Building the Car While Driving It: Lessons from an Advanced Provider Response Unit Program

Increasing volume of low acuity medical aid calls and overcrowding of emergency departments are major interrelated problems across the U.S. To mitigate these community risks, the [FD redacted – to be added before presentation] implemented a Mobile Integrated Health pilot program consisting of mobile Advanced Provider Response Units (“AP units”). The AP program, launched in 2019, has shown significant success since its implementation. The AP program’s overall goal is to better match low acuity patients with the appropriate level of care, thus preserving ALS and emergency department resources for high acuity cases. The main strategy employed by the AP unit to meet this objective is to place mobile advanced provider/paramedic teams in the field during peak hours, and utilizing these mobile teams and the advanced scope of clinical practice they possess to relieve other resources. In the initial conceptualization of the program, the main tactic used to meet the program’s objective was for the advanced provider to give definitive care in the field, acting as a ‘mobile urgent care’ capable of providing multiple treatments and discharging patients with follow up orders and prescriptions.

As one of the first programs of its kind, the AP program has undergone significant changes as the AP team has reflected on the tactics used to meet the program’s objectives. In this lecture we will outline the motivation for the program and trace the evolution of the AP program that has occurred as AP team members have reflected on outcomes achieved and adapted their tactics to better meet the objectives of the program over time. For example, we will discuss how case management, system navigation, and linkages to services have taken on crucial importance in the AP program alongside providing definitive care for low acuity calls in the field. Further, we will outline how the AP program may evolve in its next phase based on the teams’ learning so far, and discuss current and potential evaluation metrics.