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  • 6 Dec 2018 4:38 PM | AIMHI Admin (Administrator)

    Source Article | Comments courtesy of Matt Zavadsky

    Kudos to Chief Lyman and his team at Greeley Fire!

    ----------------------------------

    Colorado Fire Department Reduces 911 Calls By Helping Frequent Callers

    By MICHAEL DE YOANNA  DEC 4, 2018

    MICHAEL DE YOANNA / KUNC

    The Squad 1 crew makes their way to their truck at a downtown Greeley fire station. They're walking, not running, and once their truck is on the road, there are no flashing lights.

    "We hardly ever use the siren," says driver Darren Conradson.

    This is the Greeley Fire Department's solution to a vexing problem: 911 calls that simply aren't emergencies. 

    Instead of sending a big engine with several firefighters -- and possibly police officers and paramedics -- Squad 1 may take the call instead. None of the crew members are firefighters. Conradson is a community paramedic. The other crew members include a crisis intervention counselor and experts at helping people navigate the complex world of social services.

    Their truck is red, but it's an ambulance. It comes to a stop at Paul Villa's small house. He's 89 and used to work in the fields and then at the local meat plant.

    His goal is to keep living in his home, but he's had to resort to 911 several times for help -- but not always for what the fire department would consider an emergency.

    Proactive steps, like this simple check-in, aim to prevent those non-emergency calls, Conradson said.

    "So are you still good on your test strips?" Conradson asked Villa.

    "Yeah," Villa replied. "I'm OK."

    "And glucometer?" Conradson asked.

    "M-hmm," Villa said. "Good."

     

    Five people, 200 calls to 911

    This proactive approach, mixed with Squad 1's triaging of 911 calls as they come in, represents a major shift in culture and thought for the fire department.

    "We're very traditional," Chief Dale Lyman said with a laugh. "We like to send lots of people and big trucks to things."

    The department is set up to respond to fires, life-or-death medical emergencies, hazardous materials situations and rescues. Yet too many 911 calls, Lyman said, are more along the lines of personal emergencies, like people who couldn't get to a doctor's appointment or can't find a way to pick up their prescription.

    "So they get to a point where, 'Well, I'll call 911 and maybe somebody can help me,'" Lyman said.

     

    "There is a segment of our population in our community that doesn't -- I'll just say it -- they don't have access to health care like you or I would."

    For years, firefighters have exchanged anecdotes about such calls. That inspired Lyman to dive into the department's 911 data to learn more.

    First, the obvious: 911 calls to the Greeley Fire Department are up significantly. Since 2001, they have risen by more than 160 percent thanks, in large part, to the city's growing population.

    Yet Lyman uncovered another driver of the calls: social ills.

    "The data, once we started looking at it, proved it," Lyman said. "There is a segment of our population in our community that doesn't -- I'll just say it -- they don't have access to health care like you or I would."

    He also identified what he calls "super utilizers," people who call the department often, posing a big challenge for the

    increasingly-stretched department. In 2016, just five people generated more than 200 of the department's 911 calls.

    One of them was a homeless person and chronic alcohol abuser who called 86 times, prompting 86 trips to the emergency room.

    Another one, with mental health problems, made 26 of the calls and took 20 trips to the ER.

    "It was insanity," Lyman said. "We're sending this highly-trained expensive crew -- fire apparatus, equipment -- for legitimate big-scale problems just over and over again to these things that don't need that. (…) It was a vicious cycle that needed to be stopped."

    When Squad 1 hit the streets in a pilot last year using one of the station's old Chevy Suburbans, the frequent callers didn't just stop. But once the crew started securing long-term services and/or substance abuse help for the group, the number of 911 calls they made dropped significantly.

     

    Squad 1 in action

    After saying goodbye to Paul Villa at his house, Squad 1's crew gauge what they can do for him. Team member Meredith Munoz is also a coordinator with the nonprofit North Colorado Health Alliance and the Community Action Collaborative.

    "He's afraid if he goes and gets care because they're going to say you need to go to a nursing home or something," she said. "His wish is to die in this house so he's very reluctant to even leaving."

    That concerns Jayme Clapp, a mental health therapist with the nonprofit North Range Behavioral Health.

    "I'm assessing his loneliness and if he's had contact because that can lead to a lot of physical problems," she said. "We want to make sure he doesn't lose contact with somebody who is checking to see."

    Lyman said Squad 1 has the potential to make a positive dent on the homeless community. He told the story of one man who was linked to counseling and services through the crew and has since found a job.

    "That's huge," Lyman said. "That's one less person that might be out on the streets or sleeping in the park because of substance abuse or whatever the case may be."

    Greeley isn't alone in trying the concept. Departments in Colorado Springs and at least two other states -- New Mexico and Arizona -- have similar units and other departments around the country are studying the idea.

     

    A growing need

    So far this year, more than 12,700 calls have been made to 911. Squad 1 began operating in Feb. 1, and since then has run more than 350 of those calls.

     

    "That's one less person that might be out on the streets or sleeping in the park because of substance abuse or whatever the case may be."

    Yet the number of calls the squad is potentially needed for is much higher -- two, maybe even three, times as high. The squad only has funds to run 40 hours a week, not round-the-clock, meaning firefighters are still responding to non-emergency 911 calls.

    But before Squad 1 existed, Lyman said, firefighters weren't always able to help people facing a personal crisis. That led to frustrations, he said, because firefighters want to be helpful. Now, firefighters can refer cases to the squad's crew for follow-up.

    He said he's seeking additional streams of funding to cover more hours for the unit.

    The existing funding is from the nonprofits that participate and, on the department's side, carved out of a savings the squad helped create. Because of Squad 1, the department hasn't had to send out his big engines to respond to as many 911 calls.

    "Less miles," Lyman said. "Less wear and tear. Less fuel."


  • 6 Dec 2018 4:31 PM | AIMHI Admin (Administrator)

    Beckers's Source Article | Highlights Courtesy of Matt Zavadsky

    BCBS of Texas beats physician lawsuit alleging ER underpayments

    Written by Morgan Haefner

    December 05, 2018 

    A lawsuit filed by 49 physician groups against Blue Cross Blue Shield of Texas was dismissed Dec. 3, according to Bloomberg Law.

    The physicians' lawsuit accused BCBS of Texas of underpaying 250,000-plus claims for emergency medical care. Earlier this year, the health insurer announced a new discretionary ER policy, under which a medical director hired by the insurer reviews claims after the ER visit to determine the reason a patient opted for the ER and if they could have received treatment in a less expensive setting.

    In the original lawsuit, the physician groups said BCBS of Texas reimburses out-of-network providers at a rate that violates state law and regulations. The judge's two-page order did not explicitly explain why the case was dismissed, according to Bloomberg Law. The physician groups have 60 days to submit a new complaint with additional supporting facts.

    Anthem launched a similar policy in multiple states and has faced harsh criticism as well as numerous lawsuits. A recent report from Sen. Claire McCaskill, D-Mo., found the insurer denied 12,200 claims from members in three states during the second half of 2017 on the grounds the ER visits were "avoidable." However, when patients challenged the denials, Anthem proceeded to reverse itself and pay the claims most of the time.


  • 3 Dec 2018 1:10 PM | AIMHI Admin (Administrator)

    JAMA Source Article | Comments Courtesy of Matt Zavadsky

    Interesting study, and even more interesting (concerning) potential causes from the study authors.  The accompanying editorial attempts to offer alternate reasons for the response time differences that are at least slightly more logical.

    **Special Note: some of the terminology used relates to ambulance response time, but the average “EMS Response Time” indicated in the article of 37.5 minutes indicates this is the total EMS time – including transport to an ED.  This is evident in the study, but not clear by the study title and editorial headline**

    There seems to be two important take-a-ways from this research:

    1. There still appears to be an illogical assumption that faster ambulance response times equate to improved patient outcomes, something that has been refuted in numerous studies published in peer-reviewed journals. 
      • This study only looked at cardiac arrest cases, which represent a small % of overall EMS volume and a condition in which numerous factors other than ambulance response time has an impact (bystander CPR rates, AED use, 1st Responder response times, etc.)
    1. Many progressive EMS systems use the philosophy of on-scene stabilization prior to transport due to evidence-based research supporting this treatment modality. 
      • The researchers in this study do not seem to take that into account in the time analysis.

    ------------------------------

    Poor communities wait longer for ambulances, causing health disparities

    By Steven Ross Johnson  | November 30, 2018

    Patients that experience heart attack in low-income neighborhoods tend to wait longer for emergency medical services to arrive than those living in more affluent communities, a discrepancy that could drive health disparities between the groups.

    Ambulances took an average of four minutes longer to handle calls from low-income areas than high-incomes neighborhoods, according to an analysis published Friday in JAMA Network Open that looked at more than 63,000 cases of cardiac arrest. The study marks the first national study evaluating disparities in 911 responses for cardiac arrest in high-income and low-income neighborhoods.

    Researchers measured the time it took ambulances to arrive at a patient's location after it was dispatched, how long it took an ambulance on the scene to depart, how long it took to transport a patient from the scene to the hospital, and the total emergency medical services time. 

    The study found communities where the annual median income was between $57,000 and $113,000 had an average overall emergency response time of 37.5 minutes compared to 43 minutes in ZIP codes where the median income ranged from $20,250 to $42,642. Researchers also found EMS responses were more likely to meet nationally recognized benchmarks of arriving within eight minutes to a like-threatening event.

    Study lead author Dr. Renee Hsia, professor of emergency medicine at the University of California San Francisco and an emergency physician at Zuckerberg San Francisco General Hospital and Trauma Center, said the findings help to show one of the many inequities that have contributed to the widening gap in health outcomes between poorer and wealthier Americans.

    Research published in 2017 in Health Affairs found that 38% of people living in households with annual incomes of less than $22,500 reported to be in poor to fair health between 2011 and 2013 compared to just 12% of individuals making more than $47,000 a year. 

    "We've been talking about disparities for decades in the United States and a lot of time people think it because physicians might be biased, but this shows that there are systemic issues that we can do something about," Hsia said. "It's not just about training providers to be more culturally competent there are system-level biases that exists, and this is one of them."

    Hsia said there were a number of potential factors that could contribute to the disparity in ambulance wait times. 

    She said it was possible that the spate of hospital, emergency department and privately-owned ambulance company closures in recent years could be a contributing factor for the longer wait times. Previous research has found EDs tend to have a higher closure rate in hospitals that regularly receive a high proportion of uninsured patients due to the low reimbursement they receive. 

    A 2014 Health Affairs study also authored by Hsia found the number of EDs in the U.S. decreased by 6% between 1996 and 2009. That study found one-quarter of hospital admissions between 1999 and 2010 occurred near an ED that had closed, which led to a 5% increase in the odds of mortality at those hospitals.

    The study surmised closures could have led to longer EMS times because of the added strain it put on existing emergency departments that become more overcrowded, and lead to diverting ambulances more often to other facilities that increases transportation times.


    But Hsia said another factor for the disparity in wait times could be related to the increase in recent years in the number of privately-owned ambulance companies that are contracted by local governments to provide services to their communities. More cities and towns have turned to for-profit ambulance providers to save money since those companies tend to bill commercial and public insurers or the patient directly for their services.

    Hsia said it was possible that the shift in who's answering those emergency calls could be contributing to the disparity since companies would likely try to position their resources to better meet the needs of communities that are more likely to give the best returns.

    Hsia said government EMS directors might benefit from looking more closely at whether the response times of ambulance providers they consider contracting with are distributed evenly across poorer and richer communities.

    "I think that it's important policymakers realize that as there are these shifts going from publicly-funded entities that are providing these services to privately-funded entities that there may be different incentives that underlie their provision of these services," Hsia said. 

    Evidence has shown delays in ambulance response times can have a large impact on mortality rates. A 2001 study published in the medical journal BMJ concluded reducing ambulance response times to five minutes could almost double the survival rate for cardiac arrests.

  • 3 Dec 2018 8:45 AM | AIMHI Admin (Administrator)

    Source Article from KRWG | Comments courtesy of Matt Zavadsky

    Kudos to Paul Ford and his team at Las Cruces Fire Department!

    Las Cruces Fire Department: Mobile Integrated Healthcare

    By CASSIE MCCLURE  NOV 30, 2018

    Firefighters walk not only into flames, but into the homes of citizens. It’s in these homes that the Las Cruces Fire Department (LCFD) has seen a new need it can provide to the community - connecting citizens with resources that may aid in the quality of their lives.

    For the last two years, LCFD has provided the Mobile Integrated Healthcare program to the resident of Las Cruces. It came first from the recognition that there was a gap in healthcare for those residents who want retain their independence in their homes, but who had been depending on LCFD fulfilling their needs.

    “The challenges are anywhere from transportation-related to as simple as having durable medical equipment fail and repairs not being covered by their insurance or Medicaid,” said Paul Ford, LCFD Mobile Integrated Healthcare coordinator. “Since we’ve started the MIH program, and investigating their needs, we’ve seen a profound drop in those who would call the fire department at least once a day, by almost 90 percent.”

    Ford, along with part-time staff, focuses on finding the barriers between residents and resources within the Las Cruces community to manage their care for example helping them get their medications or being able to repair their walkers or even let them know about reduced- price transportation for seniors in Las Cruces.

    “We understand that many people do not want to lose their independence,” said Ford, “and when we knock on their door, they are usually more willing to open up and let us see the real situation they are in. Sometimes all it takes is to get their permission to call their children to let them know that their parent needs more help.”

    LCFD works with both Memorial Medical Center (MMC) and MountainView Regional Medical Center (MVM) to invite physicians and social workers to join them on visits, bridging the gap between what a provider may see at a clinic to the condition that patients may face at home.

    Dr. Roberto Aguero, a second-year medical resident at MMC, “I think every doctor in primary care should have this experience. It lets you see the harder aspects of what patients have to deal with to get to their doctor appointments and be on medications and get medications and what happens if they can’t get to follow-up appointments. Some can’t get out of the door or have literacy issues.”

    Aguero explains that what happens with an emergency transport is not only not the best care for a patient long term, but also isn’t the best for the community. “Ending up in the emergency department is the worst place to get your care.

    It’s the most expensive and the least effective,” said Aguero. “Something like the MIH program can get into their homes and see what their needs are and gets them out of the hospital; it pays for itself 10 times over.”

    He recalled a patient in Silver City who would benefit from a program like MIH. “She has schizophrenia and a hypothyroid, but when she forgets to take her medicine, she quickly decompensates,” said Aguero. “For a 20-year-old lady who is trying to stay in school and get ahead, very disabling to her and threatens her success in life.”

    LCFD also reached out to New Mexico State University to create a partnership where graduate students from its social work program work with MIH to fill gaps, especially with case management. Mendy Fowler, in her last year in the graduate program, was the first student who rode along with Ford on patient visits.

    “We get to have the boots-on-the-ground experience,” Fowler said. “We can evaluate the resources that the community has to offer, and find the gaps, especially for transportation.”

    “But there are so many barriers, not just transportation,” said Fowler. “Other things are an issue, too, like food and housing insecurity, and even problems with heating and cooling. We are working to lessen some of the health disparities that the community faces by lessen barriers and make those connections to the community.”

    If you are interested in knowing more about the MIH program, or would like to make a connection between the program or a business that may be a new resource for the MIH program to the community, please contact Paul Ford at (575) 528.3473 or pford@las-cruces.org.

  • 28 Nov 2018 8:27 AM | AIMHI Admin (Administrator)

    Source NAEMT Press Release | Comments Courtesy of Matt Zavadsky

    This is VERY cool – TMF is one of the Quality Improvement Organizations/Quality Innovation Networks who work with healthcare stakeholders to improve the quality of healthcare.

    TMF, like other QIO/QINs is contracted to CMS for healthcare quality innovation projects.

    We encourage everyone to participate in this outstanding initiative to advance the EMS profession, and the EMS transformation!

    TMF and NAEMT Partner to Release MIH-CP Learning and Action Network

    Austin, Texas – TMF Health Quality Institute in partnership with the National Association of Emergency Medical Technicians (NAEMT) announces the release of an online learning and collaboration platform aimed at increasing awareness and improving the efficiency of Mobile Integrated Healthcare–Community Paramedicine (MIH-CP) programs.

    MIH-CP is an innovative health care delivery strategy that uses experienced EMTs, paramedics and nurses in non-traditional roles, aimed at improving a patient’s care experiences, improving the health of the population at large, and reducing the per capita cost of health care. MIH-CP practitioners use their skills and experience to provide high quality care in preventive roles, maximizing the use of available health care and community resources.

    The web-based MIH-CP Learning and Action Network (LAN) features several components, including data analytics support for MIH-CP programs, a knowledge network, several educational offerings such as monthly webinars focused on a variety of MIH-CP audiences, discussion boards and MIH-CP Program Profiles. The LAN at https://mihcp.tmf.org will soon also feature a searchable database of existing U.S.-based MIH-CP programs, affinity groups and a Help Desk, which will give MIH-CP stakeholders a resource to request assistance with program development and facilitation questions.

    “Having started my medical career as an EMT, I’ve seen and understand the tremendous value that community paramedicine and mobile integrated health care can deliver to our patients and communities,” said Dr. Russell Kohl, TMF chief medical officer. “Expanding the integration of EMTs, paramedics and nurses into the ongoing care of our community is a common sense approach in improving health and the quality of health care for all Americans. TMF is excited and anxious to help move this community health effort forward through this comprehensive learning and program-development website.”

    About TMF

    TMF Health Quality Institute focuses on improving lives by improving the quality of health care through contracts with federal, state and local governments, as well as private organizations. For more than 45 years, TMF has helped health care providers and practitioners in a variety of settings improve care for their patients.

    Interested parties can contact the TMF MIH-CP LAN Administrator via email at mihcp@tmf.org

    TMF Media Contact:

    Emilie Fennell

    Director, Communications and External Relations

    TMF Health Quality Institute

    512-334-1649

    emilie.fennell@tmf.org


  • 26 Nov 2018 7:51 AM | AIMHI Admin (Administrator)

    Source article from the NY Daily News | Comments courtesy of Matt Zavadsky

    Interesting…  Something many communities are facing….

    Tip of the hat to Ken Simpson, MedStar’s COO for finding this article…

    ----------------------------------

    EXCLUSIVE: Budget watchdogs want city to cut back on fire engines responding to medical emergencies

    By JILLIAN JORGENSEN | CITY HALL BUREAU CHIEF

    NOV 25, 2018

    https://www.nydailynews.com/news/politics/ny-pol-citizens-budget-commission-ems-fire-engines-20181124-story.html

    The city could more wisely spend the $1.1 billion it costs to provide emergency medical services, a budget watchdog group says, in part by reducing the role fire engines play in responding to 911 calls — and then considering whether it really needs all of its engine companies.

    In a new report, the Citizens Budget Commission recommends ultimately reducing the number of engine companies, which for years has been a political nonstarter.

    The suggestion comes as the fire department, which is responsible for responding to medical emergencies, has seen a steady uptick in the number of calls — responding to 1.5 million in 2017, up 36% since 2000. At the same time, the number of fires in the city has decreased. But while EMS work makes up 84% of the department’s workload, it accounts for just 30% of its budget, the report’s author, Mariana Alexander, a research associate at the Citizens Budget Commission, said.

    “The fire department has adequate resources to do its job, and it’s about reassessing how those resources are allocated to match its workload,” she said.

    Fire engines are only supposed to be dispatched to the most serious medical calls, when time is of the essence — because they can often arrive faster than ambulances. But that quick arrival doesn’t always translate into much help.

    While the engines can reduce response time, firefighters can’t provide the same level of care as an ambulance crew can.

    And the engines are much more expensive to staff — with “5 or 6 people on a fire truck, and they’re all paid a lot more than your average EMT or paramedic.”

    “Sending a fire engine doesn’t necessarily reduce your workload, because the ambulance is still needed to transport,” Alexander added.

    Staffing each fire engine costs the city an average of $7.2 million a year — compared to $2.2 million a year on average for an ambulance to make three tours a day.

    “If you closed one fire engine company you could fund 10 additional ambulance tours each day,” she said.

    But closing fire engine companies has been a political third rail for years — Mayor de Blasio even got himself arrested protesting the idea under his predecessor’s mayoralty.

    “It would politically be a very heavy lift for the fire department to do,” Alexander acknowledged.

    FDNY spokesman Frank Gribbon said the engines are dispatched to life-threatening calls such as cardiac arrest, an unconscious person, or someone choking, in addition to responding to fires.

    “Engines also respond to fires and other emergencies, and we do not advocate nor support closing any of them, as the report seems to suggest,” Gribbon said.

    Reducing the role of fire engine companies isn’t the CBC’s only suggestion — it also called for mounting public campaigns to reduce unnecessary requests for ambulances and reducing the focus on response time for minor issues while beefing up the ability to quickly respond to more serious ones.

    “Many of the incidents that the fire department are responding to are not genuine emergencies. These are incidents that either medical care is not needed at all or urgent medical care is not needed,” Alexander said.

    The FDNY said it has been working with other city agencies to try to steer people to other forms of medical treatment when appropriate.

    “We share the CBC’s concern about unnecessary or inappropriate requests for ambulances — and have been working closely with NYC Health & Hospitals, Greater NY Hospitals Association. and the city health care networks that are participating in the Medicaid DSRIP program to ID appropriate alternative pathways for these patients to receive care,” Gribbon said.

    The CBC also takes to task the focus of city officials on response times for all medical calls — arguing that while a quick response is vital in emergencies like cardiac arrest, it is less important for other medical issues.

    “They adopted this kind of cardiac arrest model of responding to medical incidents where time really matters, you have to get there as soon as possible. But that’s not really the case if you sprain your ankle. It doesn’t really matter if they get there in 20 minutes,” Alexander said.

    The city should instead focus on prioritizing lower response times for its Advanced Life Support ambulances — staffed with paramedics — who can provide medicine and have more training. While the number of life-threatening calls have increased, there are fewer Advanced Life Support ambulances and more Basic Life Support ambulances, worked by emergency medical technicians. Alexander posited that was due to the focus on lowering all-around response times.

    “The City Council has been concerned about response times to all incidents not just the most critical ones,” she said.

    “There's no evidence that response time matters for those less critical incidents, where as they really really do matter for the most critical ones.”

    One way to increase the number of Advanced Life Support ambulances — and their response times -- would be to change the way they are staffed. Currently, the ambulances have two paramedics on board. The CBC suggests changing that to one paramedic and one EMT, which would both lower the cost and, spread out more paramedics, who are in short supply, over more Advanced Life Support ambulances.

    Gribbon noted the department has sought to change staffing in the past but was met with roadblocks in Albany.

    “We need state approval to change our Advanced Life Support (ALS) ambulance staffing (currently staffed by two paramedics) to a combination of one paramedic and one EMT,” he said. “We have requested making this change in the past but have been denied.”

    Vincent Variale, president of the Uniformed EMS Officers Union, Local 3621, opposes the idea.

    “I think that’s dangerous,” he said. “I think with the amount of call volume New York City EMS deals with, you need two medics there.”

    The paramedics need to be able to consult with one another and provide a continuity of care, he said.

    “I think what they need to stop doing is trying to cut back on EMS resources in a way where it’s going to endanger the life of the people of the city,” he said, arguing an increase in medical calls ought to translate into more resources.


  • 24 Nov 2018 7:47 AM | AIMHI Admin (Administrator)

    Source Article from USFA Citing Prehospital and Disaster Medicine | Comments Courtesy of Matt Zavadsky 

    Very nice findings in of a study in Prehospital and Disaster Medicine, and cited by the US Fire Administration. 

    A couple of interesting statements in the study and the citation:

    As health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes pre-hospital personnel in the community as an extension of the traditional health care system.”

    Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.”

    Tip of the hat to Mark Babson from Ada County Paramedics in Idaho (and a member of the NAEMT EMS 3.0 Committee) for sharing this information.

    -------------------------------------------

    EMS Mobile Integrated Health during disaster response

    How one community's MIH providers assisted with patient care during severe flooding

    Nov. 15, 2018

    https://www.usfa.fema.gov/current_events/111518.html

    In many communities across the country, Emergency Medical Services (EMS) provide preventative health care to help reduce unnecessary and costly trips to the emergency room and ensuing hospital admissions. EMS operating in a Mobile Integrated Health (MIH) role help patients with chronic conditions in their homes, divert ambulance calls to outpatient providers, and in some communities, use telemedicine to connect their patients with physicians from their homes.

    But what if a disaster should strike? How might MIH providers best assist in the response effort?

    A recent study1 was the first to examine the work of MIH providers — Richland County (South Carolina) EMS — during an October 2015 response to severe flooding.

    Study findings

    MIH providers were able to meet vulnerable patients' health needs in severe flooding conditions by:

    1. Reconnecting individuals in emergency shelters with:
      • Lost medications.
      • Alternative housing or social services.
      • Transportation to relocate them with family outside of the affected area.
      • Other essential health care.
    2. Readily identifying to local authorities those patients who required in-person wellness checks.
    3. Delivering food and water to patients they knew were unable to leave their homes due to a disability.
    4. Providing uninterrupted power supply for home ventilators, left ventricular assist devices, and other medical equipment.

    EMS physicians augmented MIH services during the flood response by performing telephone triage and self-care instruction to patients cut off from EMS. They responded to the field and provided consultation to MIH as needed.

    Research takeaways for MIH providers

    • Include disaster response in the MIH training curriculum.
    • Help patients prepare for disasters by emphasizing the need for an evacuation plan and to safeguard adequate supplies of medications and durable medical equipment.
    • Identify ahead of time community members with complex medical needs, such as people who require access to uninterrupted power for life-sustaining medical equipment.

    LEARN MORE ABOUT THIS RESEARCH

    Summary information for this article was provided by the NETC Library. You can request access to this research study by contacting the library at netclrc@fema.dhs.gov.

    Explore library services

    ---------------------------------------

    Utilization of Mobile Integrated Health Providers During a Flood Disaster in South Carolina (USA)

    Christopher E. Gainey (a1)Heather A. Brown (a1) and William C. Gerard (a1) 

    https://doi.org/10.1017/S1049023X18000572

    Abstract

    As health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes pre-hospital personnel in the community as an extension of the traditional health care system. These programs have been labeled as Community Paramedicine (CP) and Mobile Integrated Health (MIH). While variation exists amongst these programs, generally efforts are targeted at individuals with high rates of health care utilization. By assisting with chronic disease management and addressing the social determinants of health care, these programs have been effective in decreasing Emergency Medical Services (EMS) utilization, emergency department visits, and hospital admissions for enrolled patients.

    The actual training, roles, and structure of these programs vary according to state oversight and community needs, and while numerous reports describe the novel role these teams play in population health, their utilization during a disaster response has not been previously described. This report describes a major flooding event in October 2015 in Columbia, South Carolina (USA). While typical disaster mitigation and response efforts were employed, it became clear during the response that the MIH providers were well-equipped to assist with unique patient and public health needs. Given their already well-established connections with various community health providers and social assistance resources, the MIH team was able to reconnect patients with lost medications and durable medical equipment, connect patients with alternative housing options, and arrange access to outpatient resources for management of chronic illness.

    Mobile integrated health teams are a potentially effective resource in a disaster response, given their connections with a variety of community resources along with a unique combination of training in both disease management and social determinants of health. As roles for these providers are more clearly defined and training curricula become more developed, there appears to be a unique role for these providers in mitigating morbidity and decreasing costs in the post-disaster response. Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.

    Gainey CE, Brown HA, Gerard WC. Utilization of mobile integrated health providers during a flood disaster in South Carolina (USA). Prehosp Disaster Med.2018;33(4):432–435


  • 24 Nov 2018 7:39 AM | AIMHI Admin (Administrator)

    Associated Press Source Article | Comments Courtesy of Matt Zavadsky

    Calumet Park is a community of ~7,500 people in Cook County, IL.

    ---------------------------

    Calumet Park readies for privatized fire-protection services

    The Associated Press

    November 23, 2018

    https://apnews.com/38d0b9674b0d4d00bcd042a644ea7b29

    CALUMET PARK, Ill. (AP) — Calumet Park officials have hired a private firm to provide fire and ambulance services to spare a tight budget, in a move the village attorney says could become the norm in Chicago’s south suburbs.

    The (Tinley Park) Daily Southtown reports the village board approved a separation agreement this month with its firefighters union and a five-year contract with Kurtz Ambulance Service for fire protection and ambulance services.

    “It’s going to cause a chain reaction in the south suburbs with the communities that just can’t afford to pay the high salaries, the overtime and the equipment,” said Village Attorney Burt Odelson, noting that he was in discussions with three other south suburban communities about outsourcing their fire departments.

    Odelson, who previously engineered privatization in North Riverside that state labor regulators overturned, estimated savings at $500,000 annually.

    Kurtz takes over Dec. 1. It will supply 12 full-time staff members who are firefighters and paramedics in four-person shifts. The village currently has 30 part-time firefighters. Four current village firefighters will join the Kurtz staff.

    Calumet Park will pay $825,000 in the first year. It increases gradually each year to top out at $925,000.

    Mayor Ronald Denson said he never questioned the village department’s quality. But he says with dwindling revenue sources, “We have to make some changes if we’re going to survive.”


  • 21 Nov 2018 12:22 PM | AIMHI Admin (Administrator)

    WNEP Source Article | Comments Courtesy of Matt Zavadsky

    Nice local news story about Geisinger’s program.  The video interview is very cute!

    Dr. Doug Kupas shared the following relating to the program, and Ms. Miller’s perception:

    Although our Geisinger at Home includes physicians, nurses, physician assistants, MIH paramedics, pharmacists, mental health, dieticians, palliative care, and community health workers, the clip did not highlight all of these. It was cool that the patient that they interviewed focused on the paramedics.”

    ----------------------------------

    Healthwatch 16: Geisinger at Home

    https://wnep.com/2018/11/20/healthwatch-16-geisinger-at-home/

    JESSUP, Pa. -- It may be an old idea, but a new program is taking off for a hospital system in our area.

    Geisinger at Home is just what it sounds like -- a team of health care professionals treating a patient in his or her own home.

    Angels are all over Jeanette Miller's house in Jessup, but she says some of her favorites wear scrubs.

    "I had to have the paramedics come and shoot that intravenous into my arm and give me the liquid medicine. Thank God for Christine and Dr. Wylie. They really helped me. They were my angels," Jeanette said.

    89-year-old Jeannette is one of the 1,200 Geisinger patients now enrolled in a program called Geisinger at Home.

    "It's not for everyone. We focus on our fragile and medically complex patients," explained Kristine Collins, R.N.

    Jeannette has had heart trouble and fainted once in her kitchen. She's an example of someone who may have a hard time getting medical help on her own, but whose issues can be managed.

    "It's not just for when the patient is sick at home, although that's a great benefit and it benefitted Jeanette here, but we try to keep them as healthy as possible," said Collins.

    "Patients have complex health conditions, multiple conditions, and they have trouble getting out of their home to come to a clinic or a practice to get care. That really was the impetus to get us thinking about a new care model," said Janet Tomcavage, Geisinger's chief population health officer.

    She explains Geisinger at Home started in April. Health officials identify and reach out to people like Jeannette who have a number of hospital stays or ER visits offering an extra layer of care, 24/7.

    And she points out it's a way to cut costs, too.

    "A lot of times patients use the ED for their care and if we can get upstream we can make a difference in outcomes and lower expenses as well," Tomcavage said.

    Officials say Geisinger at Home is not just doctors or nurses. The team can include dieticians and social workers, too.

    That gives them a better picture of what may be happening at home, such as food insecurities, or safety issues.


  • 21 Nov 2018 10:08 AM | AIMHI Admin (Administrator)

    Incidental Economist Source Article | Comments Courtesy of Matt Zavadsky

    Very interesting commentary in the Incidental Economist.  Definitely worth investing the 6 minutes to watch the video.

    Tip of the hat to Gregg Margolis for sharing this find!

    ---------------

    Healthcare Triage: A Lyft to the Hospital: Can Ride Sharing Replace Ambulances?

    November 20, 2018

    By Aaron Carroll

    https://theincidentaleconomist.com/wordpress/healthcare-triage-a-lyft-to-the-hospital-can-ride-sharing-replace-ambulances/

    An ambulance ride of just a few miles can cost thousands of dollars, and a lot of it may not be covered by insurance.

    With ride-hailing services like Uber or Lyft far cheaper and now available within minutes in many areas, would using one instead be a good idea?

    Perhaps surprisingly, the answer in many cases is yes. That’s the topic of this week’s HCT.


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