Queen Anne's County Mobile Integrated Community Health Program
- Program Representative(s) Interviewed: Jared Smith, Program Manager
- Location: Queen Anne's County, Maryland
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Program Overview: Queen Anne's County Mobile
Integrated Community Health (MICH) Program brings care directly to patient’s homes. Paramedics and
community nurses make home visits to individuals referred through 911 calls, emergency department visits,
post-discharge programs, and nurse visiting agencies. Services include home safety checks, medication
inventories, and assessments of physical health, health literacy, medical history, financial status, health
goals, and social networks.
During the home visit, nurses perform comprehensive health and social needs screenings while paramedics conduct physical assessments and home safety checks. This arrangement has made it possible to deliver the program without requiring additional paramedic training. The first in-home visit also includes a telehealth visit with a pharmacist at a local hospital to discuss the patient's medications. Patients may have an additional telehealth appointment if the paramedic and nurse identify medication changes during a follow-up visit.
Based on the results of the health and safety assessments, the community nurse connects patients with medical resources, including a medical home and insurance services. After the initial visit, the program follows up with patients in three-month intervals, alternating between phone calls and home visits. The program reported graduating 75% of patients after one year.