Despite no statistically significant improvement in 30-day readmissions or quality of life scores, MIH was well received by patients and stakeholders and aligned with institutional goals, though sustaining and scaling MIH may require supportive reimbursement models and policy reforms.
Key Findings
Results
The MIH program reached a patient population with greater racial and ethnic diversity than the overall heart failure patient population at the health systems.
MIH participants were 50% Black or African American, 27% Hispanic or Latino, and 25% White
All HF patients across both health systems were 9% Black or African American, 4% Hispanic or Latino, and 42% White
73,343 total patients were treated for HF across both health systems during the trial period
1,005 patients were enrolled and randomized to MIH, of whom 414 received at least 1 MIH visit
Results
There was no statistically significant decrease in 30-day all-cause readmissions or Kansas City Cardiomyopathy Questionnaire scores among MIH participants compared to the control group.
Mean difference in KCCQ scores was 1.83 (95% CI, -0.75 to 4.40; P = .16)
The comparator group was a transitions of care coordinator control group, not usual care
The parent trial was the MIGHTy-Heart randomized clinical trial conducted from January 2021 to September 2024
The trial was conducted at 2 large urban health systems in New York, New York
Results
Adoption of the MIH program was promoted by institutional alignment and supported by leadership engagement, interdisciplinary coordination, and patient trust.
25 stakeholders were interviewed, including clinicians, paramedics, caregivers, and program leaders
20 patients were interviewed for qualitative results
Data were analyzed from January 2022 through August 2023
Directed content analysis was used to assess the five RE-AIM domains from interview data
Results
Misaligned reimbursement structures and regulatory constraints were identified as key barriers to MIH adoption.
Barriers included misaligned reimbursement and regulatory constraints
Sustaining and scaling MIH was identified as requiring supportive reimbursement models and policy reforms
These barriers were identified through semistructured interviews with stakeholders
National implementation of MIH remains limited due to insufficient understanding of barriers and facilitators to adoption and sustainability
Results
MIH was perceived as valuable by both patients and staff, with sustainability plans reflecting this perceived value.
Sustainability plans reflected MIH's perceived value to patients and staff
Despite no significant difference in primary outcomes, the program was 'well received and aligned with institutional goals'
Willingness to recommend MIH and institutional continuation plans were used as measures of maintenance within the RE-AIM framework
The MIH intervention included home visits from community paramedics, ongoing nurse care coordination, and facilitated telehealth consultations
Results
The overall HF patient population across both health systems was predominantly older and male, with 70% aged 65 years or older and 55% male.
73,343 total patients were treated for HF across both health systems during the trial period
51,420 (70%) were aged ≥65 years
39,979 (55%) were male
The study period ran from January 2021 to September 2024
What This Means
This research examined a program called Mobile Integrated Health (MIH), which sends community paramedics to visit heart failure patients at home after they leave the hospital, while also providing nurse care coordination and telehealth consultations. The study used a combination of a clinical trial and interviews with patients and healthcare staff to understand how well the program worked and what helped or hindered its use. The trial included over 73,000 heart failure patients across two New York City hospital systems, with about 1,000 enrolled in the MIH trial and 414 actually receiving at least one home visit.
The clinical trial portion found no statistically significant difference in hospital readmissions within 30 days or in patients' quality of life scores between those who received MIH and those who received standard transitions-of-care coordination. However, the program did reach a notably more racially and ethnically diverse group of patients than the overall heart failure population — for example, half of MIH participants were Black or African American, compared to only 9% of all heart failure patients at the health systems. Interview findings revealed that patients and healthcare staff viewed the program positively, and that institutional leadership support and teamwork among different healthcare roles helped the program run smoothly.
This research suggests that while MIH did not outperform standard care coordination on the primary measures studied, it successfully engaged underserved patient populations and was well regarded by those involved. Key obstacles to broader adoption included payment structures that do not reimburse this type of care and regulatory limitations on what paramedics can do outside of emergency settings. The authors suggest that changes to reimbursement policies and regulations may be needed before programs like MIH can be widely and sustainably implemented.
Reading Turchioe M, Ellison M, Topaz L, McGinnis C, Choi J, Zhao Y, et al.. (2026). Mobile Integrated Health and Post-Hospital Discharge Heart Failure Care.. JAMA network open. https://doi.org/10.1001/jamanetworkopen.2026.30229