The CORE social outreach team consists of a full-time social worker who, accompanied by a paramedic, visits low-acuity, high-frequency 911 callers in their homes to assess health care needs, as well as the social, economic and educational barriers preventing them from utilizing the proper resources. This model helps to ensure that patients who previously relied on the 911 system for routine support are working closely with their primary care physicians and have access to services and resources that can best assist with their health care challenges, reducing or eliminating their need to call for an ambulance.
When Indianapolis EMS examined our patient population in 2011, particularly our 25 most frequent callers, we found that the top 10 callers dialed 911 more than 100 times per year on average. Our top caller dialed 911 a total of 134 times in one year. After launching our social outreach team, we saw a drastic reduction in the number of times these callers dialed 911, with the average now at about 30 calls a year. The CORE social worker has met with more than 500 patients over the past few years with a success rate of more than 50 percent. We now take referrals from the Indianapolis Fire Department and other agencies.
The social outreach team provides the following services to our patients:
- Environmental and social assessments and interventions to improve patient quality of life
- Family referrals to appropriate health care and community services
- Assistance with housing, nutritional, medical, pharmaceutical and transportation needs