Evaluation of Mobile Integrated Healthcare Program Implementation for the Nashville Fire Department


Book Description

The implementation of the Patient Portability and Affordable Care Act that began in 2012 had potentially far-reaching effects on fire-based emergency medical service (EMS) transport services. Since one of the act's regulation changes was to change from fee-for-service reimbursements to value-bundled payment to providers, the Nashville Fire Department (NFD) needed to begin evaluation of implementation of a mobile integrated healthcare program in NFD. The problem was NFD had not identified if the department could benefit from implementation of a mobile integrated healthcare program. The purpose of this applied research project is to identify if NFD and the city of Nashville could benefit from implementation of a mobile integrated healthcare program. This applied research project used the evaluative research method as the process to answer the following research questions: a) What models of mobile integrated healthcare programs exist? b) Which model of mobile integrated healthcare program would be best suited for implementation in the city of Nashville? c) What are the potential costs of implementing a mobile integrated healthcare program in the city of Nashville? d) What are the potential benefits of implementing a mobile integrated healthcare program in the city of Nashville? Procedures for this project included an analysis of EMS call volume for NFD, projected costs for the number of patients potentially eligible for the program, and projected benefits for the patients eligible for the program. Cost analysis methods were considered. Due to significant limitations discovered during research, a conclusion was inferred there would be a negligible cost increase to implement a mobile integrated healthcare program in NFD using current resources within the department. Nashville Fire Department should proceed with implementation of a mobile integrated healthcare program while conducting further analysis of the program in order to take advantage of increased revenue due to the PPACA.




Mobile Integrated Healthcare


Book Description

The healthcare landscape in the United States is evolving rapidly but has largely ignored EMS, until recently. As the country focuses on cost containment and more appropriate methods to deliver services as a result of healthcare reform, EMS will need to undergo dramatic change to fill a new role in the healthcare system. The current traditional delivery method for EMS is financially unsustainable and will soon not be a viable option for care. EMS has a choice to make--adapt to the new environment or be left behind. A viable alternative to the current structure of EMS is Mobile Integrated Healthcare (MIH)--community-based health management that is fully integrated with the overall health system. Various programs like this have appeared across the United States, but a definitive resource that describes how to successfully implement such a program has not been available. Mobile Integrated Healthcare: Approach to Implementation fills this void by serving as a reference not only to the EMS community, but also to other medical professionals working toward implementation of a successful MIH program. Mobile Integrated Healthcare: Approach to Implementation provides a step-by-step approach for the identification of community needs, forming the appropriate partnerships, selection of staff, acquiring resources, patient identification, and overcoming hurdles to a successful program. Examples from successful programs across the country are included. The author team of Mobile Integrated Healthcare: Approach to Implementation has developed and implemented a functioning, successful program. Their experiences with community partners and other healthcare specialists provide a broad-based view of the future of EMS in the healthcare industry. Mobile Integrated Healthcare: Approach to Implementation is written by leaders in the field of EMS who are committed to guiding the successful evolution of EMS. Their approach to integration should be considered by EMS management, hospital-based social workers, and community partners such as county health authorities, homeless coalitions, and psychiatric services. The type of care EMS providers give needs to evolve with the changing landscape of healthcare. This text describes how healthcare professionals and community partners can work together to facilitate that change and define a successful MIH program.




The Impact of Mobile Integrated Healthcare on 911 Use and Patient Activation


Book Description

"Background: Emergency Medical Services (EMS) and Emergency Departments (EDs) are experiencing an increase in low-acuity and high frequency patients. Treating non-emergent patients with emergency resources drives up healthcare costs, leads to delays in care for all patients, and increases strain on emergency resources. To address the increase in low-acuity and high-frequency patients within the 911 system and emergency departments, mobile integrated healthcare (MIH) has emerged as an EMS-based intervention to connect patients with community resources and reduce non-emergent transports and ED visits. This program evaluation examines the impact of nurse-social worker teams in a fire-based MIH program by measuring 911 and ED use and patient activation before and after MIH interventions.Methods: Participants were enrolled in the program evaluation by the MIH field teams. Participants were either new or existing MIH patients and enrollment occurred over a 2-month period. Participants completed the patient activation questionnaire (PAM-13) at the time of enrollment and again between 8 and 12 weeks later. The number of 911 calls, transports, and ED visits for each participant was extracted from Julota and EPIC for a period of 12 weeks prior to and after the date of enrollment. The pre and post data and PAM-13 scores were compared using Wilcoxon Signed Ranks Test of Significance. The mean pre and post PAM-13 scores were also compared to evaluate the difference. Results: 19 participants were enrolled in the study. One participant died during the follow-up period. Of the remaining 18 participants, 4 completed the second PAM-13 questionnaire. There was a statistically significant reduction in 911 calls (p=0.015), transports (p=0.021), and ED visits (p=0.006) following MIH intervention (n=19). The change in PAM-13 scores (n=4) was not significant (p=0.655). The difference in the means of the pre and post PAM-13 questionnaires was an increase of 1.75. Conclusions: MIH intervention reduced 911 calls, transports, and ED visits in this program evaluation. The effect on patient activation as measured by the PAM-13 questionnaire was not significant. Given the statistical significance in reducing use of emergency services for this small sample, a longer evaluation with more participants is needed to determine if fire-based MIH using a nurse and social worker is effective in reducing emergency resource use"--Abstract.




Optimize Or Die


Book Description

This thesis analyzes current fire department practices and explores how resource deployments can be modified by innovation and optimization to result in improved services to customers. Alternative response vehicles, mobile integrated healthcare, technology adoption, accreditation, and leveraging data for policy analysis are five opportunities examined in this thesis with data used from 10 fire departments, including Dayton Fire Department. The findings show that implementing alternative vehicles for responding to medical emergencies, leveraging technology, and using data for policy implementation to adopt a mobile integrated healthcare program may decrease the cost of providing services and improve response times to meet national standards. These findings may be beneficial to fire departments across the country that are experiencing budget reductions coupled with increased demand for services.




Mobile Integrated Healthcare Models


Book Description

Hospital readmission is one measure of quality of care and is an area that needs to be addressed to cut health care costs. As part of the Affordable Care Act (ACA), the Center for Medicare and Medicaid Services (CMS) implemented the Hospital Readmissions Reduction Program (HRRP) to encourage hospitals to engage patients in discharge planning and improve care coordination to improve America's health care. Hospitals are financially penalized if they have excessive rates of hospital readmission using a three-year rolling period. To help meet HRRP's goal, various emergency medical services providers piloted or implemented mobile integrated health (MIH) models. There are several challenges for MIH, but the primary hurdle is health insurance reimbursement, particularly CMS reimbursement. Donabedian's Quality of Care Framework was used as the model to conceptualize MIH-CP and its impact on HRRP. A literature search was conducted using key terms, and inclusion and exclusion criteria yielded 10 HRRP articles and two reimbursement articles for review. Source materials from various government agencies and private entities were reviewed for background and additional information. California started developing its MIH programs in 2014 using pilot projects. The state had five pilot projects designed to evaluate MIH's safety and efficacy in reducing hospital readmissions. An evaluation of the California and three pilot projects in other states showed that they effectively reduced hospital readmissions with significant cost savings to Medicare and Medicaid. Analyses of four MIH-CP programs implemented across the nation showed similar findings. A review of reimbursement of MIH-CP services outside of pilot projects showed that several states allow MIH-CP providers to bill Medicaid and commercial insurance plans. Policymakers should evaluate the feasibility of implementing an MIH model in their jurisdiction and explore reimbursement mechanisms for MIH-CP services to be sustainable.




Health Program Planning, Implementation, and Evaluation


Book Description

A time-tested, landmark approach to health promotion and communication projects and everything that goes into making them successful. For more than 40 years, the PRECEDE-PROCEED model, developed in the early 1970s by Lawrence W. Green and first published as a text in 1980 with Marshall W. Kreuter, Sigrid G. Deeds, and Kay B. Partridge, has been effectively applied worldwide to address a broad range of health issues: risk factors like tobacco and lack of exercise, social determinants of health such as lack of access to transportation and safe housing, and major disease challenges like heart disease and guinea worm disease. In Health Program Planning, Implementation, and Evaluation, Green and his team of senior editors and chapter authors combine their expertise to offer a high-level guide to public health programming. This guide aligns with foundational public health competencies required by increasingly rigorous certification and accreditation standards. Driven by the coronavirus pandemic and a looming climate crisis, the book addresses the rapid changes in modern-day conceptions of disease prevention and health promotion. Today's public health practitioners and researchers are often called upon to address a complex web of factors, including population inequities, that influence health status, from biology to social and structural determinants. Program and policy solutions to population health challenges require systematic planning, implementation, and evaluation. Providing students with knowledge, skills, and a range of tools, the book recognizes new approaches to communication and fresh methods for reaching a greater diversity of communities. The authors highlight the importance of starting the population health planning process with an inclusive assessment of the social needs and quality-of-life concerns of the community. They explain how to assess health problems systematically in epidemiological terms and address the behavioral and environmental determinants of the most important and changeable health problems. They also cover procedures for assessing and developing the capacity of communities and organizations to implement and evaluate programs. Drawing on more than 1,200 published applications of the PRECEDE-PROCEED model, Health Program Planning, Implementation, and Evaluation features numerous case studies and contributions from internationally recognized experts, including governmental, academic, and community public health leaders, giving readers a thorough and well-rounded view of the subject. Ultimately, it is an up-to-date powerhouse for community and global health promotion at all levels. Contributors: Faten Ben Abdelaziz, John P. Allegrante, Patricia Chalela, Cam Escoffery, Maria E. Fernandez, Jonathan E. Fielding, Robert S. Gold, Shelly Golden, Holly Hunt, Vanya C. Jones, Michelle C. Kegler, Gerjo Kok, Lloyd J. Kolbe, Chris Y. Lovato, Rodney Lyn, Guy Parcel, Janey C. Peterson, Nico Pronk, Amelie G. Ramirez, Paul Terry




Health Program Planning and Evaluation: A Practical, Systematic Approach for Community Health


Book Description

The Second Edition of Health Program Planning and Evaluation will help you to systematically develop, thoughtfully implement, and rigorously evaluate health programs across a variety of health disciplines. This thorough revision includes updated examples and references throughout, reflecting the major changes within the field. This outstanding resource prepares students and professionals to become savvy consumers of evaluation reports and prudent users of evaluation consultants. It presents practical tools and concepts in language suitable for both the practicing and novice health program planner and evaluator.




Community Health Paramedicine


Book Description

Based on nationally recognized and field-tested curricula from across the country, Community Health Paramedicine offers clarity and precision in a concise format that ensures comprehension and encourages critical thinking. Important Notice: The digital edition of this book is missing some of the images or content found in the physical edition.




Nursing and Health Interventions


Book Description

Nursing and Health Interventions covers the conceptual, empirical, and practical knowledge required for engaging in intervention research. This revised edition provides step-by-step guidance on the complex process of intervention development and methods for developing, delivering, evaluating and implementing intervention, supported by a wealth of examples. The text describes each essential aspect of intervention research, from generating an intervention theory, to procedures for adopting evidence-based interventions in practice. This second edition provides up-to-date coverage of intervention research and its impact on improving standards of care. Throughout the text, readers are provided with the foundational knowledge required for generating evidence that informs treatment decisions in practice, and choosing the best approaches for designing, delivering, evaluating and implementing interventions. A valuable ‘one-stop’ resource for students, researchers, and health professionals alike, this book: Covers the importance and issues of evidence-based healthcare practice, the role of theory in research in the intervention design and evaluation, and evaluation of effectiveness and implementation of interventions in a single volume Reviews the decision-making steps and the knowledge needed to inform decisions in research and practice Discusses the limitations of evidence derived from randomized controlled trials (RCTs) Written by leading experts in the field, Nursing and Health Interventions remains an invaluable resource for nursing and healthcare students, researchers, and health practitioners wanting to understand and apply intervention to improve the quality of care.




Workplace Health Promotion Programs


Book Description

Shine a spotlight on the benefits of promoting health in the workplace Workplace Health Promotion Programs focuses on the incredible value that employee health programs can offer by exploring six key topics: behavioral health, physical health, healthy environments, health education, nutritional health, and physical activity. This in-depth resource explicitly establishes what successful workplace health promotion programs, services, and collaborations are, and then builds upon this foundational understanding by introducing methods and tools for promoting employee health and safety, while emphasizing the skills students need to do so. Through this resource, students will come to understand how to recognize employee health and safety opportunities, and how to think on a larger scale when it comes to workplace health initiatives in small, midsized, and larger employers that are comprehensive and fiscally sound. Workplace health promotion programs have the potential to both improve the health of the population as a whole and control healthcare spending in the process. Health problems are estimated to cost employers in the United States over $200 billion per year through medical costs, absenteeism, disability, and overall reduced productivity. Improving well-being through effective workplace health promotion programs can reduce this cost—and create healthier, happier workforces. Discover the design, implementation, and evaluation of workplace health promotion programs that address the range of employee health needs and concerns Understand how evidence-based programs can positively impact business and reduce health care cost Explore the larger scale implications of successful workplace health programs, including health policies, health insurance design, worker safety, employee behavior, etc. Learn how together employers and employees work to create a culture of health and well-being to support and promote employee health and safety Review the ways in which successful workplace health promotion programs can prove financially beneficial Workplace Health Promotion Programs is a resource that guides students and professionals alike in the discovery, development, and execution of successful employee health initiatives.