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HomeMy WebLinkAbout2014-11-25; City Council; 21792; Presentation on Community ParamedicineCITY OF CARLSBAD - AGENDA BILL AB# 21.792 RECEIVE A PRESENTATION ON COMMUNITY DEPT.DIRECTOR MTG. 11/25/14 PARAMEDICINE CITY ATTY. —- DEPT. FIRE CITY MGR. RECOMMENDED ACTION: Receive a presentation from Fire Chief Mike Davis regarding the scope of work, approval and implementation of Emergency Medical Services Authority (EMSA) Workforce Pilot Project (HWPP) #173 - Community Paramedicine. ITEM EXPLANATION: Carlsbad Fire Department will be participating in a Community Paramedicine Pilot Program designed to transport patients with specified conditions to alternate locations otherthan an acute care emergency department. The Office of Statewide Health Planning and Development (OSHPD) announced the approval ofthe application for Health Workforce Pilot Project (HWPP) #173 - Community Paramedicine, effective November 15, 2014. FISCAL IMPACT: None. ENVIRONMENTAL IMPACT: Pursuant to Section 15061 of the CEQA Guidelines, the activity is covered by the General Rule that CEQA applies only to projects which have the potential for causing a significant effect on the environment. Where it can be seen with certainty that there is no possibility that the activity in question may have a significant effect on the environment, the activity is not subject to CEQA- EXHIBITS: 1. Letter from the Office of Statewide Health Planning and Development (OSHPD), announcing the approval of the Emergency Medical Services Authority (EMSA) application for Health Workforce Pilot Project (HWPP) #173 - Community Paramedicine. DEPARTMENT CONTACT: Mike Davis 760-931-2141 IVlichael.davis@carlsbadca.gov FOR CLERK USE. COUNCIL ACTION: APPROVED • CONTINUED TO DATE SPECIFIC DENIED • CONTINUED TO DATE UNKNOWN CONTINUED • RETURNED TO STAFF WITHDRAWN • OTHER - SEE MINUTES AMENDED • REPORT RECEIVED • • • • t V-'rvi State of California - Health and Human Services Agency Edmund G. Brown Jr., Governor OSHPD Office of Statewide Health Planning and Development Director's Office 400 R Street, Suite 310 Sacramento, California 95811-6213 (916) 326-3600 Fax (916) 322-2531 www.oslipd.ca.gov November 14, 2014 Howard Backer, MD, MPH Director Emergency Medical Services Authority 10901 Gold Center Drive, Suite 400 Rancho Cordova, CA 95670 RE: Health Workforce Pilot Project (HWPP) #173 - Community Paramedicine Approval with Modifications Dear Dr. Backer: I am pleased to announce the approval of the Emergency Medical Services Authority (EMSA) application, HWPP #173 Community Paramedicine with modifications. This project will test, demonstrate, and evaluate the practice of Community Paramedicine in the following areas: • Transport patients with specified conditions to alternate locations other than an acute care emergency department; • Address the needs of frequent 9-1-1 callers or frequent visitors to emergency departments; • Provide short-term home follow-up care for persons recently discharged from a hospital and at increased risk of a return visit to the emergency department or readmission to the hospital; and • Provide short-term home support for persons with diabetes, asthma, congestive heart failure, or multiple chronic conditions. The Emergency Medical Services Authority, as the project sponsor, is approved to proceed with all of the concepts and pilot sites proposed in its application for HWPP #173 provided that all of the modifications specified in the OSHPD staff recommendation memorandum dated October 13, 2014 (attached for reference) are implemented. Those recommendations are as follows: Patient Safety • The sponsor shall work with the HWPP Program and HWPP #173 project evaluator to determine the scope and timeline for data submission and reports during the initial six months ofthe Phase III: Intervention Period. • The sponsor shall require all sites to inciude in their patient eligibility protocols and consent forms that patients who cannot consent due to inebriation, mental incapacity, legal incapacity, or no responsiveness will be treated in accordance with current "Access to Safe, Quality Healthcare Environments that Meet Califorrjia's Diverse and Dynamic Needs' November 14, 2014 Page 2 regulations and local protocols governing EMT-Paramedics. These patients would not be included In the pilot project unless consent is lawfully given. • The sponsor shall provide triage protocols for each site to the HWPP Program and HWPP Program Advisory Committee for review and feedback, and strengthen those protocols if requested by the HWPP Program. Representation • The sponsor shall Include a paramedic and a member ofthe general public who is not a licensed healthcare provider on each site's Community Paramedic Steering Committee. Consent Forms • The sponsor shall require all sites to incorporate the following heading on all consent forms "Informed Consent" as identified in the program regulations. • The sponsor shall require all sites to develop an Informed Consent fomn specific to languages of the population proposed to be served. Training • The sponsor shall ensure that core standards for training address multiple disciplinary team coordination. • The sponsor shall require additional training for project participants, where warranted (i.e., if afterthe review and expansion of additional data collection elements, the HWPP Program deems additional training necessary to ensure patient safety), Pilot Project Evaluation • The sponsor shall conduct an overall evaluation of the pilot project and an evaluation at the site level. Data Collection and Analysis • The sponsor shall work with the HWPP Program to more explicitly define "patient safety" as It relates to the submission of data during the Phase III: Intervention Period. • The sponsor shall work with the HWPP Program in collaboration with the HWPP Advisory Committee to Identify and expand the data elements collected during the Phase III: Intervention Period to Include patient outcomes. The expansion of patient outcomes will be specific to each site and may include Items such as: o When was the patient discharged? o Where was the patient discharged (I.e. home or hospitalized)? o Did the patient need additional treatment? • The sponsor shall collaborate with the HWPP Program in determining the frequency of data submission to HWPP. Additionally, all of the following five provisions must be met: • In addition to the requirements specified in the OSHPD staff recommendation memorandum dated October 13, 2014, the sponsor shall ensure that all project sites modify the Informed Consent form to read as follows: "Patients who cannot consent due to Inebriation, mental incapacity, legal incapacity, or no responsiveness will be treated in accordance with cun'ent regulations and local protocols governing EMT-Paramedics. An exception to this requimment will be allowed for Study sites where the main objective Is to evaluate alternative destinations for 5 November 14, 2014 Page 3 patients with mental health issues that potentially prevent them fmm having adequate capacity to consent, and where paramedics participating in the Behavioral Health Pilot Project have completed a specified Psychiatric Emergency Response Team Training Course in Behavioral Health issues in addition to the completion ofthe Community Paramedicine Core Training. In these cases, efforts should still be made to obtain informed patient consent for the study, but inability for psychiatric reasons will not prevent the patient from participating. Patients In these mental health pmjects with other reasons for incapacity, such as unresponsiveness, and patients in all other projects cannot be included in the pilot projects unless consent is lawfully given." • The sponsor shall work with the project sites to develop further consistency with the medical criteria, protocols and training for similar concepts that are being tested. • The sponsor shall ensure that all alternate destination concepts (CP 001, CP 003, CP 009 and CP 012) send additional personnel to both the statewide and local training. • The sponsor shall require all sites to pursue local Institutional Review Board (IRB) approval. • OSHPD will ensure that data safety monitoring Is included in the responsibility of the HWPP #173 Advisory Committee, through site visits and data submission reports. As was stated In the staff recommendation, the HWPP Program will: • Monitor the approved project through reporting and site visit evaluations as weH as collaborate with the HWPP Program Advisory Committee, • Request the sponsor's oversight advisory committee assist the HWPP Program with monitoring and development of guidelines to tighten protocols pursuantto any findings, and • Request the sponsor to submit a copy of each site's Institutional Review Board (IRB) approved report for each site seeking IRB approval. The IRB approval should be obtained prior to the implementation ofthe employment/utilization phase. Any findings related to an endangerment to participating patients will be addressed as follows: • Sponsor shall provide immediate notification to the HWPP Program regarding any and all patient safety concerns and adverse consequences, and • Sponsor shall advise the HWPP Program of any resolution or proposed resolution to the safety concerns and adverse consequences. Notwithstanding any proposed resolutions to safety concerns and adverse consequences the HWPP Program will: • Consider any proposed solution brought by the sponsor, the site's Community Paramedicine Steering Committee, and the HWPP Program Advisory Committee, • Consider the degree of endangerment by reviewing all data collected, reports written and any other relevant information which may provide insight into the activity, • Review program regulations and project protocols to determine if the project was operating in compliance with the stated guidelines, • Consider suspending project activities at the specified site and the tralnee(s) involved, • Consider the termination of that portion of the pilot project if it deems there has been no satisfactory resolution. November 14, 2014 Page 4 • Consider the termination of the pilot project if there were system-wide concerns relating to any endangerment activity without resolution, and make available its findings to the general public. We appreciate your willingness to modify aspects of your project as a result ofthe review and comment phase ofthe application process. This approval is granted pursuant to Health and Safety Code Section 128125 ofthe goveming administration ofthe HWPP Program. This approval is effective immediately and will expire on November 14, 2015. You will be asked to submit reports and data that describe the progress in meeting objectives, tf an extension of time is needed, you will be required to provide this Office with information to justify the request by September 15, 2015. OSHPD will monitor HWPP #173 through written reports and site visit evaluations. In addition, we expect the Advisory Committee to assist the Office with the monitoring and development of guidelines to strengthen protocols, if possible, pursuant to their findings. Ms. Kristen M. Widdifield will serve as the Program Administrator and you may contact her with any questions at (916) 326-3718 or Kristen.Widdifield@oshpd.ca.qov. Very truly yours, Dr\acDT D nA\/in ' ROBERT P. DAVID Director cc: Lupe Alonzo-Diaz, Deputy Director, Healthcare Workforce Development Division 5 Community Paramedicine New Methods of Directing Patient Care Study Principals •Fire Chief Mike Davis •Medical Director/Principal Investigator Gary Vilke, MD., FACEP, FAAEM •Pilot Project Manager Linda Allington, RN, MPH, MPA •Division Chief Mike Calderwood •Administrative Secretary Deborah Baird •All line personnel trained Background work •Fire Chief has community advisory committee. •Gap assessment done to determine needs. •Survey of key sectors of the community: –Business, healthcare, education •Overwhelming support for the program. •CFD has its own medical director: –Gary Vilke -Clinical professor of medicine at UCSD, NIH grant recipient with over 200 peer-reviewed publications. Pilot study areas approved •CFD is studying: Transport patients with specified conditions not needing emergency care to alternate, non-emergency departments. •Other pilots are focusing on these:–After assessing and treating as needed, determine whether it is appropriate to refer or release.–Address the needs of frequent 911 callers by helping them access primary care.–Provide follow up for recently discharged persons at high risk of return to ED or readmission.–Provide support for persons with diabetes, asthma, CHF, or multiple chronic conditions.–Partner with community health workers in underserved areas to provide primary care. Program Distribution Pilot Concepts EMS Providers Alternate Destinations Carlsbad Fire Dept., Fountain Valley Fire Dept., Glendale Fire Dept., Huntington Beach Fire Dept., Newport Beach Fire Dept., Pasadena Fire Dept., Santa Monica Fire Dept., Stanislaus County Post Hospital Discharge Follow-up Alameda City Fire Dept., Burbank Fire Dept., Butte County EMS, Glendale Fire Dept., Medic Ambulance, San Bernardino County Fire Dept. Directly Observed Treatment of TB Gold Coast Ambulance, Lifeline Ambulance, Ventura County Frequent 911 Callers Alameda City Fire Dept., Rural Metro, San Diego City Fire Dept. Hospice Support Santa Barbara Fire Dept., Ventura County Mental Health Stanislaus County Research Question for Pilot Can trained Community Paramedics transport patients with specific conditions not needing emergency care to alternate, non-emergency department locations? Carlsbad Fire will be using telemedicine devices to communicate with Kaiser physicians. Proof of Concept Study Traditional CP 911 Call 911 Call Dispatcher Sends Resources Dispatcher Sends Resources Truck or Engine CompanyTruck or Engine Company Ambulance Ambulance Patient Assessment & Disposition Patient Assessment & Disposition Transport to Hospital Contact Kaiser if Appropriate Kaiser Accepts Kaiser Doesn’t Accept Transport to Kaiser Transport to Local ER Operationally •Contact Kaiser via telemedicine device. •Kaiser Intermediate Care Clinic in San Marcos •Have CT, stat labs, staffed with ED physicians. •Clinical protocols have been developed & approved by the State EMS Authority. •100% case review •Interim reports & analysis to local advisory committee, EMS Authority, & OSHPD. Timeline •Project was formally approved on November 14, 2014 by the Office of Statewide Health & Planning Director. •Implementation readiness report due by the 30th of each month. •Curriculum sent to EMSA and approved. •Half of the training as been completed. •Data collection for like patient set began in April of 2014. We are in the “run-up” phase now. •University of California, San Francisco is collecting the monthly data. •CP Intervention Period expected launch June, 2015. Affordable Care Act What influence will the Affordable Care Act (ACA) have? Triple Aim Approach:Objective: •Triple Aim: Best care, look at overall populations, reduce per cap cost •The right patient to the right place at the right time •Will become very important to the whole system Outcome •Patient satisfaction •Currently survey 100 patients per month. •Did we achieve the triple aim approach? •Is this patient centric? •Did we provide the patient what they needed in a safe, efficient, and cost effective manner? 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