Integral Components for Community Paramedicine Program Development

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Integral Components for Community Paramedicine Program Development by Mind Map: Integral Components for Community Paramedicine Program Development

1. Stakeholder Engagement

1.1. Hospitals

1.1.1. ER

1.1.1.1. GEM Nurse

1.1.1.2. Physician

1.1.2. Discharge Planners

1.1.2.1. Referrals

1.1.3. Rounds for Inpatient Units

1.1.3.1. Relationship Building

1.1.3.2. Referrals

1.1.3.3. Better Understanding of Hospital Processes

1.1.3.4. Capacity Building

1.2. Community Groups

1.2.1. Religious Groups

1.2.1.1. Relationship Building

1.2.1.2. Better Understanding of Cultures within Communities

1.2.1.3. Referrals

1.2.2. Seniors Groups

1.2.2.1. Relationship Building

1.2.2.2. Integration with Existing Resources

1.2.3. Legions

1.2.3.1. Relationship Building

1.2.3.2. Integration with Existing Resources

1.3. Primary Care Providers

1.3.1. Family Health Teams

1.3.1.1. Care Coordination

1.3.1.1.1. Social Services

1.3.1.1.2. Pharmacy

1.3.1.1.3. Dietician

1.3.1.1.4. Occupational Therapist

1.3.1.1.5. Physiotherapist

1.3.2. Stand-Alone Practice

1.3.2.1. Relationship Building

1.4. LTC Facilities & Retirement Homes

1.4.1. Private

1.4.2. Public

1.5. Community Mental Health

1.5.1. Case Workers

1.5.2. Mental Health Crisis Team

1.6. Home Care Agencies

1.6.1. Private

1.6.2. Public

1.7. Allied Agencies (police and fire)

1.7.1. Police: Situation Table

1.7.2. Fire: Home Safety

1.8. Pharmacies

1.8.1. Medication Compliance

1.8.2. Community Paramedic Education

1.8.3. Client Education

2. Innovative Technology

2.1. Remote Patient Monitoring

2.1.1. CHF

2.1.2. COPD

2.1.3. Diabetes

2.1.4. High 911 Utilization

2.1.5. High ED User

2.2. Q-Tug

2.2.1. Falls Risk Assessment

2.2.1.1. Every patient

2.2.2. Wearable Device

2.3. Prehos

2.3.1. Scheduling

2.3.2. Mapping

2.3.3. Intelligent Dispatching

2.3.4. Data Analysis Capability

2.3.5. Referrals

2.3.5.1. Intake into Community Paramedic Program

2.3.5.2. Outgoing to Community Resources

2.3.6. Efficient

2.4. OTN

2.4.1. Daily Batch Starts

2.4.2. Physician Consultation

2.4.2.1. Physician Billing Capability

2.4.3. Training Opportunities

2.4.3.1. Integrated Training with Health Care Professionals

2.5. Point of Care Testing

2.5.1. Ultrasound

2.5.2. Influenza Nasal Swab

2.5.3. Urine Dips

2.5.4. INR

2.6. Phlebotomy

2.6.1. Lab Value

3. Training & Education

3.1. Community Paramedic Education

3.1.1. Enhanced Physical Assessments

3.1.1.1. Auscultation

3.1.1.2. Differential Diagnosis

3.1.1.3. Non-Acute Presentations

3.1.1.4. Pertinent - & + Findings

3.1.2. Chronic Disease Management

3.1.2.1. COPD

3.1.2.2. CHF

3.1.2.3. Diabetes

3.1.3. Enhanced Scope of Practice

3.1.3.1. ACP vs PCP

3.1.3.2. New Equipment

3.1.3.3. Non-Traditional Role

3.1.4. CSA Guideline

3.1.4.1. Canadian Paramedicine: Framework for Program Development

3.1.5. Standardized Assessment Tools

3.1.5.1. Depression Scale

3.1.5.2. Falls Risk Assessment

3.1.5.3. Home Safety Scan

3.1.6. Clinical Practice Guidelines

3.1.6.1. Medical Director Training

3.2. Patient & Family Education

3.2.1. Chronic Disease Management

3.2.1.1. CHF, COPD, Diabetes

3.2.1.1.1. Better Understanding of Disease Process

3.2.1.1.2. Non-Acute Presentations

3.2.1.1.3. Improved Medication Compliance

3.2.2. Differential Diagnosis

3.2.3. Pertinent + and - Findings

3.2.4. Depression Scale

3.2.5. Falls Risk Assessment

3.2.6. Remote Patient Monitoring

3.2.7. Home Safety Scan

3.2.8. Non-Acute Presentations

4. Patient & Family Centred Care

4.1. Patient Safety

4.2. Centred on the Patient's Goal

4.3. Caregiver Support

4.4. Patient Advocacy

5. Governance & Policy

5.1. Local

5.1.1. MOU

5.1.1.1. Pharmacies

5.1.1.2. Medical Director

5.1.2. Fiscally Responsible

5.1.2.1. Annual Budget Planning

5.1.2.2. Sustainability

5.1.3. Clinical Practice Guidelines

5.1.4. Standard Operating Procedures

5.2. Provincial

5.2.1. Regulatory College (if applicable)

5.2.2. Ministry of Health

5.2.2.1. Funding

5.2.2.2. Standards

5.2.2.3. Local Health Integration Networks

5.2.2.3.1. Funding

5.2.2.3.2. Health Link Model

5.3. Federal

5.3.1. CSA Z1630 Document

5.3.2. Fiscally Responsible

5.3.2.1. Annual Budget Planning

5.3.2.2. Sustainability

6. Standards

6.1. QA: Patient & Paramedic Safety

6.1.1. Retrospective Chart Reviews

6.1.2. Randomized Audits

6.1.3. Peer Accountability

6.2. CQI: Qualitative & Quantitative

6.2.1. Client & Caregiver Experience

6.2.2. Decrease in 911 Calls for Enrolled Clients

6.2.3. Decrease in ED Visits for Enrolled Clients

6.3. Just-Culture Approach

6.3.1. Non-Punitive

6.3.2. Constructive

6.3.3. Peer Audits

6.4. Standards

6.4.1. Legislative

6.4.1.1. MOH

6.4.2. Policy & Procedure

6.4.3. Standard Operating Procedures

7. Community Needs

7.1. Data Informing Trends

7.1.1. Population Health

7.1.1.1. Multiple Co-Morbidities

7.1.1.2. Polypharmacy Issues

7.1.1.3. Lack of Primary Care Provider

7.1.2. Social Determinants of Health

7.1.2.1. Age

7.1.2.2. Gender

7.1.2.3. Social Environments

7.1.2.4. Biology, Genetic Characteristics

7.1.2.5. Healthy Child Development

7.1.2.6. Education & Literacy

7.1.2.7. Employment & Working Conditions

7.1.2.8. Physical Environments

7.1.2.9. Health Practices & Coping Skills

7.1.3. Isolation

7.1.3.1. Geographical

7.1.3.2. Social

7.1.4. ER Utilization

7.1.5. 911 Utilization

7.2. Wellness Clinics

7.2.1. Everyone is welcome (orphaned patients)

7.2.2. Health Education Sessions

7.2.3. Community Partnerships

7.3. Community Resource Capacity Assessment

7.3.1. Palliative Care

7.3.2. Primary Care Providers

7.3.3. Home Supports

7.3.4. Social Supports

7.4. 911 Response

7.4.1. Higher Level of Care

7.4.1.1. ACP

7.4.2. Increased Community Coverage

7.4.3. Decreased Response Times

7.5. Healthcare System Savings

7.5.1. Decrease in 911 Calls

7.5.2. ER Diversions

7.5.3. Decreased Length of Stay in Hospital

8. Logistics

8.1. New/Different Equipment

8.1.1. Phlebotomy

8.1.2. Cardiac Monitors

8.1.3. True BP Machine

8.1.4. POC Testing

8.1.5. Cost

8.1.6. Maintenance

8.2. Vehicles

8.2.1. Cleaning

8.2.2. Maintenance

8.2.3. Cost

8.2.4. Type/Designation

8.2.4.1. SUV

8.2.4.2. Car

8.2.4.3. Side-by-Side

8.2.4.4. Bicycle

8.3. Standards

8.3.1. Maintenance

8.3.2. Ministry of Health Requirements

8.3.3. Warranty

8.4. Staffing

8.4.1. ACP

8.4.2. PCP

8.4.3. Full-time

8.4.4. Part-time

9. Amber Hultink PARA 453 Integral Components for Community Paramedicine Program Development

10. LEGEND:

10.1. Central Node/First Layer: Main Theme

10.2. Second Layer: Integral Components for the development of a Community Paramedic Program

10.3. Third Layer: Key Components that are used to establish and define each of the Integral Components.

10.4. Fourth Layer: Specific Aspects for each of the Key Components.

10.5. Fifth Layer: More in depth layer to help define the complexity of each Specific Aspect.

10.6. Sixth Layer: Where applicable, a more detailed description of factors that all ultimately influence the Key Components.

11. References

11.1. Ruest, M., Stitchman, A., & Day, C. (2012). Evaluating the impact on 911 calls by an in-home programme with a multidisciplinary team. International Paramedic Practice, 2(2), 41-48. Evaluating the impact on 911 calls by an in-home programme with a multidisciplinary team | International Paramedic Practice | Vol 2, No 2

11.2. Williams, J. (2013). Community paramedicine: a global phenomenon?Expanding paramedic scope of practice in the community: a systematic review of the literature. Bigham BL, Kennedy SM, Drennan I (2013) Prehosp Emerg Care 17(3): 361–72. Journal Of Paramedic Practice, 5(10), 592-593. Community paramedicine: a global phenomenon? | Journal of Paramedic Practice | Vol 5, No 10

11.3. Ministry of Health and Long Term Care: Home and Community Care Branch. (2017). Community Paramedicine Framework for Planning, Implementation and Evaluation (p. 22). Toronto, ON: Ontario Government.

11.4. From the Report Submitted to the Minister of Health and Long-Term Care and the Minister Responsible for Seniors on recommendations to inform a Seniors Strategy for Ontario. (2013). Living Longer, Living Well: Highlights and Key Recommendations (p. 21). Provincial Lead, Ontario’s Seniors Strategy.

11.5. O’Meara, P., Stirling, C., Ruest, M., & Martin, A. (2015). Community paramedicine model of care: an observational, ethnographic case study. BMC Health Services Research, 16(1). Community paramedicine model of care: an observational, ethnographic case study

11.6. Bourke, L., Humphreys, J., Wakerman, J., & Taylor, J. (2012). Understanding rural and remote health: A framework for analysis in Australia. Health & Place, 18(3), 496-503. http://dx.doi.org/10.1016/j.healthplace.2012.02.009

11.7. Edwards, N. C., & Maclean-Davis, C. (2008). Social justice and core competencies for public health; Improving the fit. Canadian Journal of Public Health, 99(2), 130-132. Social Justice and Core Competencies for Public Health: Improving the Fit on JSTOR

11.8. CSA Group, Nolan, M., & Poirier, P. (2017). Community paramedicine: Framework for program development. Canadian Standards Association, (1), 34.