Community Healthcare Integrated Paramedicine Program (CHIPP)
- Need: To reduce 911 use and improve older adults' health in rural Santa Cruz County, Arizona.
- Intervention: Community paramedics make scheduled visits to patients and connect them to other community resources.
- Results: CHIPP has assisted over 150 people so far, and 911 calls have decreased.
Arizona's rural Santa Cruz County is a Health Professional Shortage Area in primary care. This lack of primary care providers can lead some people to utilize emergency medical services for non-emergencies, which is expensive and might take emergency medical technicians (EMTs) away from other calls.
In addition, many older adults in this county live by themselves and don't have family nearby. Some of these adults have Alzheimer's or other forms of dementia but can't afford memory care or assisted living. Others aren't able to leave the house to buy food or see the doctor.
To reduce 911 use for non-emergencies and improve older adults' health, the Rio Rico Medical & Fire District created the Community Healthcare Integrated Paramedicine Program (CHIPP), in which firefighters and EMTs receive community paramedicine training and provide in-home care to older patients.
The Rio Rico Medical & Fire District partners with the Tubac Fire District, Sonoita-Elgin Fire District, Nogales Fire Department, Arizona Poison and Drug Information Center, and healthcare facilities and organizations. The Rio Rico Medical & Fire District received a 2015-2018 Federal Office of Rural Health Policy (FORHP) Rural Health Care Services Outreach Grant to support this program.
This KOLD News 13 video contains more information about CHIPP:
Clinicians, primary care offices and hospital staff, and home health agencies refer super-utilizing older patients (55 or older) with chronic conditions to CHIPP. Eligible conditions include:
- Alzheimer's or other dementias
- Behavioral health issues
- Congestive heart failure
- Post-myocardial infarction syndrome
CHIPP paramedics then make scheduled home visits to community members and provide the following free services:
- Checking and tracking of vital signs, like weight and blood sugar
- Chronic disease education
- Delivery of medications
- Home inspections, to check for fall risks and other hazards
- Medication management support
- Referrals to community resources like home repair and social services
All providers are trained in community paramedicine, which teaches them to see the larger issue instead of the specific reason a patient called. For example, a patient may call with a specific health concern like anxiety, but the provider notices that the house is unkempt or there are tripping hazards like unsecured rugs. That provider can call CHIPP and get the patient connected with any needed resources or care.
For medication management support, CHIPP partners with the Arizona Poison and Drug Information Center. CHIPP staff document their patients' medications and send the information to the center's pharmacist. The pharmacist reviews the list and contacts CHIPP with any concerns (for example, if a dosage seems too high or if certain medications will negatively interact with others). CHIPP staff then communicate these concerns to the patient and his/her primary care provider.
CHIPP has assisted over 150 people so far, and 911 calls have decreased.
In addition, Rio Rico Medical & Fire District has been recognized as a Treat and Refer provider, which allows EMS staff responding to 911 calls in which patients don't need an ambulance to assess and refer patients to more appropriate care, like urgent care or behavioral health.
CHIPP staff are also looking into ways to address social isolation.
Resources are available in some communities but not others, which can limit how some residents are helped. For example, public transportation and Meals on Wheels are available in Nogales but not in Rio Rico.
Complete a needs assessment. CHIPP staff completed a formal assessment, but informal assessments work too. Ask community agencies and first responders what resources are available and what services are needed. First responders and 911 operators can also ask patients and other community members what services they need.
Network within the county to identify where you can send those residents who need help. Through its grant, CHIPP started a collaborative focus group with other agencies in the county.
Contact InformationTangye Beckham, Director
Chronic disease management
December 18, 2018
Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.