Headline
The results of a multi-year evaluation of community paramedicine and triage to alternative destination programs across California show improvements in the coordination of medical, behavioral health, and social services, as well as reductions in ambulance transports, emergency department (ED) visits, and hospital readmissions.
Context
Community paramedicine and mobile integrated health (MIH-CP) programs are innovative care models that expand the role of paramedics and emergency medical technicians, enabling them to provide a broader range of nonemergency home- and community-based services. Connecting patients to MIH-CP programs following 9-1-1 calls, ED visits or hospitalizations, or provider referral, can play an important role in increasing access to primary, preventive, and follow-up care services; improving health outcomes; and reducing preventable acute care utilization.
In 2021, California implemented AB 1544, which granted local emergency medical service agencies the authority to develop community paramedicine or triage to alternate destination programs. The legislation permits five distinct care models: (1) case management services for individuals with frequent ED visits; (2) directly observed therapy for people with tuberculosis; (3) home-based treatment for hospice patients; (4) transportation to mental health crisis centers for people with mental health needs; and (5) transportation to sobering centers for people who are acutely intoxicated.
This report includes key findings from the first year and a half of 13 programs authorized under AB 1544 as of September 2022. Additionally, it incorporates findings from over five years of a series of pilot programs that preceded AB 1544.
Findings
The report presents notable findings across the community paramedicine or triage to alternate destination programs, indicating reductions in avoidable use of acute care, improved care coordination, and increased trust between patients and health care providers. Across the three programs offering case management for individuals with frequent ED visits, pre- and post-intervention assessments revealed significant reductions in the total number of 9-1-1 calls made by program enrollees, with reductions ranging from 19% to 35%. For hospice patient enrollees, there was a substantial decrease in the percentage of 9-1-1 calls leading to ED visits, declining from 80% to 38%, aligning with enrollees’ preferences for home-based care, when possible. Among the programs providing transport to crisis centers instead of the ED for individuals experiencing mental health needs, between 27% and 40% of screened individuals were successfully transported to a crisis center. Finally, less than 2% of patients receiving transport to sobering centers as an alternative to the ED were transferred to an ED within six hours of admission to the sobering center, suggesting that this intervention was effective at providing the right care at the right time for individuals who are intoxicated.
Takeaways
California’s community paramedicine and triage to alternative destination programs offer instructive examples of how MIH-CP programs can improve outcomes. The variety of care models across the 13 programs reflects the flexibility of MIH-CP, which can be adapted to align with local priorities and provider capacity. California’s approach also exemplifies the critical role of state policy in creating regulatory pathways to allow local jurisdictions to implement MIH-CP programs.