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May 5, 2017

Calif. community paramedicine project results in continued success

UCSF Healthforce Center

MODESTO, Calif. — A new independent study of California’s Community Paramedicine pilot projects shows encouraging results, demonstrating how specially trained paramedics can safely help improve patient care, reduce unnecessary emergency department transports, and lower health care costs.

The study by the University of California, San Francisco (UCSF) Healthforce Center is the first independent evaluation of California’s 13 Paramedicine pilot projects, which includes a successful program in Stanislaus County.

The evaluation showed the Stanislaus County Alternative Destination – Behavioral Health project produced remarkable results, providing behavioral health care patients with direct access to more appropriate mental health facilities while substantially reducing the number of unnecessary and costly emergency department visits.

"Community paramedicine is a game changer for our community," said Kevin Mackey, MD, Stanislaus pilot project director and medical director of Mountain-Valley EMS Agency. "In fact, community paramedicine is a game changer for health care. For our community, every patient that is safely triaged away from a hospital emergency department has measurable effects, like reducing bed space demand as well as reducing demand on resources. However, the unexpected benefits have been systemwide support, law enforcement utilization improvements, and most importantly, reduced time to definitive care for our patients."

Community paramedicine is an exciting and evolving model of community-based health care designed to provide safe, effective, and cost-efficient services when short-term intervention is needed and where access to care may be limited. Community paramedicine is designed to integrate existing health care resources while utilizing the unique skills of specially trained paramedics and their availability 24 hours a day, seven days a week. The program mobilizes community paramedics to perform services outside of their traditional emergency response and transport roles, helping facilitate more appropriate use of emergency care resources while enhancing access to primary care for medically underserved populations.

"The demand for mental health services requires a greater level of interagency cooperation that includes prehospital care providers," said Sheriff Adam Christianson of Stanislaus County Sheriff’s Department. "Working together with our EMS partners, this program has truly made a difference in the communities we serve."

Stanislaus Community Paramedicine Pilot Project

The Stanislaus County Alternative Destination – Behavioral Health program is designed to provide behavioral health patients with direct access to mental health facilities, when no emergency medical condition is present. In response to 911 calls, specially trained community paramedics conduct on-the-spot patient medical screenings to determine whether the behavioral health patients could be safely transported directly to a mental health crisis facility. The pilot project substantially reduced the rate at which patients with behavioral health needs were transported to an emergency department, which reduced health care costs, improved patient care, and enhanced community safety.

Results

  • Prior to the pilot project, nearly all 911 calls involving patients with behavioral health needs led to an ED transport for medical screening. After the pilot project was implemented, approximately one-third of behavioral health patients were transported directly to the mental health crisis center instead of an ED.
  • Reduced the amount of time it took for behavioral health patients to receive treatment by mental health professionals.
  • Enhanced community safety by reducing the amount of time that law enforcement devotes to behavioral health care needs.
  • Accrued total monthly savings of $15,361; successfully offset cost of program implementation, and led to net savings of $8,913 per month.
  • Savings accrued primarily to Medi-Cal because most patients enrolled in the pilot project were Medi-Cal beneficiaries.

California Community Paramedicine Background

Community paramedicine programs operate in 33 states, including, Colorado, Minnesota, Maine, North Carolina and Texas. The programs are tailored to fit the unique needs of individual communities, and have demonstrated how paramedics can be trained to safely and effectively perform expanded roles, improve patient care and reduce unnecessary health care costs.

California began testing the Community paramedicine approach in 2014 by conducting 13 pilot projects throughout the state. The pilot projects focus on post-hospital discharge care, frequent emergency services users (911 callers), directly observed tuberculosis care, hospice care, behavioral health care and alternate destination programs.

The UCSF Healthforce Center evaluation is the first independent study of California’s paramedicine pilot programs and was funded by the California Health Care Foundation. The new evaluation studied patient care, patient safety, financial cost, and overall results. No adverse outcome is attributable to any of the pilot projects. No other health professionals were displaced.

The California Emergency Medical Services Authority (EMSA), working in partnership with the California Health Care Foundation, oversees the California Community Paramedicine pilot project. The program focuses on providing services where access to health care is limited or when a short-term intervention is needed. It is not meant to supersede or replace any health programs that are already available in the community.

To read the full UCSF evaluation, click here.


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