Table 3 Drivers, rationale and purpose of new models of care in Ontario

Appropriateness of care pathway: right type of care for a client’s needs; improving comfort and client experience

“Patient experience has been, is a very key factor in in seeing the benefit of these programs.” (Participant 19; Care Manager)

“So how can we take the patients that are calling 911 anyway and help them get the treatment they need, get the relief that they need, and not put them in a position where they have to go to the hospital if that’s not what their goals of care are?” (Participant 8; Paramedic)

Systemic and operational benefit: reducing emergency service and emergency department use, addressing hospital overcrowding, cost reduction

“They also looked at 9-1-1 avoidance and things like that, which-- 9-1-1 calls did go down from this population when they knew this service was available. So that was kind of one of the metrics. They also looked at emergency department visits and things like that.” (Participant 1; Paramedic)

Access to care: increasing access or touchpoints to health and social services, particularly for hard-to-reach or under-served populations

“How do we narrow our focus? And that vulnerable population was kind of our threshold or lens to say, okay, yes, we can include you in our criteria” (Participant 6; Paramedic)

“All I know is where our team specifically goes. And I think that this is kind of across the board in a lot of places. It’s where nobody else is going.” (Participant 14; Paramedic)

“And what we were finding is that is how we were coming up with most of the issues and problems and discovering them, was those room-to-room wellness checks, because they were very apprehensive to come to us.” (Participant 16; Paramedic)

Need for a mobile, timely, flexible 24/7 resource: paramedics have mobility, staffing, equipment and logistics infrastructure to deliver a service on-demand

“So what is also key for them, for us, I find is their responsiveness to go in and do quick visits within 24 to 48 h.” (Participant 10; Nursing, Occupational or Physical Therapist)

“So when a discharge coordinator is picking a service to refer a patient to, sometimes they pick paramedicine because they know it’s rapidly mobilized without question.” (Participant 18; Paramedic)

Gap in service: unmet local needs for reasons such as: resource shortages, clients not qualifying for services from other providers, jurisdictional issues

“So there’s people in the community, I think, that are lost in the system. So they’re getting missed because maybe they don’t qualify for homecare, but the hospital discharged them because we don’t have facility to keep them in beds at the hospital.” (Participant 3; Paramedic)

“When we started to look at rolling out the CP [community paramedicine] program, we identified, as I said through the retrospective analysis, where are we seeing the pressures? And then from that, how do we engage with our community partners to say, how do we, you know, work to resolve this together?” (Participant 26; Paramedic)