Dallas MIH-CP Program Reduces Enrolled Patients` Calls by 82%

Since Dallas Fire-Rescue began a proactive pilot program in March 2014 involving firefighter-paramedics making house calls, the frequency of 9-1-1 calls by patients in its Mobile Community Healthcare Program has plummeted by 82%.

The drastic reduction has saved the city significant sums via fewer emergency runs, and hospitals by fewer emergency room visits for patients, many uninsured. The eighth-largest city in the United States, Dallas covers some 380 square miles and 1.18 million residents.

“We’ve seen a run reduction among those enrolled in this program from 2,870 calls in the year before enrollment to 510. That’s monumental,” says Norman Seals, assistant chief of the Emergency Medical Services Bureau for the Dallas Fire-Rescue Department.

The Mobile Community Healthcare Program employs Dallas Fire-Rescue community paramedics to focus on chronically ill patients and those recently discharged from a local hospital. Paramedics evaluate medical needs, teach enrolled patients ways to better manage their health and provide them with referrals to necessary services.

“In the ‘proof of concept’ phase in the first few months of the program, we looked at what was being done in other places with similar programs and designed our own in a fire department-based system,” says Marshal Isaacs, MD, medical director of Dallas Fire-Rescue. “Was it safe? Was it beneficial to patients? Was it good for the healthcare system? We proved that it was. And it has been.”

For example, a hospital partner may refer a discharged trauma patient to Dallas Fire-Rescue. Paramedics go into the field to ensure the patient is properly set up for home recovery and is taking medications as prescribed. The hospital partner pays Dallas Fire-Rescue for their services, which costs less than readmission penalties.

Lessons Learned

“Case management has been a challenge,” says Seals. “As firefighters, our case management process generally lasts anywhere from 30 minutes to four hours. In this program, we’re dealing with patients for sometimes 6–8 months before they ‘graduate.’ Dr. Isaacs has been great about bringing hospital case management principles together with ours.”

Over the course of the pilot program’s first two years, Isaacs has been surprised by “how little medical intervention these patients need acutely, especially high-frequency patients.”

What they found instead was that that the vast majority of work the community paramedics are doing with patients falls under the auspices of education; medication reconciliation, inventory and management; and healthcare system navigation.

“Hospital patients often have little to no social support,” explains Seals. “Perhaps they lack transportation. Sometimes they lack food. We’ve been able to form really good relationships with 50 or 60 community-based partners that cover those services. That’s been absolutely critical to the success of the program.”

Since the program’s onset, only 22 of 297 referred patients, or 7.4%, have refused service. “We’re not sure if it’s a privacy issue, for good or bad reasons, but we know the subset of patients we can only take so far in the program, if at all,” Isaacs says. “Those patients tend to have severe mental illness or recalcitrant alcohol and substance abuse disorders and are unwilling to accept treatment.”

What’s Next?

The pilot program has grown from four to seven paramedics. Hospital partners have grown from one—Parkland Health & Hospital—to three health systems for contracts totaling $700,000.

“For the most part, the program is still city-funded,” says Seals, adding that Dallas Fire-Rescue was the first metropolitan fire-based EMS agency in the United States to develop a program of its kind. “The end goal is to be at least budget-neutral for the city, which we plan to do with more hospital partners and through grants.”  

A custom data management system is being developed that, when fully implemented, will propel the Mobile Community Healthcare Program.

“There are so many areas of need,” says Seals, adding that hospice and mental health patients would benefit from the program to reduce revocation. “We aren’t trying to replace existing programs or services. Our role is to fill some gaps.”