More than 80 percent of Baltimore City Fire Department 911 responses are for EMS incidents, putting a strain on the fire department’s capability to respond to other types of emergencies. In response, the fire department, University of Maryland Medical Center, the City of Baltimore, and the University of Maryland, Baltimore are piloting a new healthcare delivery model called Mobile Integrated Healthcare – Community Paramedicine (MIH-CP).
This community-based program, which involves 30 fire department registered nurses and paramedics, is creating a free, multidisciplinary care model that provides care outside the hospital setting. It is designed to reduce health disparities, decrease emergency department visits and prevent hospital readmissions.
“You have to meet patients where they are, and that’s what this program is doing,” said Jay Perman, M.D., president of the University of Maryland, Baltimore, at a recent news conference, according to an article in the Baltimore Sun. “It’s low-tech, it’s high-tech, it’s community-based. It combines what we can do with our telehealth abilities. And it is a model that puts the patient at the center of the team.”
The partnership estimates the program could save the Fire Department $1.7 million per year, and University of Maryland Medical Center (UMMC) more than $4 million a year, according to the Sun’s story.
The paramedics and nurses with advanced training 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. The first patients enrolled in May 2018.
Baltimore officials have noted that 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 healthcare utilization and emergency medical service (EMS) responses in West Baltimore. Also, there are national estimates that 15 of persons transported to emergency rooms could be treated safely in non-urgent settings. They stress that this statistic is likely higher in West Baltimore given the challenges to healthcare access, lower health literacy and the complexity of chronic diseases.
The new Minor Definitive Care Now (MDCN) program augments routine Baltimore City 911 service, giving patients with low-acuity conditions the option of on-scene treatment of their illness or injury, avoiding ambulance transport and ED waiting time. By treating patients at the scene of illness or injury, the MDCN program seeks to help patients return to their lives faster, prevents ambulance transportation, reduces ED wait times and potentially reduces healthcare costs.
Another aspect of the community paramedicine team’s work is to effectively transition patients to their home after discharge from the hospital. The Transitional Health Support (THS) program identifies patients with medical or social needs through UMMC’s interdisciplinary rounds. Seventy percent of the patients who have been offered the services of the THS program accepted them, according to city statistics.
“As one of the busiest EMS systems in the U.S., per capita, MIH-CP sheds light on the need for additional resources that support the Baltimore City Fire Department. The high demand from non-emergency patients affects hospital and emergency department overcrowding and severely limits the number of medic units available to rapidly respond to medical emergencies,” said Niles Ford, Baltimore City Fire Chief, in a statement. “As a result, MIH-CP’s focus is on enhancing patient care with home visits, community medical intervention and a more personalized medical treatment option that will mitigate the strain on our emergency departments and EMS providers. BCFD is proud to be part of this partnership because we know the direct, positive impact it will have on the community we serve.”
