Date of Award

Spring 6-12-2021

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)



Faculty Chair

Dr. Christine Hoyle

Faculty Reader

Dr. Lorie Wild

Executive Summary

Executive Summary

Introduction: In the United States, 5% of the patient population generally consumes over 50% of total healthcare costs (Cohen, 2014; Health Commons Project, 2019). These high-need patients are impacted by a wide range of medical, behavioral and functional conditions and limitations, and bear a disproportionate burden of social challenges. The current health care system is not designed to serve this high-need patient population. However, a new community service called Community Paramedicine (CP), or Mobile Integrated Health (MIH), could serve high-need patient populations.

Problems and Purpose Statement: Individuals in the Pacific Northwest are not receiving adequate care and are overly reliant on emergency services. These individuals make greater use of expensive resources like the 9-1-1 system. Health care systems have implemented “best practice” strategies to target high-need populations. However, the care remains fragmented (Long, et al., 2017). CP-MIH could help drive Quadruple Aim for high-need patient populations. Fire departments need help to operationalize these programs to be successful and the clinical question proposed is: What do fire departments need to setup, scale and sustain a CP-MIH service?

Methods: The DNP project began with a Memorandum of Understanding (MOU). The MOU was created to establish a member-owned Regional Learning Network for stakeholders interested in helping to develop CP-MIH services. The Regional Learning Network website was created to focus on sharing workflows and best practices, evaluating and piloting digital tools, and collaboration with stakeholders. Finally, the CP-MIH Readiness and Needs Assessment Questionnaire was a 16-question qualitative questionnaire that assessed each fire department’s readiness and needs.

Results/Outcomes: The CP-MIH Readiness and Needs Assessment Questionnaire was created to help fire departments determine their readiness in developing a CP-MIH service. The questionnaire resulted in responses from 17 out of 27 fire departments (63% response rate). From the questionnaire responses, we learned fire departments are investing time, energy, and resources to roll-out CP-MIH services in their community. Additionally, fire departments are using a unique set of people, processes, and Information Technology (IT) tools to deliver CP-MIH services. Most fire departments have also established key stakeholder buy-in and formed partnerships. However, fire departments need the right IT tools and systems to demonstrate impact and return-on-investment, as well as sustainable financing. Finally, 16 of 17 fire departments who responded to the questionnaire were interested in joining the Regional Learning Network.

Sustainability: To maintain sustainability, the Regional Learning Network will need to continue to collaborate and learn from one another to develop a platform of tools and services to help accelerate development of CP-MIH programs. This will be called the “CP-MIH Toolkit.” Collaboration will be needed for future revisions of the CP-MIH Toolkit. Furthermore, grant funding will be needed to keep the Regional Learning Network and development of the CP-MIH Toolkit active.

Implications: This project included several fire departments which covered many different demographics. Changes in demographics and differences in populations, fire department agencies, and resources provided within the community may be such that the CP-MIH Toolkit as designed does not translate across diverse communities. Furthermore, CP-MIH is a new and innovative service with little existing research which could inhibit quality outcomes. Finally, CP-MIH’s return-on-investment is a concern. These implications could impact the profession and outcomes in various communities. Finally, the Advanced Nurse Practitioner can benefit from the knowledge of CP-MIH programs by understanding the communities in which the Nurse Practitioner works, and new and alternative services can help address health disparities experienced by high-needs populations.


Cohen, S. B. (2014). The concentration and persistence in the level of health expenditures over time: Estimates for the U.S. population, 2011-2012. Statistical Brief 449 Agency for Healthcare Research and Quality.

Introducing F. D. C. A. R. E. S and the health commons project. (2019) Health Commons Project.

Long, P., Abrahm, M., Milstein, A., Anderson, G., Apton, K. L., Dahlberg, M. L., Wicher, D. (2017). Effective care for high-need patients: Opportunities for improving outcomes, value, and health. National Academy of Medicine.