INTERVIEW: Dr. James Dunford on San Diego Community Paramedicine

Feb 8, 2016 by

San Diego City Medical Director Dr. James Dunford worked to launch San Diego’s Resource Access Program (RAP) to better handle EMS “mega-users”, which has kicked off a wave of EMS innovation in the area. In 2008, San Diego’s hospital system had 25-30 patients who were taken nearly weekly to the ED (50+ times per year); it was apparent that the Emergency Department was ill-equipped to handle the kind of chronic issues for which these patients needed assistance. RAP came in to provide community paramedicine services specifically for this group of mega-users.

Through their patient-centered approach, integrated with cloud technology, RAP decreased the number of mega-users by 84% in the three years of their pilot program. At the same time, San Diego EMS charges fell by 32% (from $689,743 to $468,394). Hours spent by EMS workers caring for frequent callers dropped by 40%, improving response time for other calls. San Diego EMS also saw a 47% reduction in the number of miles traveled by emergency vehicles in response to calls from “mega-users”. These numbers are significant to San Diego EMS systems and hospitals alike; the funds saved here can be put towards new EMS innovation, and also have cut down on 30-day hospital readmission fines under the Affordable Care Act. On the ground, RAP’s staff has expanded from one community paramedic to five, and the program is looking towards an initiative to allow EMS transportation to alternate destinations.

The financial and practical successes of RAP are an excellent example of the ways in which a patient-centric approach can save money and time while improving patients’ healthcare experiences. When community paramedics are able to access data on their patient’s past 911 calls  in real time, they understand each incident more holistically and are able to provide better care. This has enabled RAP to expand and support more frequent callers.

Outside of San Diego and RAP, Dr. Dunford is also advocating for healthcare delivery reform on the national level, as a principal investigator for the Promoting Innovations in EMS (PIE) Project. Dr. Dunford and other project leaders have drafted a policy recommendation to create a national framework of EMS innovation by identifying and overcoming obstacles for community paramedicine. Their work has just entered a public comment period. Raise your voice and be a part of the future of EMS innovation!

Read the full interview for more insight into Dr. Dunford’s work with community paramedicine, then join NYMIHA for the latest news in mobile integrated healthcare.

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