Why It Matters
Because fire departments are important community partners in the drive to improve population health.
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Calling 911 to Pursue Population Health

By Adam Davis | Wednesday, March 30, 2016

Calling 911 to Pursue Population Health

You might be surprised to learn that fire departments are playing a big role in the drive toward population health.

If you think about it, though, it makes sense. We’re trusted members of the community. We’re in the homes of people in need on a daily basis. We’re in a position to help patients in ways that their health care providers can’t.

The Kent Regional Fire Authority in Kent, Washington, is always looking for opportunities to improve our service to meet the needs of the community. Five years ago, we developed a new kind of medical service, FD Cares, which responds to 911 callers with non-emergent medical needs, high-volume EMS users, and high-risk patients in our response area. A fragmented health care system wasn’t meeting the needs of a subset of the population: frequent users of 911 services.

We would never have discovered this if we hadn’t started analyzing our incident response data in a new way. 

Learning from ‘Hot Spotting’

A fire department, just like an emergency department, typically looks at patients in terms of incident responses or isolated visits. Over the last several years, as the idea of hot spotters emerged out of Camden, New Jersey, we began looking at volume of use by patients, rather than incidents. As participants in IHI’s Better Health and Lower Costs for Patients with Complex Needs Collaborative, we started asking new questions.

How frequently are our patients using emergency services? Does this frequency suggest chronic social or medical issues that are contributing to the 911 calls? We shifted to a patient-centric view of the data.

A Two-Pronged Approach

In addition to our urgent services, we now also conduct proactive visits. FD Cares works with our partnering agencies, including health care providers and payers, to identify and engage high-risk patients and high-volume 911 callers, as well as emergency department users.

For example, we recently saw a 67-year-old woman who lived in an adult family home who was calling 911 frequently for chest pain. We made a proactive visit and sat down with the patient, the manager and nurse for the adult family home, and the patient’s family. We reviewed some of her history, asked about her symptoms, and tried to learn more about her situation. 

We discovered that she has a history of anxiety, and had recently discontinued her anti-anxiety medication and started an anti-psychotic. We determined that her attacks were anxiety-driven chest pain, and that her new medication was causing some upsetting side effects.

The nurse helped arrange for the patient to see her primary care provider, who changed her prescription to better meet her needs. She hasn’t needed to call 911 since.

We’re still crunching the data, but the results so far look promising. We appear to be saving money by using a low-cost vehicle, stabilizing more patients at home, and navigating patients to lower-cost alternatives to the emergency department. We also receive a high rate of positive patient satisfaction scores.

Another benefit, which we didn’t expect, is that we’re influencing patients’ utilization of 911 and emergency department services. By connecting patients with the right type of care, we can help them find the health care they need through the most appropriate service. We’re finding that these visits alter their future health-seeking behavior.

Community Accountability

Communities hold fire departments accountable. They won’t hesitate to let us know if we’re not meeting their needs.

This makes the great feedback we hear from many of our patients especially rewarding. We even hear appreciation from members of the community who have just heard about what we’re doing.

People seem happy that we’re trying to anticipate what our community needs from us. Many patients also like that we provide a more subdued response to their calls than in the past. Sometimes, people just need help getting to their feet after a fall. They’re often grateful that you don’t arrive with a fire engine and flashing lights.

Just about every community in the US is facing budget pressures. Our voters look at the cost of health care, the police, and the fire service, and they want proof that that the valuable services we provide are cost efficient. In Kent, they’re glad to see that we’ve made improvements while stabilizing our costs in the last few years. Voters are always pleased when their taxes don’t go up!

What We’ve Learned

FD Cares will always be a work in progress, but we’ve learned a great deal that might benefit many different organizations working toward population health, not just other fire departments or EMS programs. A few places to start:

  • Use your data to shift from incident response to patient-centered programs.
  • Commit to working across organizations to develop a community of care for patients.
  • Organize jobs around patients. Don’t organize jobs around providers.
  • Don’t waste too much time trying to build the perfect solution.

Change is challenging and sometimes slow. It takes a lot of work to engage new people and partners beyond our silos. But it’s worthwhile to work together — in the end, we can better meet patients’ needs.

Adam Davis, DNP, is Lead Nurse for the Kent Regional Fire Authority's FD Cares Program. The FD Cares program participated in IHI's Better Health and Lower Costs for Patients with Complex Needs Collaborative, the basis of IHI’s Impacting Outcomes and Costs for Patients with Complex Needs seminar.


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