Mobile Integrated Healthcare Practice

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Resource Access Program (RAP)

Date of latest update

September 2014


San Diego

For More Information Contact

Anne Jensen,; James Dunford,

Population Served

1.3 million people; roughly 1,200 are frequent 911 callers

The Need

A small population of individuals use emergency services in disproportion to the general public. These individuals often suffer from difficult health or social circumstances. Their underlying issues may remain unaddressed as they seek primary assistance from ill-suited acute care services. The resulting episodic, uncoordinated care is of lower quality and higher cost and simultaneously consumes valuable public safety and acute care resources.

The Goal

RAP identifies vulnerable individuals through a variety of surveillance techniques, investigates the circumstances of the individuals, and seeks to connect them to the appropriate resources for their situation.

Medical Oversight

City of San Diego EMS Medical Director James Dunford, M.D.

Key Partners

Not reported


Five community paramedics



Plans for Sustainability


Technology Used

Street Sense:

Program Results

Between the pre and post periods, EMS encounters declined 37.6% from 736 to 459 (p = 0.001), resulting in a 32.1% decrease in EMS charges from $689,743 to $468,394 (p = 0.004). The EMS task time and mileage decreased by 39.8% and 47.5%, respectively, accounting for 262 (p = 0.008) hours and 1,940 (p = 0.006) miles. The number of ED encounters at the one participating hospital declined 28.1% from 199 to 143, which correlated with a 12.7% decrease in charges from $413,410 to $360,779. The number of IP admissions declined by 9.1% from 33 to 30, corresponding to a 5.9% decrease in IP charges from $687,306 to $646,881. Hospital length of stay declined 27.9%, from 122 to 88 days. Across all services, total charges declined by $314,406.

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Mobile Integrated Healthcare Practice

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