EMS World

JUL 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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EMSWORLD.com | JULY 2018 39 charge rehabilitation were allowed in the inclusion criteria. Excluded were patients living outside the referenced zip code or in kidney failure and receiving dialysis. Once identified by a member of the hospital team a s qualif ying , patient s were introduced to the program by the p aram e dic o r c are mana ger using a "warm handoff" approach in the hospital. They shared information and obtained cons ent. Each patient wa s of fered a home visit and/or referral and coordi- nation of community-based ser vices. If a patient was not able to meet with the paramedic in the hospital, staff explained the program, shared information, and had the patient sign an agreement. EMS House Calls In the CP program, the paramedic makes the first home visit within 48 hours of discharge. During the visit paramedics isolate all medications. These are iden- tified and reconciled for duplication, with education provided on ever y thing pre- scribed. They check expiration dates and conduct some pill counts to make sure the patient is taking their meds appro- priately. They also provide counseling on discharge instructions and make referrals to community ser vices. Depending on patient needs, the para- medic performs any combination of the following activities during a home visit: • Assists in filling prescriptions, sor t- ing medications, and explaining how to take them as prescribed (using teach- back medication cards as appropriate); • Provides counseling on hospital and clinic discharge instructions; • P r o v i d e s d i s e a s e m a n a g e m e n t , including review of the disease pro- cess; utilizes zone tools for reporting symptoms; ensures PCP will follow up (zone tools educate patients about red flags to report to their provider); • Per forms nutritional a ssessments with referral to Meal s on Wheel s if necessar y; • Discusses fall prevention with refer- ral to communit y program Matter of Balance if necessar y; • Ac tivates a comprehensive home safet y checklist (a ssessing lighting, sidewalks, phone accessibility, emer- gency numbers, trip hazards, fire extin- guishers, smoke alarms, items within reach without using ladders, heaters, and emergency medical information). The paramedic concludes the home visit by either making or following up with referral s to needed ser vices . O f the patients seen, 70% had their medi- cal issues resolved on site, and the rest received continued suppor t and care coordination for up to 90 days. "On paper the program is 90 days, but this depends on the situation each patient is experiencing ," s ays Joshua Clouse, Plano Fire-Rescue's communi- t y paramedicine coordinator. "It star ts with a minimum of once-a-week visits for evaluation, education, and referrals. Once they're managing on their own with a dedicated out-of-hospital healthcare team, they are discharged. They are also educated on the after-hours and urgent- condition processes." Promising Results During the initial pilot in 2015, 61 patients were identified and enrolled by coalition hospitals. The majorit y were Medicare beneficiaries, with an average age of 7 7, mostly seen in the home setting. A s determined by September 2016 reconciled fee-for-ser vice claims, the annual hospital admission rate in the Nor th Dalla s (Plan o) area p er 1,000 beneficiaries showed a statistically sig- nificant reduc tion from 242.62 at the beginning of the project to 236.69 by its end. This was a relative improvement of 2.4% and translates to an estimated 698 fewer hospital admissions per year. Other cost savings included: • Ambulance transport: $419 average cost; $27,459 expenditure savings • Hospital ED visit savings: $969 aver- age cost; $7 7,298 expenditure savings • A l l- c a u s e h o s p i t a l a d m i s s i o n : $10,500 average cost; $715,875 expen- diture savings. "We're finding through these programs that we can do more for our patients than just schlep them all to the emergency room," s ays Mat t Zavadsk y, MS-HSA , NREMT, of Fort Worth's MedStar Mobile Healthcare, who participated in the coali- tion and consulted for the CP program. "It's improved the patient's experience in ways we never imagined while dramati- cally saving healthcare expenditures." Where Now? Hospital participation in the CP program expanded from one to five in the Nor th Dalla s communit y during this project. Interest has also spread to the pharmacy department at one hospital: After much collaboration the facility was able to pro- vide medication planners for the para- medics to use in medication education. For EMS units looking to of fer these programs, critical components are iden- tif ying community needs and the ser vic- es available to address patients' social needs, and forging relationships between community stakeholders and EMS. Pay- ment is also critical. In Texas some hos- pitals will reimburse EMS ser vices under a contracted fee; however, this arrange- ment may not prove sustainable. Other CP programs either par tner with or are licensed as home health agencies and paid under the home healthcare model. "Many patients within our target popu- lation routinely call 9-1-1 to be evaluated but aren't transpor ted," s ays Clouse. "Under the current CMS pay schedule, th os e p rov id er s won't b e p aid, even though they 've incurred a significant expense. By not transporting the patient, on average, $3,500 in unnecessar y emer- gency room expenses would be saved." By partnering with community stake- holders, the reach and impact of com- munit y paramedicine can continue to improve health outcomes. ABOUT THE AUTHORS Kristine "Kris" S. Calderon, PhD, CHES, is senior innovative strategist and researcher for the TMF Health Quality Institute. Donna Zimmerman, RN, BSN, is a quality improvement consultant with the TMF Health Quality Institute. Joshua Clouse, BSBM, CP-C, Lic-P, is a firefighter- paramedic with Plano Fire-Rescue and coordinates the department's community paramedicine program. Matt Zavadsky, MS-HSA, EMT, is chief strategic integration officer for MedStar Mobile Healthcare. Michelle Stehling, RD, LD, is health services consultant-II with the TMF Health Quality Institute.

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