Maine EMS Community Paramedicine Pilot Program Evaluation

In November 2014, the Muskie School of Public Service at the University of Southern Maine was awarded a contract to evaluate the implementation of the statewide CP Pilot Program in Maine. This report presents process level results from the evaluation. The report includes findings from interviews with the twelve community paramedicine pilot sites in Maine and with the state of Maine EMS office. The layout of the report follows the key themes and categories from our interviews: Staffing Training Stakeholders and Partners CP Services CP Event Data Collection Funding Challenges Successes Sustainability The report concludes with lessons learned which may be helpful for future community paramedicine pilot projects

Evidence-Based Falls Prevention in CAHs (Policy Brief #24)

Inpatient falls are a serious patient safety problem in Critical Access Hospitals (CAHs). Injuries from falls are also costly -- it is estimated that patients injured in a fall sustain upwards of 60% higher total charges than other hospitalized patients. This brief is one in a series of policy briefs identifying and assessing evidence-based patient safety and quality improvement interventions appropriate for use by state Flex Programs and CAHs. Key Findings: Hospital falls are a serious patient safety problem, accounting for nearly 84% of all inpatient incidents. Most falls commonly occur as a result of medication related issues, toileting needs, and hospital environmental conditions. Effective falls interventions target both intrinsic (e.g. physiologic) and extrinsic (e.g. environmental) risk factors. Effective falls prevention teams are interdisciplinary and are embedded in a culture of patient safety. Education for and communication across all staff contributes to successful falls prevention programs

Rural Health Action Network Enhanced Outreach Initiative. Year One Final Report

Healthy Community Coalition (HCC), in coordination with the Rural Health Action Network (RHAN) of greater Franklin County, is implementing a multi-faceted outreach program to improve health outcomes among the rural poor living with chronic conditions in greater Franklin County, Maine. The goals of the Franklin County Rural Health Action Network Enhanced Outreach Initiative (RHAN-EOI) include: Expand access to quality services; Expand training for community health extenders; Decrease hospital admissions, emergency department use, and costs; and Improve communication and care coordination across project partners This report highlights the implementation and progress of HCC RHAN in Year 1. For more information, please contact M. Lindsey Smith at [email protected]

Community Paramedicine in Rural Areas: State and Local Findings and the Role of the State Flex Program (Policy Brief #35)

This study examined the evidence base for community paramedicine in rural communities, the role of community paramedics in rural healthcare delivery systems, the challenges faced by states in implementing community paramedicine programs, and the role of the state Flex programs in supporting development of community paramedicine programs. Additionally, the study provides a snapshot of community paramedicine programs currently being developed and/or implemented in rural areas. Another FMT briefing paper describes these same findings in detail. Highlights: Many rural community paramedicine programs are in pilot stages. Most community paramedics work within an expanded role rather than an expanded scope of practice, the latter requiring legislative or regulatory change. Funding and reimbursement for community paramedicine services are major challenges for the sustainability of community paramedicine programs. Data collection is vital for community paramedicine programs to be able to show value, including shared saving and patient outcomes. Collaboration at local and state levels is essential for buy-in, and partnering with the State Office of Rural Health is especially helpful in the early development and outreach efforts for rural community paramedicine programs

Exploring State Data Sources to Monitor Rural Emergency Medical Services Performance Improvement

In 1981, responsibility for overseeing emergency medical services (EMS) largely shifted to states and localities, contributing to the creation of a fragmented national picture of the state of EMS that is most evident in the resultant data collection and reporting issues that curb the availability of EMS data. These patchwork systems of care disproportionately affect rural areas, where myriad challenges – from a high reliance on a volunteer workforce to low call volumes and inadequate reimbursement – hinder performance. Previous studies by the Flex Monitoring Team (FMT) highlighted how little is known about the administrative, operational, and clinical capacity of rural EMS, which are key to investigate further before considering traditional EMS outcome measures. In this study, the FMT convened an expert panel comprised of representatives from a variety of stakeholders to highlight existing data challenges EMS face, identify data to support rural EMS performance measurement, as well as reassess the FMT’s 2017 rural-relevant EMS performance measures. Among the themes raised by the panel, experts suggested that improved engagement in oversight by state EMS agencies would increase accountability by local EMS; however, they cited a lack of staff capacity and expertise to analyze data in states, as well as disagreement between states on relevant measures. The FMT created EMS capacity measures to monitor and improve rural EMS capacity, along with the National Highway Traffic Safety Administration’s EMS Compass outcome measures to monitor performance. Potential opportunities identified by the panel to source standardized data for those measures include an assessment tool developed through the Joint Committee of Rural Emergency Care, or for the relevant data to be collected by state EMS agencies through their existing EMS service licensure process, many of which already collect some of the relevant data. Electronic patient care records, the typical source of data to calculate EMS clinical and non-clinical performance measures, can be collected and reported to states through the National EMS Information System (NEMSIS). Though not perfect, targeted efforts to improve the collection of local EMS data provides an opportunity for state EMS agencies and State Flex Programs (SFPs) to train local services in data collection, in addition to educating them on how to access and use their own data for performance improvement. This collaboration can also play a role in supporting improved health information exchange between EMS, hospitals, and other providers, which help improve the quality of pre-hospital care and assist in monitoring the quality and outcomes of care across the system of care. The importance of reliable, standardized, and timely data from local and state EMS is underscored by the recently launched Medicare Ground Ambulance Data Collection System, a Centers for Medicare and Medicaid Services study that will collect information to evaluate how ground ambulance costs relate to current payment policies. In turn, this will be used to formulate a report to Congress assessing the adequacy of Medicare ground ambulance payment rates and geographic variations in cost. As the data will be used to assess reimbursement rates across urban, rural, and super rural areas, accurate data collection and reporting is vital. The expert panel also reaffirmed the validity of FMT’s rural-relevant measures and raised questions about monitoring the measures longitudinally or developing measures to assess financial performance and sustainability. Additional work is needed to understand how to best use these measures to track rural EMS capacity over time, as well as identify the relevant financial measures

Ambulance Deserts: Geographic Disparities in the Provision of Ambulance Services [Chartbook]

This chartbook begins with a broad overview of ambulance services including common types of organizational structure(s) and workforce and reimbursement issues. The methods section provides our definition of ambulance deserts and describes how ambulance deserts are illustrated in the national and state maps. The results section begins with an overall description of the prevalence of ambulance deserts in rural and urban counties across the 41 states for which data were available at the time, and the variation in the percent of people living in ambulance deserts across the four census regions. States are ranked in terms of the percent of counties in each state with ambulance deserts, the number of ambulance stations per 100,000 residents, and the number and percent of people living in ambulance deserts. National level maps illustrating the number and percent of people living in ambulance deserts at the county level are presented overall, as well as by rural and urban counties. State level maps illustrating the location of ambulance stations, health care facilities, and ambulance deserts at the census block level are presented in Appendix A. Finally, the discussion and conclusions section summarizes the findings and sets the stage for future analyses of populations most at risk for adverse health outcomes associated with poor access to ambulance services. For more information, please contact Dr. Yvonne Jonk, [email protected]

Promoting a Culture of Safety: Use of the Hospital Survey on Patient Safety Culture in CAHs (Briefing Paper #30)

The Institute of Medicine has emphasized the importance of establishing a culture of safety to improve patient care, specifically: developing clear, highly visible patient safety programs that focus organizational attention on safety; using non-punitive systems for reporting and analyzing errors; incorporating well-established safety principles such as standardized and simplified equipment, supplies, and work processes; and establishing proven interdisciplinary team training programs for providers. We sought to investigate the degree to which these elements are present or absent in Critical Access Hospitals. This report presents the results of a literature review and a rural patient safety expert panel comprised of representatives from federal and state government and academia. There is another policy brief that summarizes these same findings