SUSAN MCBRIDE, PHD. & AMY HOOTEN
The Greater Longview Optimal Wellness (GLOW) initiative has its roots in a community paramedicine model of care. Community paramedicine models of care provide a strategy that is working across the nation to address non-medical drivers of health. Community Health Paramedicine is an emerging field that extends the role of paramedics beyond the traditional emergency response. There is a growing body of evidence that programs like GLOW can address needs of the community that are beyond the capacity and reach of our traditional medicine model of care.
Rahim, et al1, notes that the expanded role of community paramedicine has notable innovative benefits reflected in the model of care noted in Figure 1 (below). The GLOW initiative hits on every single component of these innovative benefits noted in this new model of care— with growing capacity to meet the needs of the community of Longview. Community paramedicine can provide low acuity primary care to the disadvantaged and vulnerable within communities thereby addressing service gaps within communities2. Individuals frequently using emergency medical services (EMS) often have issues that can be more appropriately addressed with non-urgent care. Overall, inappropriate utilization of 911 depletes limited resources in communities with limited resources of the healthcare systems (Agarwal et al., 2019).
Public Health
Emergency Medical Services
Patient Safety, Fire, and Injury Prevention
Transportation to ED
Social Determinants of Health Support
Community Paramedicine
Primary Care Practices
Digital Health
Mobile Clinics
Home Health
Behavioral
Health
Innovation Benefits
Care at the Right Access Point
Reduced Non-Urgent ED Transport
Health Care Resource Augmentation
Improved Care Coordination
New VBC Models Enablement
Improved Info and Data Exchange Amongst EDs, PCPs, CBOs, and Behavioral Health Centers
SDOH Support and Services
Expanded Portfolio of Health Services in the Communities
Improved EMS Revenue for Reinvestment in Advanced Training, Infrastructure, and Workforce
About GLOW
The GLOW initiative is among six Texas Accountable Communities for Health Initiative (TACHI) sites in Texas, funded by the Episcopal Health Foundation (EHF) and Saint David’s Foundation. The city of Longview, TX established a not-for-profit 501C3 governed by the GLOW community board of stakeholder leadership. This multi-agency collaboration in Longview and Gregg counties in East Texas includes cooperative agreements from critical stakeholders, including but not limited to the two area hospitals, mental health facilities, Federally Qualified Healthcare Clinics (FQHCs), City Fire Department, Police Department, and United Way. (See below.)
Longview Regional Medical Center
Partners in Prevention Coalition for Drug Free Youth & Bridges Out of Poverty
Police Outreach Services Team (POST)
WellnessPointe
United Way of Greater Longview
Opioid Abatement Trust Fund Initiatives
Special Health Resources (SHR)
Substance Abuse and Mental Health Services Administration (SAMHSA)
Community Healthcore
Gregg County Sheriff’s Department Health Department Judiciary System/Department
County of Gregg
Episcopal Health Foundation in collaboration with St. David’s Foundation
Christus Good Shepherd Health System
Homeless Resource Day
GLOW’s mission is to:
- identify the top utilizers of the 911 system (8 calls or more);
- enroll clients into GLOW and navigate them to community service organizations that will alleviate unmet needs determined through social determinates of health screenings; and
- perform a community health paramedicine visit to reduce 911 system utilization and readmission rates.
The GLOW initiative has begun to impact the community served and has demonstrated results in the program’s effectiveness.
Impact of GLOW on Hospital Encounters
GLOW has made a significant difference at Good Shepherd Medical Center, a major hospital in Longview. A total of 68 GLOW clients, who remained in the initiative for an average of 377 days, were evaluated for their emergency department (ED) usage and associated hospital charges. Using the hospital’s electronic medical records, our evaluation findings include:
It is important to note for both ED visits and reencounters that this analysis is based on charges on the encounter record for the hospital. Hospitals are not fully reimbursed for total charges, particularly when uninsured or underinsured are cared for. Therefore, this analysis does not reflect an estimated cost but can be used as a proxy measure of potential savings to hospitals. However, charges can reflect utilization reduction and a proxy to total cost savings.
Compassion, Trust, and Doing Things Differently
When evaluating GLOW using qualitative methods, important themes emerged that illustrate how community paramedicine makes a difference in communities like Longview, Texas. For example, during narrative interviews with GLOW staff, social and family support arose as a major community need. GLOW’s process includes identifying the client’s current providers and determining the availability of family members or friends to assist with their needs. In cases where a support system is lacking, GLOW paramedicine professionals take proactive steps to establish one.
The staff’s cohesion and compassion enable clients to receive exceptional care, often exceeding their previous experiences. GLOW’s success is founded on transforming conventional practices by bridging the gap between clients and essential services that they may not have been aware of prior to interacting with GLOW. Paramedicine staff stated, “we do things differently”. They also note that the “Trust the Uniform” holistic approach ensures nearly immediate care for clients while alleviating the burden on already overburdened emergency services. Staff further indicate, “these people trust us when they see the uniform”.
GLOW staff members revealed that GLOW changes the narrative with how high utilizers of 911 services interact with emergency services. Instead of calling a paramedic to assist a patient with medication adherence or getting out of bed, GLOW staff connected community resources with these high utilizers to make sure their needs are met while reducing the burden to our EMS services. GLOW is making a difference in the community it serves, changing the lives of many within the community in positive ways.
Lessons Learned and Next Steps
The GLOW initiative has revealed a great deal about how to develop, execute and refine a program addressing non-medical drivers of health and the needs of some of the most vulnerable in their community. Lessons learned from this initiative so far include:
- engaging important community leaders and their respective organizations is a key to success.
- keeping the community members engaged as individuals within the organization move and shift is challenging and a continually evolving requirement.
- acquiring data and maturing the use of important information for managing and serving the GLOW enrolled individuals effectively is hard work and essential for evaluating the program. Developing a data infrastructure depends on trusting relationships, legal agreements and support from organizations and staff that can help with the management of healthcare data.
The next steps for GLOW are to continue to keep the community engaged and to push to long-term financial sustainability. To do this effectively we need to demonstrate the value of this program measurably and that takes data and information to measure impact. Our immediate next steps are to further automate data collection working with GLOW partners, particularly our hospital partners and to work with the Texas health information exchanges (HIEs) within the region and state to determine the best model for automating data for the program and its evaluation. In November 2024, the Department of State Health Services and the Episcopal Health Foundation will host a roundtable paramedicine intervention event where we hope to learn from others in Texas about how they are addressing data management and automation. We intend to share insights from the conversation, particularly as it relates to developing the data infrastructure for these community initiatives.
In conclusion, GLOW initiative is transforming their community in valuable ways. While GLOW partners are experiencing incredible wins, there is more work to be done to further develop and automate the data infrastructure to improve, sustain, and evaluate the initiative for a healthier community. ⚙
1. Rahim F, Jain B, Patel T, et al. Community Paramedicine: An Innovative Model for Value-Based Care Delivery. J Public Health Manag Pract. 2023;29(2):E65-e68.
2. Spelten E, Thomas B, van Vuuren J, et al. Implementing community paramedicine: A known player in a new role. A narrative review. Australas Emerg Care. 2024;27(1):21-25.
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