The proposed pilot study will determine what information is needed for a subsequent translational research project that can assist the Los Angeles Fire Department in transforming its EMS services to optimize quality of care received by one million annual service requesters and reduce misuse of urgent care services. The LAFD seeks to coordinate and integrate their services more effectively into the existing web-work of community health and social services providers within service areas. Today only 1% of LAFD EMS calls are associated with fire suppression. EMS has become a preeminent frontline medical provider by default in communities with disparities in access to medical care in Los Angeles. There is a high priority requirement to optimize triage for patients with a wide range of presenting conditions, especially in the higher demand are segment over 50 years. Today thousands of patients are being transported by EMS to the ER who are subacute, have functional limitations or lack access to usual care. This study will examine one specific LAFD service region, Battalion 13, in South Los Angeles, an area with one of the highest EMS request rates and lowest availability of health providers to identify targets for innovative linkage to services providers and novel interventions. The goal is to gather information for a translational study to foster integration of EMS within a community health framework by efficiently diverting sub-acute cases to more appropriate providers, thereby improving accountability to patients in meeting real needs for sub-acute medical care. We propose a mixed method research design, including qualitative interviews, focus groups, and extensive manipulation of LAFD services data sets for population-area assessment, to capture both the demand and supply side of EMS systems and their clients, and the investigators are very experienced in using these methods for clinical, public health, and health care utilization research.

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