EMS World

FEB 2017

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | FEBRUARY 2017 25 T he number of mobile integrated health- care and communit y paramedicine (MIH-CP) programs across the country still appears to be growing significantly. Leaders of early programs like those at MedStar (Texas), REMSA (Nevada), Allina Health (Minnesota) and UPMC (Pennsylvania) receive inqui- ries almost daily about starting and maintaining programs. The two most commonly asked questions center around training models for community para- medics and how to economically sustain MIH-CP programs. There may be a perfect solution to both of those issues: community health worker (CHW) certification. Who Are CHWs? According to the Centers for Disease Control and Pre- vention (CDC), CHWs are front-line health workers who have a close understanding of the communities they serve. CHWs build individual and community capacity by increasing health knowledge and self- sufficiency through a range of activities such as out- reach, community education, informal counseling, social support and advocacy. The federal Office of Management and Budget's Standard Occupational Classification system includes a unique occupational classification for community health worker (SOC 21-1094). Community health workers serve in urban, suburban and rural settings, commonly helping link people to needed healthcare information and services. The Bureau of Labor Statistics definition says there are more than 48,000 people employed in this profes- sion nationally, with a mean annual wage of $40,000. Their definition includes the following: "Assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for individuals and community health needs, and provide services such as first aid and blood pressure screening. May collect data to help identify community health needs." Roles in the System CHW roles and activities are tailored to meet the unique needs of local communities. They also depend on factors such as whether the CHW works in the healthcare or social services sector. Generally these roles may include: » Helping individuals, families, groups and com- munities develop their capacity and access to resourc- es, including health insurance, food, housing, quality care and health information; » Facilitating communication and client empow- erment in interactions with healthcare/social service systems; » Helping healthcare and social service systems become culturally relevant and responsive to their service populations; » Helping people understand their health condition(s) and develop strategies to improve their health and well-being; » Helping to build understanding and social capital to support healthier behaviors and lifestyle choices; » Delivering health information using culturally appropriate terms and concepts; » Linking people to healthcare/social service resources; » Providing informal counseling, support and follow-up; » Advocating for local health needs; » Providing health services, such as monitoring blood pressure and providing first aid; » Making home visits to chronically ill patients, pregnant women and nursing mothers, individuals at high risk of health problems and the elderly; » Translating and interpreting for clients and healthcare/social service providers. Managers of active MIH-CP programs who just read that list of potential roles may be scratching their heads and thinking, That sounds a lot like what our community paramedics do! And they are right, but there's more. Evidence-Based Interventions Here's the most interesting news: CHWs have been extensively researched, and the outcomes for the services they provide are evidence-based. Emerging MIH-CP programs have been building this base with case studies and data reporting, but peer-reviewed, published evidence is still a challenge, not because MIH-CP programs do not result in enhanced out- comes but due to the fact they're still relatively new. The Agency for Healthcare Research and Quality (AHRQ)—the policy research arm of the Department of Health and Human Services (HHS)—released an evidence-based summary report developed by RTI International on the impact of CHW interventions. The report identified over 50 different studies of CHW interventions in published literature. It is interesting to note that AHRQ has published on several MIH-CP programs through its Healthcare Innovations Exchange and that RTI International was the program evaluation agency for the REMSA CMS Innovation award. Additionally, a 2011 report Communit y health worker s have been e x tensively researched, and the outcomes for the ser vices they provide are evidence-ba sed.

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