Mobile integrated health care is the opportunity to employ providers
differently. The University of Maryland Medical
Center and Baltimore City Fire Department partnered together to think
about how do we embrace the community and how do we support their health. And
let's think outside the walls of a hospital.
If you're looking at the root causes of what how we got here it's really health
disparities and the social determinants of health. So this is actually moving the
care and moving this health support outside the walls of an office, outside
the walls of a hospital so that we actually figure out where patients need
that support and get them that support where they are. Number one we're on the
9-1-1 side, number two we're on the transition side
to help them get from the hospital to their home more effectively. And this is
new and novel. This is as innovative as you can get.
Baltimore City is the second busiest EMS system in the nation. We're transporting
about a hundred thousand times a year, so every 5.2 minutes we're
transporting somebody to the emergency department, regardless of complaint.
Oftentimes people get transported to the emergency room they aren't really
qualified or necessary for the emergency room. The program Minor Definitive Care
Now is aimed at the 9-1-1 system and trying to improve care and project care
to where folks need the care in a low acuity setting. Partnering a paramedic up
with either a nurse practitioner or a physician. In West Baltimore, somebody
calls 911 one. It's for a minor-type complaint, the team has the ability to
respond to the scene. If the patient consents for treatment on scene,
all 9-1-1 resources are returned to service. My feet went from under me and my old
back and I head banged up against the steps. I don't know who came first -
the ambulance or this program. They asked me did I wanna go to the emergency room. Did I
have to go to the emergency room? They basically did everything the emergency room would've done anyhow.
In essence it's a mobile urgent care. When we monitor the 9-1-1 system, see a
call that could be taken by the Minor Definitive Care Now team, and we
actually dispatch, with lights and sirens, right to your home, right to your street
corner. And we see you're right there, and hopefully we treat you right there on
scene. We show up in these vehicles. They have all the typical medical equipment
that a regular ambulance would have for a paramedic. And they also have some
equipment that the nurse practitioner and the doctors can use.
I've had one patient already that she cut her hand, I think, on some open
glass, and the nurse practitioner was they're able to suture
her hand on scene, rather than her being in the ER. Just pretty good because had
I had to go to the emergency room. I would've been in there all day long. And
I got the same type of treatment I got from the University of Maryland
program that the had come see me. So I think I made out pretty good.
the model for our transitional health care program is that our paramedics go
bedside in the hospital see a patient right in the hospital and they say hey
listen we have this opportunity for you and for the next 30 days we'll follow
you in your home whenever Eddie to be discharged we have a team from the fire
department and also the Medical Center who goes bedside discusses our program
our transitional health support program with the patient and then within 48
hours about 80% of our patients are seen in their home had an initial evaluation
done by our paramedic team from your discharge how do you feel slightly
better slightly worse the same I feel good when I started coughing and choking
each morning cougar number and then our interdisciplinary team Social Work case
managers pharmacists doctors nurses all look at that assessment and say ok this
person needs help with transportation help with insurance help with vision
help with dentistry coordination of their care between a cardiologist a
pulmonologist an endocrinologist and then we pick that person up and for 30
days we embrace that patient so that they're actually able to better
understand how to support their own health the most common questions that
they ask of me when I go into the home or medication questions why do I take
this medication what's the purpose of me taking this medications how often should
I take it and am I gonna have any side effects from this medication so that's
one of the common questions that they ask our goal is to kind of keep her from
going back in and help address any needs or concerns that she has in the meantime
and help you know kind of coordinate all the different care that she may have
received in the hospital and outpatient prior to that make sure she has her
medications make sure you know she has everything that she needs to be
successful in staying healthy goal of the program is to educate these patients
so that they know what to do to stay healthy to stay out away from being
admitted to the hospital and these are innovative approaches and we're pushing
the envelope on supporting folks health this is a great program that's I cannot
wait to expand across the entire city it's something that is really needed
that we'll really be able to help the citizens of Baltimore the difference in
this program is we've made an impact and I think we're making a difference and
that to us and our entire team really drives us and mode
dates us to keep doing it and keep building it and keep getting better it's
not only our patient satisfied not only our quality metrics started that I'm
really starting to have an impact but lastly our patients find value to this
and a costless and that's I think a potential national model the we in
Baltimore our champion