MI HealthPaving the way to a healthier community

Amber Starn MPH, EpidemiologistMary Hannah RN, BSN, MPH, CDE

MI Health• In its simplest definition, Mobile Integrated Healthcare (MIH) is the

provision of healthcare using patient-centered, mobile resources in the out-of-hospital environment.

• In the interest of health literacy and branding, our planning team for MIH shortened the name to MI Health.

• This initiative has involved years of planning and initially started when the Charles County Department of Emergency Services presented the concept of MIH to the their local hospital and department of health.

• The strong partnership that exists in this county contributed to launching this initiative.

MI HealthHistory of MIH

• In 1996, the National Highway Traffic and Safety Administration (NHTSA) released a

document titled “EMS Agenda for the Future” outlining a roadmap for EMS systems to

use to bridge the gap between EMS and the rest of the health care system.

• It stated in the 21st century, EMS will be community based healthcare management, with

the ability to identify and modify illness and injury risks, provide acute care for those with

injuries or illness, and contribute to the care of those with chronic conditions.

• The concept would be partially abandoned for the next few decades until the Affordable

Care Act (ACA) would rejuvenate it.

MI HealthGoals of Mobile Integrated Healthcare

• Decrease the percentage of ED visits and 911 system calls among participants by 25%

• Increase the number of participants who visit their primary care provider twice a year

for routine care

• Increase health literacy by educating participants on prevention/management of their

disease processes

• Make at least one referral per participant to a needed community, health, or social

service

• Give people the tools to self-manage their disease processes

• Zone sheets

EVERYDAY WEIGH YOURSELF IN THE MORNING BEFORE BREAKFAST AND WRITE IT DOWN TAKE YOUR MEDICINE AS DIRECTED CHECK FOR SWELLING IN YOUR FEET, ANKLES, LEGS, AND ABDOMEN (WAIST AREA) MAKE FOOD CHOICES AS DIRECTED FOR RENAL DIET BALANCE ACTIVITY AND REST PERIODS

GREEN ZONE – ALL CLEAR: THIS IS YOUR SAFE ZONEYOUR SYMPTOMS ARE UNDER CONTROL IF YOU HAVE: NO SHORTNESS OF BREATH NO SWELLING OF YOUR FEET, ANKLES, LEGS, OR ABDOMEN NO CHEST PAIN NO CHANGE IN NORMAL URINATION

YELLOW ZONE – CAUTION: THIS ZONE IS WARNINGCALL YOUR DOCTOR’S OFFICE IF YOU HAVE: NAUSEA, VOMITING, OR LOSS OF APPETITE MORE SHORTNESS OF BREATH OR HICCUPS THAT WILL NOT STOP MORE SWELLING OF YOUR FEET, ANKLES, LEGS, OR ABDOMEN NO ENERGY OR FEELING MORE TIRED ITCHY SKIN OR A RASH DECREASED URINATION OR DARK-COLORED URINE FEELING UNEASY, YOU KNOW SOMETHING IS NOT RIGHT ABDOMINAL OR LOW BACK PAIN

RED ZONE - *EMERGENCY*GO TO THE EMERGENCY ROOM OR CALL 911 IF YOU HAVE ANY OF THE FOLLOWING: STRUGGLING TO BREATHE RACING HEART RATE AND/OR PALPITATIONS CHEST PAIN SEIZURE OR CONFUSION (CAN’T THINK CLEARLY) ABILITY TO URINATE SUDDENLY DECLINES

RENAL FAILURE ZONES

MI HealthThe Stakeholders

• Charles County Department of

Health

• University of Maryland Charles

Regional Medical Center

• Charles County Department of

Emergency Services

The MIH Team• Nurse

• Paramedic

• Community Health Worker

The Charles County MIH Team

MI HealthWhere do patients come from?

• Hospital nurse navigators and discharge planners

• Community case managers

• EMS referrals

• Stage 2: Health department and other partner agencies

MI HealthHow do patients enter the program?

• Discharge planner identifies patients at risk for

readmission• Inclusion is voluntary

• High utilizers• 6 or more visits to the ED in 3 months

MI HealthHow is the program funded?• Community Health Resources Commission

• 3 year, $400,000 grant

• Contributions• DoH – Management of the grant, Nurse, CHW, CRISP, office space for the team

• DES – paramedic, vehicle, diagnostic/communication equipment

• UM CRMC- funding towards the paramedic position, initial referral source, MI Health workgroup for creation of education tools and resource lists

MI HealthWhat does a patient visit look like?During the initial visit, the MIH team:• Assesses the patient's vital signs • Reviews discharge paperwork• Evaluates compliance with discharge instructions• Completes a medication evaluation• Conducts an environmental scan of the home for safety issues p• Provides health education and chronic disease self management information when

appropriate. • After the initial visit, the MIH team staff provide the high touch and communication

needed to keep the patients engaging in this program and out of the emergency department.

MI HealthMaking a difference one client at a time• The Starfish StoryOriginal Story by: Loren EisleyOne day a man was walking along the beach when he noticed

a boy picking something up and gently throwing it into the ocean. Approaching the boy, he asked, What are you doing?The youth replied, Throwing starfish back into the ocean.

The surf is up and the tide is going out. If I don’t throw them back, they’ll die.Son,the man said, don’t you realize there are miles and miles of beach and hundreds

of starfish? You can’t make a difference!

After listening politely, the boy bent down, picked up another starfish,and threw it back into the surf. Then, smiling at the man, he saidI made a difference for that one.

MI Health• Reaching long term goals of this project includes a reduction in the

UM CRMC readmission rates and a 10% reduction in the use of CCDES for transports of high utilizers for non-emergent transport. These goals are important for proving the return on investment with this project, yet the initial goal is to invest in and help transition one person at a time.

MI HealthLessons learned• The MOU process can be time intensive and cumbersome,

especially once legal teams are involved.• Take the time to explore other programs that have launched (e.g.

Queen Anne's County and Prince Georges County). This allowed for sharing of best practices and preparation of charting tools.

• Be adaptable. As you plan, you will not think of every possible scenario. The team will need to make changes as they go.

MI HealthSuccess Story• Client was frequent user of hospital ED. Well known to EMS and

hospital. • Client was very anxious when team arrived. Thought they were coming

to arrest for frequent ED visits. The client recognized the MIH team members instantly relaxed.

• Team was able to link the patient with community resources include behavioral health services, transportation as well safety improvements to the home to prevent falls.

• The frequent communication with MIH staff lead to an immediate decrease in ED usage. Client was very appreciative of the team.

MI HealthCurrent Program Measures• Number of patients enrolled• Number of home visits• Number of patient encounters• Number of home assessments completed• Number of EMS call among participants• Number of ED visits among participants• Number of hospital admissions among participants

MI Health

Questions?Feel free to contact us if you have any questions or would

like additional information.Amber Starn, Charles County Department of HealthPhone: 301-609-5748, Email: amber.starn@maryland.govMary Hannah, University of Maryland Charles Regional

Medical CenterPhone: 301-609-4976, Email: mhannah@umm.edu