Lebanon Mobile Integrated Health

Right person, right care, right place, right time.

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Mobile Integrated Health Team photo (from left to right): Amanda St. Ivany, Community Nurse; Jeremy Thibeault, Community Paramedic; and Rachael McMillan, Community Nurse
Mobile Integrated Health Team photo: (left to right) Amanda St. Ivany, Community Nurse; Jeremy Thibeault, Community Paramedic; and Rachael McMillan, Community Nurse.

This statement describes the goal of the Lebanon Fire Department and Dartmouth Hitchcock Medical Center (DHMC) Mobile Integrated Health Program. Nationally and locally, health systems and community organizations are working together to meet the health needs of our populations and address escalating healthcare costs. Increasingly, traditional emergency medicine services (EMS)—or paramedics and emergency medical technicians (EMTs)—are evolving as partners in the larger healthcare ecosystem, an ecosystem linking traditional healthcare providers and community-based organizations in a coordinated system of care.

Please refer to the following sections on this page:

What is mobile integrated health?

The Lebanon Mobile Integrated Health (MIH) Program employs community paramedics and community nurses to support patients in our communities. Community paramedicine is an essential component of an MIH program. The National Rural Health Association defines community paramedicine as “an organized system of services, based on local need, which are provided by emergency medical technicians and paramedics integrated into the local or regional healthcare system and overseen by emergency and primary care physicians.”

Paramedicine programs operate in communities to:

  • Follow up with patients after discharge to prevent hospital readmissions
  • Prevent unnecessary emergency medical service (EMS) transports and hospital admissions
  • Provide chronic and preventive care to patients in a community in the home setting

Evidence from the literature shows that paramedicine programs can decrease:

  • 9-1-1 calls
  • Cost of care while attaining high levels of patient satisfaction
  • Emergency department (ED) use
  • Hospital admissions and readmissions

Our team has designed and implemented a Community Paramedic Program within the Lebanon Fire Department. DHMC has designed this program to optimize healthcare service delivery for our Dartmouth Health patients living in Lebanon and West Lebanon.

The Lebanon community nurses joined the Lebanon Fire Department in November 2021 to complete the Lebanon MIH program. The community nurses work closely with the community paramedic to provide an expanded spectrum of health-related supports. For more information about the Lebanon MIH program please contact us by email at MIH@lebanonnh.gov.

    Program goals

    As part of the Lebanon MIH program, the community paramedic has the following goals:

    • Improve the overall health of patients
    • Prevent hospital admissions and readmissions
    • Prevent unnecessary emergency medical transports and emergency room visits
    • Support patients after hospital discharge

    Services provided

    As part of the Lebanon MIH program, the community paramedic provides the following services:

    • Chronic disease management such as education, monitoring, and assistance managing:
      • Chronic obstructive pulmonary disease
      • Congestive heart failure
      • Diabetes
    • Home safety evaluations
    • Medication reconciliation and education
    • Support during transitions in care, for example, providing support in the home after an inpatient stay
    • Vital signs monitoring
    • Wound care
    • Other interventions within the paramedic scope of practice

    Please note that community paramedic services do not replace regular clinic visits. Community paramedic services provide extra support to patients in their homes.

    Patients and populations impacted

    The Lebanon MIH Program serves patients who satisfy all the following requirements:

    • Able to participate in self-care
    • Live in Lebanon or West Lebanon, New Hampshire
    • Receive primary or specialty care at Alice Peck Day Memorial Hospital (APD), their clinics, or DHMC
    • Would benefit from short-term interventions for an acute condition or exacerbation of a chronic condition

    Provider teams

    The Lebanon MIH program has been developed to work closely with the following provider teams and clinics:

    APD

    • Emergency Department
    • Primary Care

    DHMC

    • Emergency Department
    • Geriatric Emergency Department
    • Primary Care (at DHMC and Heater Road)

    Resources

    Our project team

    • Sally Kraft, MD, MPH, Vice President Population Health, Dartmouth Health
    • Barbara Farnsworth, MS, Director, Community Health Partnerships, DHMC
      Email: barbara.g.farnsworth@hitchcock.org
    • Cory Howarth, APRN, Dartmouth Hitchcock Clinics, Heater Road
    • Thomas Trimarco, MD, EMS Medical Director, DHMC, APD and New London Hospital
    • Hilary Schuler, Community Health Partnership Coordinator, DHMC
      Email: hilary.a.schuler@hitchcock.org
    • Jeremy Thibeault, Firefighter/Paramedic, Lebanon Fire Department
    • Jim Wheatley, Firefighter/Paramedic, Captain, Lebanon Fire Department

    Learning and data

    Our program collects and analyzes data in the following areas:

    • Patient experience
      • Patient satisfaction with Community Paramedic Program
      • Patient self-assessment of health status
    • Health outcomes:
      • ED visits 6 months pre- and post-program engagement
      • ED visits 6 months pre- and post-encounter for patients who decline participation
      • ED visits within 30 days of hospital discharge for patients referred while inpatient
    • Cost of care:
      • Ambulance dispatch 6-month pre- and post-program engagement
      • Hospital readmissions within 30 days of hospital discharge for patients in our MIH program
      • Length of hospital stay for MIH enrolled patients admitted to the hospital (planned and unplanned)
    • Staff experience:
      • DHMC care team satisfaction with the Community Paramedic Program
      • Lebanon Fire staff satisfaction
      • Number of specific protocols and educations modules developed
      • Number of community paramedic providers trained
    • Operational metrics:
      • Medication reconciliations completed
      • Number of patients admitted to Community Paramedic Program
      • Number of social service referrals provided

    Community Advisory Council

      Members

      Amanda St. Ivany

      City of Lebanon, Lebanon Community Nurse

      Barbara Farnsworth

      Dartmouth Health, Community Health

      Brian Lombardo, MD

      Alice Peck Day, Primary Care

      Carla Richters

      Community member/patient representative    

      Chief Chris Christopoulos

      City of Lebanon, Fire Department

      Cory Howarth, APRN

      Dartmouth Health, Heater Road, Primary Care

      Daniela I. Bridgwater

      Dartmouth Health, Accountable Care Org

      Deb Goodrum

      Dartmouth Health, Geriatric ED

      Ditha Alonso

      Lebanon Housing Executive Director

      Ellen Flaherty

      Dartmouth Health, Centers for Health and Aging

      Heather Giaccone

      City of Lebanon, Lebanon Community Nurse

      Hilary Schuler

      Dartmouth Health, Community Health

      Janet Lowell

      Community Nurse Connection

      Jim Culhane

      Lake Sunapee VNA, Executive Director

      Johanna L. Beliveau

      Visiting Nurse and Hospice for VT and NH, CEO

      Kappy Coppettone

      Grafton County Senior Citizens Council, Case Manager

      Kristin Barnum

      Community Nurse Connection, Executive Director

      Laurie Harding

      Community Member

      Lisa Paquette

      White River Family Practice

      Lynne Goodwin

      City of Lebanon, Human Services

      Margaret Georgia, Kathleen O'Brien

      Dartmouth Health, Care Management

      Pattie Beek

      Quail Hollow, Manager

      Richard Norris

      City of Lebanon, Police Department

      Roger Osmun

      West Central Behavioral Health, CEO

      Sally Kraft, MD

      Dartmouth Health, Population Health

      Stacie Deiner (Anesthesiology)

      Dartmouth Health, Surgical Services

      Tom Trimarco, MD

      Dartmouth Health, Emergency Department