Evaluating Community Paramedicine in South Bend
The Community Paramedicine program was first introduced by the South Bend Fire Department to City leadership through the City’s performance management program, SB Stat. During the meeting, preliminary research was presented as well as possible models for the program to follow.
The overall goal was to decrease the number of non-emergency transports by SBFD. Emergency response systems frequently have overutilizers, who may see calling 911 as the easiest or only way to get help for medical issues, emergency or not. This can put undue strain on the emergency health system, including the dispatch center, ambulance transport, and emergency rooms.
The basic premise of community paramedicine is that it’s a preventative program. In South Bend, our pilot program consisted of one paramedic, Suzie Krill, visiting overutilizers in order to discover and address the underlying issues through other avenues.
Going into the pilot, the assumption was that clients were calling 911 more than necessary because they did not have a primary care physician to consult. So, our community paramedic’s goal was to connect clients with primary care facilities and physicians.
Learning deeply and empathizing with users
As more clients came through the program, the more the SBFD EMS team learned that many clients were calling 911 because of issues outside of the original scope. For example, a client could be calling frequently because she slips and falls in the shower. In this case, a lack of access to a primary care physician is not the reason for overutilization, but instead a lack of access to medical equipment like a grab bar.
As new challenges arose, the network of community organizations grew and strengthened to connect clients to local and national programs and resources. Throughout the pilot, Suzie worked with a myriad of community partners in order to connect clients with the resources they needed, including students from local colleges who were studying social work or a related field.
Data & Lessons Learned
With such qualitative work, data entry was an ongoing challenge and we’re continuing to iterate on how best to capture Suzie’s work. As the solutions shifted from referrals for doctors or specialists to connecting with local social service organizations and finding low-tech medical devices, how we record this information has also needed to shift.
SBFD is working with a local medical information group, Michiana Health Information Network, to connect the data from the community paramedicine to the clients’ other health records. Data input was designed to fit our initial needs, leading to workarounds and multiple sources of data in order to track the time and resources used in service to the clients.
Measuring Success
Our measures of success throughout the program have been the number of calls and visits to the ER during and after the community paramedicine program. In order to measure this, we compare the number of 911 calls, ER visits, inpatient visits, and primary care visits from the year preceding to the year after being discharged from the program. It’s important to use timeframes specific to clients, rather than a general range of dates as clients entered and exited the program at different times. It’s easy to look at the numbers and say that clients have called 911 significantly since discharge from the program, but they could have only been out of the program for a few weeks or months, as compared to the full year previous.
Another way we’re measuring success is the amount of money saved to the Fire Department by doing fewer transports, and to the local healthcare system as a whole. We can call the program a success based on reduced emergency calls and visits, but it’s easier to justify maintaining and expanding when it’s saving money too. Calculating the savings to the Fire Department has proven difficult, as it’s hard to pin down the cost to the department per transport. EMS staff will still be paid the same whether there’s 5 calls or 50 calls, as they are meant to be on standby for emergencies.
Moving Forward
In our current climate, the South Bend Fire Department continues to serve its clients while maintaining physical distance. This includes moving to remote check-ins when possible and contactless delivery of medication and other supplies.
The EMS team is looking to add another paramedic to the program this summer, which ideally would double the amount of clients the program is able to support.
We’re looking forward to expanding this program and continuing to track its successes.
