Phone home: Community paramedicine pilot program expands access to care
A phone call can make a world of difference for patients returning home from the hospital after a heart attack or heart failure. With the fear of another heart event, many lifestyle changes and a whole bunch of questions, it’s nice to receive a check-in from a health care provider.
Could it also prevent readmission for another heart attack or heart failure?
That’s what a new Butte County EMS pilot program hopes to find out. The ambulance service is operating one of California’s 12 two-year community paramedicine pilot programs. Its goal is to decrease the number of readmissions within 30 days for Butte County residents recently discharged home from Enloe Medical Center with a diagnosis of heart attack or heart failure.
“If we can keep people healthy at home, give them a positive experience by being there for them and help them avoid an ambulance transport and lengthy emergency room visit, then we have done our job,” said Neal Cline, RN, JD, MICN, CFRN, MICP, project lead for the program and Assistant Chief for Butte County EMS, a joint venture between Enloe Ambulance and First Responder Ambulance.
Meeting heart patients’ needs at home
Community paramedics receive a daily list of patients who meet the criteria for the program and they follow up by researching each patient and calling them within 72 hours after discharge.
During the call, the paramedic will ask a series of questions to determine the individual’s health status and needs. If necessary, the paramedic can then schedule a home visit to provide a safety assessment, facilitate transportation to a pharmacy or a doctor’s appointment, or help with understanding or accessing medications. They may also identify other health care issues that could be addressed with a doctor’s appointment.
In the first six months of the program, Butte County EMS worked with 202 discharged patients, providing follow-up services that included 15 home visits. Only 18 readmissions occurred among these patients within 30 days after their discharge; the majority of these were due to a diagnosis unrelated to heart failure or heart attack.
What is community paramedicine?
Community paramedicine is an emerging field in health care in which paramedics operate outside their customary emergency response and transport roles to facilitate more appropriate use of emergency care resources or enhance access to primary care for medically underserved populations.
Through the pilot programs, community paramedicine services are being provided for free with the hope that proven efficacy will create a paradigm shift for the use of paramedics in California, enabling them to deliver care at a resident’s home. Currently the California Code of Regulations Title 22 only allows paramedics to practice at the scene of an emergency or transport patients between hospitals.
A successful post-discharge support program can also benefit hospitals by protecting them from hefty financial penalties (in the millions) for excessive readmission rates.
Colorado, Maine, Minnesota, North Carolina and Texas already practice community paramedicine.
The other California EMS providers that implemented pilot programs are in the counties of Alameda, Los Angeles, Orange, Santa Barbara, San Bernardino, San Diego, Stanislaus, Solano and Ventura. Each has chosen a service to focus on. These include transportation to urgent care or mental health clinics; hospice support; follow-up treatment of tuberculosis; follow up for patients discharged from the hospital; and assistance for frequent users of emergency medical services to establish care with a primary care physician or social services.
The overall pilot is scheduled to end in 2017. A U.C. San Francisco-based independent project evaluation team will then issue a report.