ADMIN & CLINICAL OPERATIONS
Mobile Integrated Health: Can We Decrease Patient Returns to the ED?
SAEM PULSE | NOVEMBER-DECEMBER 2022
By Rida Farook; Thomas Hagerman, MD; Michael B. Holbrook, MD, MBA; Thomas Derkowski, MHA, CCEMT-P; Sean Drake, MD; Matthew Ball, MD; and Joseph Miller, MD, MS on behalf of the SAEM ED Administration & Clinical Operations Interest Group
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The transition from the emergency department (ED) to home carries risks for a substantial proportion of ED patients. These risks are particularly present among vulnerable patients who have barriers to timely outpatient follow-up. One potential solution to mitigate risk and improve overall patient care is the introduction of Mobile Integrated Health (MIH) and Community Paramedicine programs (MIH-CP). These programs were first introduced in 1992 to address health care disparities experienced by patients in rural communities. Eventually, MIH-CP programs expanded beyond rural areas into suburban and urban communities to meet patients at their homes to address wellness, disease prevention, post discharge care, and medical compliance. In the past ten years, there has been a substantial increase in the number of these programs and the breadth of care provided. Existing small studies suggest that MIH-CP programs may reduce ED re-visits, improve the
“Existing small studies suggest that MIH-CP programs may reduce ED re-visits, improve the efficiency of patient care, and are associated with overall cost reduction.” efficiency of patient care, and are associated with overall cost reduction. For example, when MIH-CP programs were implemented in Nova Scotia, ED readmissions were reduced by 23% in 2002 and 2003. The MedStart Mobile Health Program in Dallas-Fort Worth, Texas avoided 1,893 transports to the ED between January 2010 and February 2015, with an average patient satisfaction score of 4.9 out of 5. It also saved an average of $7,620 on payment charges per patient impacted by the program. Additionally, in the program in Dallas-Fort Worth, the readmission rate
for enrolled patients with congestive heart failure was found to be only 16.3% compared to the national readmission rate of 23%. In terms of patient costs, the MIH run by Niagara EMS in Ontario, Canada saved $171,573 per onethousand calls compared to regular ambulance responses in 2018. In Los Angeles, MIH and CP programs particularly assisted people experiencing homelessness in managing their health as they were found to have a 19 times higher rate for ambulance transport prior to implementation of these programs. Additionally, in terms of increasing care
