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    Maryland Department of Health
    Maryland Community Health Resources Commission

    Reducing avoidable ED visits and promoting care in the community (17 grants also listed in other categories)

    Grantee Organization: Baltimore City Fire Department
    Jurisdiction Served: Baltimore City
    Grant and Amount: 19-004 ($600,000) 
    Grant Project Description: This two-year project would expand the City's existing EMS/Mobile Integrated Health program by adding a new data analytics platform and Artificial Intelligence to identify and address low acuity calls so that the City EMS can be freed up to respond to more serious calls.  The data analytics would also inform home visits performed by the community paramedicine team.  The project also involves an interactive, two-way patient communication, monitoring patients for self-reported unmet needs and other risks for readmission and/or calling 911 again, thereby activating patients most at-risk for extended home visiting services​ (This grant is also listed in 'Expanding access to primary care services).
    Organization Contact Information: https://fire.baltimorecity.gov/


    Grantee Organization: Chase Brexton Health Services
    Jurisdiction Served: Baltimore City
    Grant and Amount: 19-009 ($300,000) 
    Grant Project Description: This two-year project supports community-hospital partnership between Chase Brexton and Johns Hopkins Hospital to refer individuals seeking oral health care services at the hospital ED to dental care provided at Chase Brexton.  The goals of the project are to provide a permanent dental home for patients at Chase and reduce avoidable dental-related ED visits.  Under the project, Chase and Hopkins will develop a formalized referral process with the Hopkins ED for patients with urgent oral health needs.  The project involves providing patient transportation; financial assistance for medications; enrollment for health insurance options; health education; care coordination and outreach for missed appointments; and referrals for medical and psychosocial support services (This grant is also listed in 'Expanding access to dental services'). 
    Organization Contact Information: https://www.chasebrexton.org/


    Grantee Organization: Esperanza Center. 
    Jurisdiction Served: Baltimore City
    Grant Amount: 18-007 ($150,000) 
    Grant Project Description: This two-year project increases access to culturally competent, patient-centered care in a free clinic in Baltimore City, perhaps the only one in the state that serves only low-income uninsured individuals. The project would increase the number of hours of staffing for the clinic to provide primary care as well as referrals to specialty care and services to address social determinants of health. The program at the Esperanza Center offers the strong potential of reducing avoidable hospital utilization for primary care services by the target population (This grant is also listed in 'Expanding access to primary care services')​.
    Organization Contact Information:     www.catholiccharities-md.org/services/esperanza-center/health-center 


    Grantee Organization:     Wicomico County Health Department/EMS
    Jurisdiction Served: Wicomico County
    Grant and Amount: 18-006 ($90,000)
    Grant Project Description: This two-year project aims to reduce preventable 911 calls through the use of a team consisting of an emergency medical technician and a registered nurse. The team would identify frequent callers to 911 for non-emergent conditions and would conduct welfare checks, case management, safety planning, and refer patients to primary care physicians, medical specialists, and, if necessary, in-home care providers. The program offers the potential to help reduce avoidable EMS and hospital utilization services and is replicable in other rural areas of the state (This grant is also listed in 'Expanding access to primary care services')​. 
    Organization Contact Information: www.wicomicohealth.org​

     
    Grantee Organization: Prince George’s County Fire/EMS 
    Jurisdiction Served: Prince George’s
    Grant and Amount: 18-005 ($175,000) 
    Grant Project Description:     This two-year grant supports a Mobile Integrated Health project which aims to reduce preventable 911 calls through the use of community paramedics who would interact with at-risk residents who frequently call 911 for non-emergent conditions. The integrated health team would connect these residents with quality healthcare services and other necessary community supports. The program offers the 2 potential to help reduce avoidable EMS and hospital utilization services and is replicable in other areas of the state (This grant is also listed in 'Expanding access to primary care services'). ​ 
    Organization Contact Information: http://www.princegeorgescountymd.gov/222/FireEmergency-Medical-Services

     
    Grantee Organization: Anne Arundel Health Department
    Jurisdiction Served:  Anne Arundel 
    Grants and Amount:  17-014 ($200,000) 
    Grant Project Description:       This two-year grant is being used to expand access to emergency dental services for low-income adults in Anne Arundel County, with a particular emphasis on diverting preventable dental-related ED visits. The target population is low-income Medicare and Medicaid adults. The project will build on the existing REACH Program in Anne Arundel by linking patients with private dentists and building the capacity of the existing dental clinic(s) at the Health Department to serve more residents. CHRC grant funding is being utilized to support the salary of a dental patient navigator and to provide discounted costs for dental services to program participants (This grant is also listed in 'Expanding access to dental services')​.
    Organization Contact Information: http://www.aahealth.org/


    Grantee Organization: Lower Shore Clinic
    Jurisdiction Served: Lower Shore
    Grant and Amount: 16-012 ($105,000) 
    Grant Project Description: This two-year grant provides funding to support the 'CareLink' program that targets individuals with behavioral health needs who Present at the Peninsula Regional Medical Center (PRMC) ED in high volumes and provides intensive case management services for these individuals in a community setting post-hospital discharge. The proposal involves a partnership with PRMC and is designed to help reduce 30-day readmission rates for individuals participating in the program.  CHRC grant funds are being utilized to support the salary costs of program staff (This grant is also listed in 'Increasing Access to Integrated Behavioral Health Services').
    Organization Contact Information: http://www.gogettersinc.org/Lower-Shore-Clinic.html


    Grantee Organization: Charles County Health Department
    Jurisdiction Served: Charles
    Grant and Amount: 16-013 ($400,000) 
    Grant Project Description: This three-year grant supports an innovative “public health-EMS-hospital” partnership that seeks to address utilization of EMS and ED services in Charles County by assisting frequent ED/EMS users to manage their chronic conditions in a primary care setting or at home. The program is a collaboration among the Charles County Health Department, Charles EMS, and Charles Regional Hospital. Grant funding is being utilized to support a Mobile Integrated Healthcare team comprised of a paramedic, a nurse practitioner, and two community health workers (This grant is also listed in 'Expanding Access to Primary Care Services'). 
    Organization Contact Information:     www.charlescountyhealth.org


    Grantee Organization: Family Services, Inc. 
    Jurisdiction Served: Montgomery County
    Grant Amount: 15-006 ($250,000) 
    Grant Project Description: This two-year grant provides funding to expand Family Services' CareLink program to Holy Cross Hospital and Holy Cross Germantown Hospital. The CareLink program was previously successfully implemented at Washington Adventist Hospital and Shady Grove Hospital. The program targets individuals at a high risk for readmission who have behavioral health needs and/or medical conditions complicated by socio-economic factors. Grant funding is utilized to support the salary costs program staff (This grant is also listed in 'Increasing Access to Integrated Behavioral Health Services')​​.
    Organization Contact Information: http://www.fs-inc.org/


    Grantee Organization: Harford County Health Department
    Jurisdiction Served: Harford County
    Grant and Amount: 15-008 ($320,000)
    Grant Project Description: This three-year grant provides funding to support the partnership between Harford Health Department and Upper Chesapeake Health (UCH) to identify high-risk, high-cost populations and would 'integrate' the care coordination efforts of Harford Health Department with disease management efforts of UCH. Grant funds are utilized to cover the salary costs of program staff (This grant is also listed in 'Expanding Access to Primary Care Services')​​. 
    Organization Contact Information: http://harfordcountyhealth.com/

     
    Grantee Organization: Medstar Union Memorial Hospital 
    Jurisdiction Served: Baltimore City
    Grant and Amount: 15-009 ($150,000) 
    Grant Project Description: This two-year grant supports a hospital-community partnership to reduce preventable hospital ED visits and refer individuals to ongoing primary care services in community based settings.  The grant involved hospital-community partnerships and funded a patient navigator position who worked with 2,695 individuals over the course of the program to link individuals with a primary care provider.  (This grant is also listed in 'Expanding Access to Primary Care Services')​. 
    Organization Contact Information: http://www.medstarunionmemorial.org/

     
    Grantee Organization: Health Care Access Maryland
    Jurisdiction Served:  Baltimore City 
    Grants and Amount:  14-011 ($800,000) 
    Grant Project Description:   This three-year grant supports a program that targets individuals with chronic disease conditions who frequently utilize the Sinai Hospital emergency departments and promotes access to primary and preventative care services in the community. The program helps residents enroll in public health care coverage and navigate the complex health care system. Grant funds are being used to support new ED diversion teams deployed in two hospitals in Baltimore City (Sinai and Northwest Hospitals) (This grant is also listed in 'Expanding Access to Primary Care Services')​.
    Organization Contact Information: www.healthcareaccessmaryland.org


    Grantee Organization: Total Health Care
    Jurisdiction Served: Baltimore City
    Grant and Amount: 08-022 ($100,250) 
    Grant Project Description: This one-year grant supported a program with Total Health Care to reduce ED visits for non-emergency conditions by clients accessing Maryland General Hospital's ED. The grantee placed Outreach Coordinators in the hospital's ED during peak usage hours to educate patients on appropriate ED use and to assist patients in connecting with a primary care provider in the community. The grantee reported an 8% reduction in ED visits at Maryland General Hospital from the year prior to the grant's implementation (This grant is also listed in 'Expanding Access to Primary Care Services')​.
    Organization Contact Information: www.totalhealthcare.org

     
    Grantee Organization: University of Maryland Department of Family Medicine
    Jurisdiction Served: Baltimore City
    Grant and Amount: 08-023 ($499,749)
    Grant Project Description: This three-year grant supported the Better Access to Care (BAC) Program aimed at reducing hospital ED visits using the Chronic Care Model for patients with diabetes, depression and asthma. Patients were referred from the UM hospital ED and other community organizations. Grant funds were used to support the salary costs of program staff (This grant is also listed in 'Expanding Access to Primary Care Services')​. 
    Organization Contact Information: www.medschool.umaryland.edu/familymedicine

     
    Grantee Organization: Upper Chesapeake Health
    Grant and Amount: 08-024 ($485,743) 
    Jurisdiction Served: Harford County
    Grant Project Description: This three-year grant supported the development of a comprehensive ED diversion program to redirect uninsured patients away from using emergency rooms for non-emergent visits by redirecting uninsured and underinsured patients towards a medical home for primary and preventative care, as well as linking them to a comprehensive community based continuum of care (mental health, specialty care, substance abuse, entitlement programs, etc.). The program provided a medical home for patients at the Upper Chesapeake HealthLink Primary Care Clinic. Grant funding was utilized to support staff salaries. During the three year grant period, 2,487 patients were served by the HealthLink PCC (This grant is also listed in 'Expanding Access to Primary Care Services')​. 
    Organization Contact Information: http://www.uchs.org/


    Grantee Organization: Chase Brexton Health Services Inc.
    Grant and Amount: 07-005 ($200,000)
    Jurisdiction Served: Howard County 
    Grant Project Description: This two-year grant supported a program aimed at reducing avoidable visits to the emergency department at Howard County General Hospital. The program employed outreach workers in the ED to connect patients to a Chase Brexton health center location for follow-up care. Funds were used to support personnel costs and to implement a digital interface between the hospital and Chase Brexton. The program served over 600 patients and provided for over 900 patient visits in ambulatory care settings (This grant is also listed in 'Expanding Access to Primary Care Services')​.
    Organization Contact Information: www.chasebrexton.org


    Grantee Organization: Frederick Community Action Agency 
    Jurisdiction Served: Frederick County 
    Grant Amount: 07-006 ($353,585) 
    Grant Project Description: This three-year grant supported the Access to Care Program which provided primary health care services to low-income, uninsured adults and children in Frederick County. CHRC grant funds were utilized to support salary costs for staff to implement this program. This grant allowed for 1,324 patients to be served and provided these patients with 3,740 visits in ambulatory care settings (This grant is also listed in 'Expanding Access to Primary Care Services')​​.
    Organization Contact Information: www.cityoffrederick.com/Index.aspx?NID=183​