Mobile Integrated Healthcare Outcome Measures

In April 2014, several EMS-based mobile integrated healthcare and community paramedic (MIH-CP) pioneers embarked on an ambitious project to develop outcome measures for MIH-CP programs.


The MIH-CP Performance Measurement project was initiated to develop and describe performance measures that encourage achieving the optimum sustainability and utilization of patient-centered mobile resources in the out-of-hospital environment and achieves the Institute for Healthcare Improvement’s Triple Aim initiatives–improve the quality and experience of care; improve the health of populations; and reduce per capita cost.


Together, this group reviewed and refined the measures project based on four domains:

  • Structure: The acquisition of physical materials and development of system infrastructures needed to execute the service delivery model, such as executive sponsorship, organizational readiness assessment, plan for integration with healthcare systems, and community health needs assessment.
  • Outcomes: How the system impacts the values of patients, their health and well-being, such as quality of care, utilization, cost of care and experience of care metrics.
  • Balancing: How changes designed to improve one part of the system are impacting other parts of the system, such as impacts on other stakeholders like payers, employees or community partners such as primary and specialty care utilization, public and stakeholder engagement, and partner and practitioner satisfaction.
  • Process: The status of fundamental activities associated with the service; how the components in the system are performing, progress toward improvement goals such as clinical and operations metrics, referral and enrollment metrics and volume of contact metrics.


The measures project addresses pay-for-performance and program performance measurement in the area of community health services provided in the MIH-CP models. It offers a universe of measures from which an agency (or a state that’s sponsoring MIH-CP pilot projects) can choose to describe the outcomes of the suite of services that it provides. The document provides a data dictionary for, and descriptions of, outcome measures that will produce meaningful data that can be compared from program to program across the country.


The core team members for the project are:

  • Brenda Staffan, Regional EMS Authority (Reno, Nev.)
  • Dan Swayze, University of Pittsburgh Center for Emergency Medicine (Pittsburgh, Pa.)
  • Gary Wingrove, Mayo Medical Transport (Minnesota and Wisconsin)
  • Brian LaCroix, Allina Healthcare System (Minneapolis, Minn.)
  • Brent Myers, Wake County EMS (Raleigh, N.C.)
  • Matt Zavadsky, MedStar Mobile Healthcare (Fort Worth, Texas)

On April 8, 2015, the MIH-CP measures project took a major leap forward with the hosting of a national rollout of the draft measures tool via webinar with over 50 participants. Invited participants included more than 25 agencies currently operating EMS-based MIH-CP programs representing diverse system design models (public, private, fire, and hospital), and MIH programs (community paramedic, 9-1-1 nurse triage, ambulance transport alternatives, station-based clinics).

Attending the national rollout was also nearly every EMS-related association or advocacy group such as the American Ambulance Association (AAA), the American College of Emergency Physicians (ACEP), the National Association of EMS Physicians (NAEMSP), the International Academies of Emergency Dispatch (IAED), the National Association of EMTs (NAEMT), the National Association of State EMS Officials (NASEMSO), the International Association of Fire Chiefs (IAFC), the International Association of Fire Fighters (IAFF), the National Fire Protection Association (NFPA), the Academy of International Mobile Healthcare Integration (AIMHI) and many others.


Finally, the rollout was also attended by key federal partners and groups invited by the core team that have a unique insight into performance measures for healthcare such as the Agency for Healthcare Research and Quality (AHRQ), the Institute for Healthcare Improvement (IHI), the National Committee on Quality Assurance (NCQA) and the Commission for the Accreditation of Ambulance Services (CAAS).


During the rollout, proposed outcome measures for the community paramedic programs were discussed and consensus was reached on 17 core measures from all measure domains that the operating agencies felt were meaningful, trackable and reportable. These are all marked with a star of life symbol. The group also established work groups to establish measures and metrics for three additional areas:

  • Process measures for the community paramedic intervention;
  • Outcome measures for 9-1-1 nurse triage interventions; and
  • Outcome measures for ambulance transport alternative interventions.

Next Steps & Additional Participants

Everyone involved in this project understands this will be an evolving process that will require continuous refinement and participation from stakeholders. We invite other participants to become involved in the process, participate in the various work groups and review teams, and help us establish reasonable and effective measurement strategies for the evolving MIH-CP service delivery model.


If you would like to download the current measures document, the list of participating agencies and associations, notes from the various stakeholder meetings, or volunteer to become part of the team, please visit

Invited Participating Agencies:

Acadian Ambulance


Ada County Paramedics (Idaho)


Allina Health System


Arlington Fire Department (Texas)




California EMS Authority


Carlsbad Fire (Calif.)


Chandler Fire & Medical Department (Ariz.)


Christian Hospital EMS (Mo.)


Dallas Fire Department (Texas)


Eagle County Paramedics (Colo.)


Humbolt General Hospital (Nev)


Lifeguard Ambulance Service (Ala.)


Louisville EMS (Ky.)


McKinney Fire Department (Texas)


Medic Ambulance (Calif.)


MedStar Mobile Healthcare (Texas)


MedEx Ambulance (Ill.)


Mesa Fire & Medical Department (Ariz.)


Mt. Sinai Hospital (N.Y.)


Nature Coast EMS (Fla.)


North Memorial Hospital (Minn.)


North Shore University/LIJ Health System (N.Y.)


Prosser Health District (Wash.)



REMSA (Nev.)


San Diego Medical Enterprise (Calif.)


UPMC/Community Connect (Pa.)


Wake County (N.C.)


Yale New Haven Hospital (Conn.)

Invited Associations & Stakeholder Participants:

American Ambulance Association (AAA)


American College of Emergency Physicians (ACEP)


Agency for Healthcare Research and Quality (AHRQ)


Academy of International Mobile Healthcare Integration (AIMHI)


Association of State and Territorial Health Officials (ASTHO)


Commission on the Accreditation of Ambulance Services (CAAS)


CMS Quality Improvement Organization – Health Insight


Hennepin Technical College


International Academies of Emergency Dispatch (IAED)


International Association of EMS Chiefs (IAEMSC)


International Association of Fire Chiefs (IAFC)


International Association of Fire Fighters (IAFF)


Institute for Healthcare Improvement (IHI)


National Association of EMS Educators (NAEMSE)


National Association of EMS Physicians (NAEMSP)


National Association of EMTs (NAEMT)


National Rural Health Association (NRHA)


National Association of State EMS Officials (NASEMSO)


National Committee for Quality Assurance (NCQA)


National EMS Information System (NEMSIS)


National EMS Management Association (NEMSMA)


National Fire Protection Agency (NFPA)


University of California–Los Angeles (UCLA)


University of California–San Francisco (UCSF)


University of Nevada–Reno (UN-R)


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