has been no out of service hours documented by REMSA’s Community Paramedics.   

Additionally, REMSA’s Community Paramedics have served as the 2nd ambulance provider for Nye Co. EMS in Tonopah approximately 80% of the time.    

• Responses—282 
• Clinic Assist Responses—19 
• Hospital Transports—106 
• Nurse Healthline Calls—310   
• Transport percentage—42% 
• Non-transport percentage—49% 
• Alternative Destination transport percentage—9% 
• Community Paramedic home referral program—1 currently enrolled for COPD   

Patients have benefited, and survivability rates have improved from the increased level of service and advanced life support practice that has become a normal response to all requests for service within Northern Nye Co. and the surrounding areas.