EMS World

JUL 2018

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38 JULY 2018 | EMSWORLD.com BONUS CONTENT: COMMUNITY PARAMEDICINE W ith readmission rates at an all-time high among Medi- care beneficiaries, the North Dallas (Plano) Care Coordina- tion Community Coalition was looking for innovative interventions. Members of the coalition—which includes 17 acute care hos- pitals and stakeholders in the North Dallas area—wanted to increase accountability for readmissions across the care continuum, engage providers outside their silos, and foster communication and collaboration as a healthcare community. Community Coalition The TMF Health Q ualit y Ins titute, an Austin-based nonprofit and CMS' con- trac te d Q ualit y In n ovati o n N et wo r k- Qualit y Improvement Organization for Arkans a s, Missouri, Oklahoma, Texa s, and Puerto Rico, worked collaboratively with stakeholders to form the North Dal- las Care Coordination Community Coali- tion with the goal of reducing hospital readmissions. The coalition determined the barri- ers to care transition in the communit y included poor communication between providers, lack of medication reconcilia- tion and patient family support, and the need for more ef fective patient educa- tion. Af ter one hospital shared an out- come of reduced readmissions through referral of patients to a CP program, the Plano Fire-Rescue team was asked to join the coalition and share best practices. In collab oration w ith the co alition, Pl an o Fire - Re s cu e h ad p e r fo r m e d a SWOT (strengths , weaknesses , oppor- tunities, threats) analysis to assist with strategic deployment of a communit y- wide CP program. The SWOT analysis further supported readmis sio n d eter minant s p rev io usly identified by the coalition, including lack of communication and care coordination within postacute care; a need for better medication reconciliation and improved education for medications; and address- ing indigent healthcare and referral to mental health resources. The coalition determined many patients do not have a primar y care physician or ongoing treat- ment plan, and the CP program could both bridge them to a primar y care provider and avoid costs via reduced emergency transports and ER evaluations. Within the coalition, TMF QIN-QIO and Plano Fire-Rescue teams shared inter- vention strategies and resources such as zone tools, a resource for patients to easily recognize if they're safe with their symptoms or need to notif y their provider or physician. After several collaborative meetings, including consultation with the MedStar Mobile Healthcare team from For t Wor th, the CP program team pre- sented a home-visit inter vention it could deploy in the communit y. The coalition agreed to support the CP inter vention via patient referral from member hospitals as long as medication reconciliation, home safety education, and patient education resources were provided as needed. Big Goals With the purpose of bridging the gap between primar y care and EMS, the CP program expanded the paramedic's role to involve in-home patient v isit s and referrals to community-based ser vices. Outcome goals included lowering hospi- tal admissions and readmissions among a targeted group of patients who utilized EMS ser vice s frequently for noneme - rent situations (the high-utilizer group, or HUG). The s e goal s were ba s ed on nearly 1,200 9-1-1 calls made by 200 HUG patients in the Plano area during 2015. Patients referred to the program were those identified a s needing follow-up but nonemergent care. Within the hos- pitals patients were assessed utilizing a risk-assessment tool similar to the LACE tool (a popular scoring index used for CHF patients), built into the hospital's elec- tronic health system and suppor ted by community partners. Those patients who 1) had CHF, 2) had multiple admissions, 3) didn't qualif y for home health nursing, 4) lived in Plano, and 5) were vetted by navi- gators at the hospital were referred to the CP program. Both skilled nursing facility/ assisted-living facility care and postdis- By Kristine 'Kris' S. Calderon, PhD, CHES; Donna Zimmerman, RN, BSN; Joshua Clouse, BSBM, CP-C, Lic-P; Matt Zavadsky, MS-HSA, EMT; and Michelle Stehling, RD, LD Community Paramedics Reduce Hospital, Ambulance Use Texas program lowered readmissions and cut nonemergent 9-1-1 calls using community paramedics Photo: Josh Clouse

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