A Community Paramedic Clinic at a Day Center for Adults Experiencing Homelessness.

People experiencing homelessness have difficulty accessing primary care and are vulnerable to poor health outcomes. Gaps in health care access are particularly apparent in smaller communities, which often lack the large-scale public health investments and infrastructures of metropolitan areas. Community paramedics (CPs) have advanced training in chronic disease management and social determinants of health and can deliver primary care services to patients with medical complexity and residents of medically underserved areas. However, the feasibility of leveraging community paramedicine to deliver acute, chronic, and preventive services to people experiencing homelessness is unknown. The authors evaluated the feasibility of a fixed-site CP clinic at a day center for adults experiencing homelessness in a small metropolitan area of the U.S. Midwest. CPs provided free health services to drop-in patients twice a week with general supervision by a physician medical director. The clinic was developed by the CP team with financial support from Mayo Clinic. The authors' objectives were to: (1) assess implementation of the program (e.g., feasibility and acceptability); and (2) identify areas for improvement and perceptions of program sustainability. Study outcomes were selected based on their utility for program decision-making. Data sources included metrics on care volumes and services (ascertained from electronic health records and CP patient tracker log) plus surveys and interviews with CPs, day center staff, county partners, and leadership from the ambulance service, hospital, and county; patients/clients were not interviewed as part of this report. Electronic surveys and semi-structured interviews included questions on program acceptability, feasibility, and sustainability. CP surveys included additional questions regarding role clarity, knowledge and skills, beliefs about capabilities, work stress, and safety concerns. Metrics and surveys were analyzed descriptively. Interviews were analyzed by using a rapid template-driven approach organized around core survey/interview constructs. Between January and June 2022, CPs provided care on 38 days and conducted 127 visits (mean [standard deviation], 3.3 [1.6] visits per day). Patients had a mean (standard deviation) of 4.1 (3.3) Elixhauser index conditions, most frequently hypertension, depression, drug or alcohol use, diabetes, and other serious mental health conditions. Vital sign checks, clinical assessment, medication management/education, and wound care were among the most common services provided. Thirty-one program stakeholders completed surveys, and 13 completed interviews. Both survey ratings and qualitative data on program acceptability, appropriateness, and feasibility were favorable across groups. Among sustainability domains, survey ratings were least favorable for the financial stability domain. Interview data also suggest concerns about sustainability and the need for robust community collaboration to support future growth. Mayo Clinic's experience shows the feasibility and acceptability of CP care, but it also raises questions about long-term sustainability, as well as whether CPs operate in a clear scope of practice and bridge to other health care providers and systems.