The Business Case for Community Paramedicine: Lessons from Commonwealth Care Alliance's Pilot Program

Mobile integrated health care and community paramedicine (MIH-CP) programs expand the role of traditional emergency medical services personnel to address non-emergency needs and bring outpatient primary and urgent care into patients' homes. These programs offer potential for reducing health care costs, eliminating unecessary emergency department use, and shifting service back to community-based and home settings. Between 2014 and 2015, the Massachusetts-based Commonwealth Care Alliance (CCA) piloted a community paramedicine prgoram, Acute Community Care (ACC), to serve its members in the Greater Boston area.This brief summarizes ACC's business case assessment, which showed that increasing patient volume after the pilot period would reuslt in net savings given the progam's success in averting unnecessary emergency care. By illustrating cost considerations for an expansion of MIH-CP services, this brief may inform the design and sustainability planning of other MIH-CP programs. The business case assessment was conducted by Mathematica Policy Research through support from the Center for Health Care Strategies' Complex Care Innovation Lab, a Kaiser Permanente Community Benefit-funded initiative

Racial Disparities in Emergency Department Mortality and Departure Status among Trauma Patients in Massachusetts

Background: Understanding racial inequities in emergency medical care for traumatic injuries is important to policy considerations. Methods: We analyzed data on the first emergency department (ED) visit for trauma treatment among patients in the Massachusetts (MA) Statewide Trauma Registry. This Registry collects information on all trauma patients who die in the ED, or are dead on arrival, or who are transferred between hospitals in MA. This analysis included ED visits among MA residents aged 15 years and older from 2008 through 2010. Those who died on arrival were excluded. Patients were grouped as non-Hispanic white, non-Hispanic black, Hispanic, Asian, and other or unknown races. We compared injury severity, departure status and ED mortality among the 5 groups while adjusting for severity, sex and age. Results: The 27,453 patients averaged 57.3 years of age, and included 44.9% women, 83.4% whites, 5.4% blacks, 6.8% Hispanics, 1.3% Asians, and 3.1% other or unknown races. In total, 534 (1.95%) died in ED. There was no clinically significant difference in injury severity among race groups. Compared to whites, blacks and other race group had higher mortality (OR=1.62, p=0.006 and OR=2.30, p Conclusions: Substantial racial disparities in ED mortality and departure status were observed among MA trauma patients. Determinants of the disparities are under investigation in an ongoing study funded by the National Institute on Minority Health and Health Disparities