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首页> 外文期刊>Western Journal of Emergency Medicine >Development and Implementation of a Community Paramedicine Program in Rural United States
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Development and Implementation of a Community Paramedicine Program in Rural United States

机译：美国农村社区Paramedicine计划的开发与实施

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Introduction: Community paramedicine (CP) is an innovative care model focused on medical management for patients suffering from chronic diseases or other conditions that result in over-utilization of healthcare services. Despite their value, CP care models are not widely used in United States healthcare settings. More research is needed to understand the feasibility and effectiveness of implementing CP programs. Our objective was to develop a CP program to better meet the needs of complex, high-utilizer patients in a rural setting.Methods: We conducted an observational descriptive case series in a community, 25-bed, critical access hospital and primary care clinic in a rural Wisconsin county. Multiple stakeholders from the local health system and associated ambulance service were active participants in program development and implementation. Eligible patients receiving the intervention were identified as complex or high need by a referring physician. Primary outcomes included measures of emergency department, hospital, and clinic utilization. Secondary measures included provider and patient satisfaction.Results: We characterized 32 unique patients as high utilizers requiring assistance in medical management. These patients were enrolled into the program and categorized as high utilizers requiring assistance in medical management. The median age was 76 years, and 68.8% were female. After six months, we found a statistically significant decline in patient utilization for primary care (53.3%, p = .006) and ED visits (59.3%, p = .007), but not for hospitalizations (60%, p = .13, non-significant (NS), compared to the six months preceding enrollment. Overall, the total number of healthcare contacts was increased after implementation (623 before vs 790 after, + 167, +26.8%).?Implementation of the CP program resulted in increased overall use of local healthcare resources in patients referred by physicians as high utilizers.Conclusion: The implementation of an in-home CP program targeting high users of healthcare resources resulted in a decrease in utilization in the hospital, ED, and primary care settings; however, it was balanced and exceeded by the number of CP visits. CP programs align well with population health strategies and could be better leveraged to fill gaps in care and promote appropriate access to healthcare services. Further study is required to determine whether the shift in type of healthcare access reduces or increases cost.
机译：简介：社区Paramedicine（CP）是一款专注于患有慢性疾病或其他导致医疗保健服务过度使用的其他条件的患者的医学管理的创新护理模型。尽管它们的价值，CP Care模型并未广泛用于美国医疗保健设置。需要更多的研究来了解实施CP计划的可行性和有效性。我们的目标是开发一个CP计划，以更好地满足农村环境中复杂的高实用患者的需求。方法：我们在社区，25张，关键接入医院和初级保健诊所进行了一系列观测性描述性案例系列威斯康星州乡村。来自当地卫生系统和相关救护服务服务的多个利益攸关方在方案开发和实施方面是积极参与者。接受干预的符合条件的患者被转介医生确定为复杂或高需求。主要成果包括急诊部，医院和临床利用的措施。次要措施包括提供者和患者满意度。结果：我们将32名独特的患者视为需要在医疗管理中提供援助的高利用者。这些患者注册了该计划，并作为需要在医疗管理中提供援助的高利用者进行分类。中位年龄为76岁，女性是68.8％。六个月后，我们发现患者利用统计上显着下降初级保健（53.3％，p = .006）和ed访问（59.3％，p = .007），但不适合住院（60％，p = .13 ，非重要（NS），与先进的六个月相比。总体而言，实施后，医疗保健触点的总数增加（623岁以后，+ 167，+ 26.8％）。？CP计划的实施导致了CP计划随着医生称为高利用者的患者的患者的整体使用局部医疗资源增加。结论：瞄准医疗资源高用户的家庭CP计划的实施导致医院，ED和初级护理环境中的利用率降低;但是，它的CP访问数量平衡和超过。CP程序与人口健康策略齐全，可以更好地利用填补差距，促进适当的医疗服务。需要进一步的研究来确定医疗保健访问类型是否会降低或增加成本。

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