Background: Comparing Full-Time (FT) and Part-Time (PT) staffing models for a mobile integrated health (MIH) program established by a local Fire Department. Objective: Determine if the program is sustainable and which staffing model is more effective at obtaining sustainability. Design: Quality Improvement project with retrospective data review. Setting: Green Valley Fire District in Green Valley, Arizona. A predominant retirement community. Target: The residents of the Green Valley Fire District. Interventions: Utilizing the RE-AIM framework, a retrospective review of the data collected by the previously implemented MIH Program in Green Valley was completed. The framework was utilized to review relevant data and determine if the program has achieved the expected outcomes, and maintained a sustainable and transferable MIH program. Measurement: Decrease in emergency medical (EM) calls for service with the implementation of the MIH program. Comparing staffing models for consistency in services. Results: The results showed a decline in EM calls for service with the MIH program, and more consistency in availability and patient services with the FT staffing model. Limitations: The demographics of the community limit the generalizability and transferability of the data obtained from the project. Additional data should be collected and analyzed both retrospectively and for successive years to substantiate the benefits and continue to improve the effectiveness of the MIH program. Conclusions: The program could be used as a model for other MIH programs, with adjustments made for the respective community. The value or sustainability of any MIH program cannot be limited to revenue solely. Other perspectives of value added service and cost savings must also be considered. Significance: This study highlights the effectiveness of an MIH program in a small retirement community and shows the benefit of a FT staffing model versus a PT staffing model for consistency of patient care and daily program operations. There are also multiple aspects of value to an MIH program, some of which are difficult to conceptualize and measure based on historical models of healthcare delivery and Fire Department Services. Further review of these types of programs is needed to establish the overall benefits of MIH.

Background: Community paramedicine (CP) is an emerging form of health services delivery with the potential to reduce emergency department (ED) visits and to improve access to care. Rationale: There is growing global interest towards CP. Studies have focused on health outcomes and cost-effectiveness, but there is no comprehensive understanding about the types of CP programs and training; this knowledge may support the development of CP programs, training, and policy. Objectives: To describe CP programs and the skills for each program type, and to inform recommendations for CP programming and growth. Methods: A systematic review of MEDLINE and Embase was completed in duplicate by two independent reviewers. The Mixed Methods Appraisal Tool (MMAT) was used to assess studies’ methodological quality. A full methodology is available on PROSPERO (CRD42017051774). Results: The yield of 47 studies captured 44 unique CP programs. CP programs most often served emergency callers and individuals at risk for ED admission or readmission or hospitalization. The most common services provided were physical assessment; and assessment, referral and/or transport to community services. Training was not described by 43% of CP programs, and the mean MMAT score was three out of four criteria met. Study heterogeneity prevented meta-analysis of health outcomes. Discussion: CP programs have adapted to various populations by providing different services and training. CP training is centred on technical skills and knowledge. Since CP often involves more client interactions and inter-professional collaboration than traditional paramedicine, CP training should also include communication and teamwork skills. Challenges to CP growth include unclear role definition, introducing new healthcare roles, and competing services. Conclusion: Of the 44 unique CP programs, common services provided included physical assessments and assessing clients for community services. CP training was centred on technical skills and knowledge, but there should be more training on communication and teamwork skills. / Thesis / Master of Public Health (MPH) / Community paramedicine (CP) is an emerging form of health services delivery with programs established internationally. Community paramedics take on expanded paramedicine roles, including community-based health promotion and prevention activities. Studies on CP have focused on health outcomes and cost-effectiveness, but there is no comprehensive understanding about the types of CP programs and training. Through a systematic review of the literature, the goals of this thesis are to describe CP programs and the skills required for each program type, and to use findings to inform recommendations for CP program development and growth. No other literature review provides information on the components of CP programs and their training. Communities interested in CP can use the findings of this thesis to inform the development of their CP programs and training. By discussing challenges facing continued CP growth, this thesis also identifies areas for change at the program and policy levels.