Online Program

Mobile integrated health care practice – improving population health through innovative alignment of existing mobile health infrastructure

Sunday, November 3, 2013

Eric Beck, DO, NREMT-P, Assistant Professor, Assistant Residency Program Director, Emergency Medicine, University of Chicago, EMS System for the City of Chicago; University of Chicago, Chicago, IL
White Lynn, MS, Resuscitation and Accountable Care, American Medical Response, Greenwood Village, CO
Jeffrey Goodloe, MD, NREMT-P, EMS Section Chief, Department of Emergency Medicine, EMS System for Oklahoma City and Tulsa; University of Oklahoma, Tulsa, OK
Brent Meyers, MD, MPH, Wake County Emergency Medical Services, Wake County EMS, Raleigh, NC
Hawnwan Moy, MD, Department of Emergency Medicine, University of North Carolina, Chapel Hill
David Tan, MD, Division of Emergency Medicine, Washington University School of Medicine, St. Louis, MO
Scott Bourn, PhD, RN, EMT-P, AMR National Resource Center, American Medical Response, Greenwood Village, CO
Jeffrey Beeson, DO, RN, EMT-P, Emergency Physician Advisory Board of Fort Worth, MedStar Mobile Healthcare, Fort Worth, TX
Alan Craig, MS, ACP, American Medical Response, Greenwood Village, CO
Edward Racht, MD, American Medical Response, Greenwood Village, CO
Joan Mellor, HeartRescue, Medtronic Foundation, Minneapolis
Fragmentation of care, barriers to access, and outdated delivery and payment models have left patients and clinicians frustrated. Mobile Integrated Healthcare Practice (MIHP) is a conceptual model designed to optimize an existing system of 24/7 triage and transport services. MIHP provides a framework for more timely and appropriate use of community-based healthcare services. Currently, community paramedicine programs have demonstrated remarkable success implementing pilot projects which link public health, emergency medical services (EMS) systems, and hospitals. Some of these program have reduced re-hospitalization rates while others have focused on mental illness, substance abuse and social needs. However, realizing improved health for an entire population requires a more comprehensive and integrative delivery model, with infrastructure allowing patients to navigate the health care system in a way that ensures the most appropriate access to care.

The MIHP framework describes a novel healthcare delivery model that links existing mobile health infrastructure and personnel, communications and information technology infrastructure, as well as a spectrum of other existing resources and personnel in a collaborative enterprise to improve the health of a defined population. MIHP harnesses strategic partnerships among community stakeholders, is driven by a community needs assessment and performance measurements that are patient centered, outcome based, and focused on quality and value.

911-EMS systems are uniquely positioned to support a Mobile Integrated Healthcare Practice. Leveraging the preexisting EMS infrastructure as a health care navigation strategy is sound. EMS currently exists in virtually every community, is potentially linked to all levels of care through its 24/7 capability for mobility and readiness, and is equipped with a workforce that has expertise in planning, coordination and communication in addition to the capacity to assess patient needs and provide appropriate care.

In the MIHP model, a partnership of community stakeholders determines local needs and service gaps. The existing EMS infrastructure is used to guide patient navigation and care, assisting patients to access the most appropriate resources in a timely manner. Additionally, EMS is able to provide scheduled and unscheduled care through primary, secondary, and tertiary interventions. Many EMS systems possess under utilized point-of-care electronic patient record and biometrics systems. When integrated with request-for-service information from dispatch systems, geographic information systems and population health data, the existing EMS infrastructure becomes a powerful tool for launching and supporting this new model. With innovative alignment, MIHP is able to simultaneously improve the quality, outcomes, and value for patients and populations.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Other professions or practice related to public health
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe how existing mobile health infrastructure can be optimized and linked to other existing community resources to improve value and patient outcomes; Differentiate mobile integrated health care practice from community paramedicine and home health; Name the components of a mobile integrated health care practices

Keyword(s): Community-Based Health Care, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary author of this abstract, one of the leader concept developers. As an EMS Medical Director for the 3rd most populous US city and as former paramedic, I have extensive experience in prehospital care, EMS systems and oversight, and advanced study in health outcomes management. Previous experience includes grant funded projects and research in EMS, out of hospital cardiac arrest, transitions in care, and prehospital quality improvement.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.