Mobile Integrated Health Care and Community Paramedicine: A Position Statement and Resource Document of NAEMSP

Emergency medical services (EMS) are integral to public health and safety and provide health care to both individuals and communities. Community paramedicine (CP) and mobile integrated health care (MIH) programs are expanded models of EMS that provide needs-based, patient-centered care in the community. Successful implementation requires a community health needs assessment, engaged EMS medical directors, multidisciplinary collaboration, and sustainable reimbursement that recognizes prehospital care delivery beyond traditional payment for transport. Engaged and knowledgeable EMS physician medical directors, preferably with EMS board certification, must guide CP and MIH programs.CP and MIH programs should be tailored to meet local community needs based on a community health needs assessment and designed to bridge local gaps in access or care without duplication of services. The role of EMS clinicians should be clearly defined by the physician medical director and reflect the boundaries of collaborative practice.Physician medical directors may seek additional guidance on CP and MIH practice from state regulatory bodies, though practice regulations and standards should not stifle innovation and be established upon available data and outcome measures. Any state training or certification regulations should be dependent upon the expanded services provided and made with input from physician EMS medical directors.Clinician training programs intending to be comprehensive in approach should use standardized curricula. In programs with a limited expanded scope of practice, modularized training specific to the targeted disease processes may be appropriate. In both cases, CP and MIH clinicians should undergo regular competency evaluation supported by the physician medical director.State and federal agencies should establish reimbursement systems under Medicare and Medicaid, and EMS agencies should work with private payors to ensure reimbursement for the provision of community paramedicine and mobile integrated health care, decoupled from reimbursement for transportation.Data collection and analysis using standardized tools, methods, and reporting structures are essential for the evaluation and growth of CP and MIH programs. CP and MIH research should develop a standard taxonomy for describing programs, identify common data definitions and outcomes measures, collaboratively aggregate data, and advocate for development of data reporting standards. Engaged and knowledgeable EMS physician medical directors, preferably with EMS board certification, must guide CP and MIH programs. CP and MIH programs should be tailored to meet local community needs based on a community health needs assessment and designed to bridge local gaps in access or care without duplication of services. The role of EMS clinicians should be clearly defined by the physician medical director and reflect the boundaries of collaborative practice. Physician medical directors may seek additional guidance on CP and MIH practice from state regulatory bodies, though practice regulations and standards should not stifle innovation and be established upon available data and outcome measures. Any state training or certification regulations should be dependent upon the expanded services provided and made with input from physician EMS medical directors. Clinician training programs intending to be comprehensive in approach should use standardized curricula. In programs with a limited expanded scope of practice, modularized training specific to the targeted disease processes may be appropriate. In both cases, CP and MIH clinicians should undergo regular competency evaluation supported by the physician medical director. State and federal agencies should establish reimbursement systems under Medicare and Medicaid, and EMS agencies should work with private payors to ensure reimbursement for the provision of community paramedicine and mobile integrated health care, decoupled from reimbursement for transportation. Data collection and analysis using standardized tools, methods, and reporting structures are essential for the evaluation and growth of CP and MIH programs. CP and MIH research should develop a standard taxonomy for describing programs, identify common data definitions and outcomes measures, collaboratively aggregate data, and advocate for development of data reporting standards.