Delivery of Care

Building a mobile integrated care system in Central Falls

With the scheduled opening of the new Neighborhood Health Station in January, a series of trainings were held in coordination with Central Falls EMS technicians to create a coordinated approach to mobile integrated care

Photo by Richard Asinof

Jarrod Pinette, the Central Falls emergency medical services coordinator.

By Richard Asinof
Posted 12/10/18
With the pending opening next month of the new facility housing the Neighborhood Health Station in Central Falls, Blackstone Valley Community Health Care and the City of Central Falls are coordinating a system of mobile integrated care.
What other cities in Rhode Island will invest in developing mobile integrated care systems involving EMS services with primary and urgent care? When will the Recovery Navigation Program in Providence, which shut down in July of 2018, be replaced? Is there an app that can be developed to spur use by residents of the new mobile integrated care system?

Alcohol intoxication still remains as one of the top impressions for EMS transport to emergency rooms at hospitals across Rhode Island. One strategy that the city of Central Falls has adopted is to delay opening hours for liquor stores in the summer, which appears to have decreased the incidence of such transports.

CENTRAL FALLS – One of the innovative approaches being adopted by the Neighborhood Health Station being built by Blackstone Valley Community Health Care at 1000 Broad St., which is now scheduled to open in early January of 2019, is an effort to better coordinate primary care and urgent care with the participation of the city’s Emergency Medical Services responders.

In the past, the accepted practice was to transport all emergency calls to a hospital emergency room. With the closing of the emergency department at Memorial Hospital in Pawtucket, and the opening of the new Neighborhood Health Station, including an urgent care center, the opportunity exists to develop an integrated approach to emergency services as a way to provide better care to residents as well as to lower costs.

A weeklong series of training sessions were held each morning last week at the Navigant Credit Union offices on Broad Street. One of the major goals was to create a shared “bypass criteria” for mobile integrated care, enabling the Central Falls EMS technicians to know when to proceed directly to a hospital emergency department and not consult with the Notre Dame Express Care by phone.

An equally important aim was to build a level of collaboration and trust about the primary care and urgent care services being offered by the Neighborhood Health Station, reassuring the technicians that their jobs were not threatened by the new approach, and engaging with them about the kinds of health care problems they encounter.

Dr. Michael Fine coordinated the interactive trainings around areas of primary care. Fine is the senior population health and clinical services officer at Blackstone Valley Community Health Care and also serves as the health policy advisor to Central Falls Mayor James Diossa.

The topics included: ear pain, skin and rashes, OB and GYN, viral and bacterial illnesses, musculoskeletal and back pain, high blood pressure and stroke, among others.

The skinny on dermatology
On Wednesday morning, Dec. 5, Convergence RI attended a number of the presentations, including a workshop on “Dermatology in Primary Care,” led by Dr. Christina Pacheco, the chief medical officer at Blackstone Valley.
Pacheco began her talk by saying: Like the ER, we see all comers, though usually with less acuity.” She stressed that patients often don’t always come as advertised.

In her presentation, Pacheco showed photographic examples of what she described as the most common skin complaints, including: eczema, dermatitis, psoriasis, fungal and bacterial infections, scabies and lice, and abnormal pigmented lesions.

Pacheco then engaged in an interactive approach, asking the emergency responders to name the different skin conditions. She then asked the rhetorical question: So when do I worry?

She urged the EMTs to use what they knew, such as vital signs and their instincts about being sick vs. not sick.

Her conclusion: the vast majority of skin problems are not an emergency, but when they are, you can tell by using the skills you already have.

A good thing
Jarrod Pinette, the Central Falls emergency medical services coordinator, said he welcomed the opportunity to engage with doctors around developing a mobile integrated care system, saying that the concept “should be a good thing” for everyone – residents, EMS technicians and primary care providers in Central Falls.

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