USCF Source Report (PDF) | Comments courtesy of Matt Zavadsky

With special thanks to Lou Meyer from the California Healthcare Foundation and the California EMS Authority, here is the most recent report by UCSF on the 13 California CP Pilot programs.

With all the interest in ET3, we’ve attached highlights of the Alternate Destination – Urgent Care programs. The results from these programs could provide agencies with specific information you may want to consider when researching keys to success for alternate destination models.

In the next few days, we’ll also send out the report findings from RTI on the REMSA Ambulance Transport Alternative (ATA) program they did as part of their CMMI Healthcare Innovation Award (HCIA).

The full report is available here.

From the UCSF Report 

All three Alternate Destination – Urgent Care projects enrolled patients who had any of the following five

conditions: isolated closed extremity injury, laceration with controlled bleeding, soft tissue injury, isolated

fever or cough, and other minor injury. One site, Carlsbad, also enrolled patients who had generalized weakness.

Forty-eight persons were enrolled in the three Alternate Destination – Urgent Care projects through November 2017. Orange County’s project had the largest enrollment (34 patients), and Carlsbad’s project had the smallest enrollment (two patients). UCLA’s Alternate Destination – Urgent Care project closed in May 2017, and Carlsbad’s and Orange County’s projects closed in November 2017. All closures of Alternate Destination – Urgent Care projects were due to low enrollment.

There are multiple reasons why enrollment in the Alternate Destination – Urgent Care projects was substantially lower than anticipated. All three sites had fewer patients than expected who met all of the criteria for inclusion in the pilot project. In addition, many 911 calls occurred at times of the day during which urgent care centers were closed. In the case of Carlsbad’s project, enrollment was limited to non-elderly adults who had insurance coverage through a single health plan.

Safety

The Alternate Destination – Urgent Care projects did not harm patients. Among the 48 patients enrolled in the Alternate Destination – Urgent Care projects, two patients (4%) were subsequently transferred to an ED within six hours of arrival at an urgent care center. In addition, nine patients (19%) were transported to an urgent care center but then rerouted to an ED because clinicians at the urgent care center declined to treat the patient. None of these patients had life-threatening conditions, and there were no adverse outcomes. The reasons for transport from an urgent care center to an ED are listed in Table 11. Additional detail about the two transfers to an ED within six hours of arrival at an urgent care center can be found in the initial public report on the community paramedicine pilot projects.

Conclusion

The community paramedicine pilot projects have demonstrated that specially trained paramedics can provide services beyond their traditional and current statutory scope of practice in California. No adverse outcome is attributable to any of these pilot projects.

These pilot projects integrate with existing health care resources and utilize the unique skills of paramedics and their availability 24 hours per day, 7 days per week. The community paramedics operate at all times under medical control – either directly or by protocols developed by physicians experienced in EMS and emergency care.

Research conducted to date indicates that community paramedicine programs are improving the effectiveness and efficiency of the health care system. The seventh concept, Alternate Destination – Urgent Care, shows potential, but further research involving a larger volume of patients transported to urgent care centers with wider ranges of services and expanded hours is needed to draw definitive conclusions.