Catherine R Counts
Doctorate
Doctorate Title: An Evaluation of the Environmental and Organizational Factors Associated with the Formation of Community Paramedicine Programs.
Doctorate Description: Background: As healthcare costs within the United States increase, novel delivery models are gaining popularity. One model that has yet to be evaluated is Mobile Integrated Healthcare or Community Paramedicine (MIHCP). MIHCP exists within the realm of emergency medical services (EMS) and acts as a mobile extension of primary care for those patients that use EMS in place of more traditional services. The goal of most MIHCP programs is either to decrease the inappropriate overutilization of EMS or to assist other organizations in the care of their patients outside of the ambulatory setting.
Purpose: Stage one of this study aimed to use Resource Dependency Theory to evaluate the environmental and organizational characteristics that foster the existence of MIHCP programs. Stage two aimed to determine if those counties with programs see a systematically measurable effect on related EMS call volumes.
Methods: Stage one was a retrospective, quasi-experimental, cross-sectional design in which logistic regression was used to compare counties identified in a 2014 survey of MIHCP programs to those counties without such a program. Stage two used propensity score matching to compare call volumes provided by the National EMS Information Systems (NEMSIS) dataset in counties with and without MIHCP programs. Specific types of programs that focused on readmissions, super utilizers, diabetics and patients with chronic respiratory illnesses were also evaluated.
Results: Stage one of this study demonstrated that counties with high EMS munificence, high healthcare dynamism, and low healthcare complexity are more likely to contain an MIHCP program. Results were inconclusive on healthcare munificence and EMS complexity. In stage two there was a 1.58% increase in related call volumes in counties with an MIHCP program focused on readmissions, but this was only minimally statistically significant (p < 0.1).
Conclusions: This study demonstrates that MIHCP programs are more likely to exist in dynamic environments with a low level of competition across the healthcare sector. It also shows that efforts to pass laws specific to MIHCP programs appear to be effective. Perhaps most importantly, it demonstrates the plausible connections available between EMS and health services research, specifically that EMS can be evaluated at the organizational level. However, until more data is available advancing the degree to which the EMS industry is researched will be limited.
Details:
Type: PhD
University: Tulane University
Primary Supervisor: Dr Mark Diana
Category: Other
Funding: None
Start Date: 2013
End Date: 2017
Status: Complete
Thesis
Awaiting
Research Interests
Publications
Paramedic PhD is endorsed by:
