Southern California Program

Los Angeles Fire Department Foundation

Health Care
Los Angeles, CA
June 2017

The Los Angeles Fire Department (LAFD) is the sole provider of 911 response for America’s second largest city, and has seen rapid growth in 911 use for non-urgent medical complaints, 911 frequent users, and patients with mental health complaints.  In 2016, LAFD launched an Advanced Practitioner Response Unit (APRU) with three missions: (1) Mobile Urgent Care response, including on-scene treatment, release and follow-up referral for low-acuity 911 callers; (2) Comprehensive assessment and social work referral for 911 frequent users; and, (3) On scene medical clearance for mental health patients with transport to psychiatric urgent care.  Initial results have been promising in safely diverting patients from overcrowded emergency departments by providing treatment on the scene and connections to additional community-based care.  The next step, which the W. M. Keck Foundation will support with a two-year grant, is to conduct a study of the mobile integrated health delivery model’s effectiveness.  The methodology will involve a multi-disciplinary, multi-institutional mixed-methods approach to assess patient safety and experience, utilization of acute healthcare services and overall emergency care costs.  Working with polling professionals, LAFD will develop, test, and validate a phone survey to assess APRU clients' experience of care.  Working with other emergency service and hospital partners, investigators will prospectively collect health care utilization data on APRU and matched-control patients transported to nearby emergency departments in 2018.  Health services researchers and health economists will analyze cost data.  The findings are expected to provide useful information about the quality and safety of pre-hospital care to encourage new reimbursement mechanisms and replication of the model.

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