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Pilot program uses extended paramedic visits to assess and coach patients recently discharged from the hospital

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This article was originally published in June 2013.

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In a Boise area pilot project, paramedics are taking on a new role to help patients avoid a return trip to the hospital. Within 48 hours of being discharged from a hospital, high-risk patients receive a two-hour home visit with a community paramedic, then weekly follow-up phone calls for a month. While the initiative is still in its early stages, results are promising—patient satisfaction scores are high and readmissions are being prevented.

Nationwide, heart failure patients are at particularly high risk to be readmitted to a hospital within 30 days of their discharge, but only two of the 16 patients visited following a heart failure-related discharge have returned due to a heart failure-related cause.

“Compared to a 911 call, where we might be on the scene for 20 minutes, we can get a lot done in two hours,” noted Mark Babson, a community paramedic with Ada County Paramedics. “We can see how a clinical plan will fit into the patient’s life, barriers that a provider might not know about, or challenges that the patient doesn’t even realize are in the work ahead. It’s one thing to eat right when the hospital staff prepares it for you, but how do you get that food in the cupboard at home?”

The community paramedic typically performs a physical assessment of both the patient and home (for example, drawing attention to throw rugs or other potential tripping hazards), acquires vital signs (including an EKG, if needed), ensures that the patient understands and is implementing the care plan, and helps the patient organize his or her medications. “If a patient needs more information about a medication, or hasn’t filled a particular prescription because of the cost, we can coach them to talk to their doctor about it,” Babson explained.

Coordinating follow-up care is an important part of the home visit. Studies have shown that readmission risk decreases when patients schedule an appointment with their physician shortly after discharge. “We can help the patient make all those phone calls while we’re there in the home, and share our recommendation with the provider whether the patient has an urgent need to be seen right away,” Babson said.

Assessing patient needs is, of course, a natural fit for paramedics. They, too, are uniquely qualified to both speak the language of providers and effectively communicate with “patients living under a bridge or in a mansion,” Babson noted. “When we first started talking to our community stakeholders about this project, you could just see the light bulbs go on as they realized what we can do besides respond to 911 calls.”

Partnership with hospitals and other stakeholders is important. As part of their discharge planning, St. Lukes refers heart failure patients to receive the community paramedic services. Ada County’s program was funded for its first two years by the Ada County commissioners.

The community paramedic program is now in its second year, with the first year consumed by completing a needs assessment and engaging stakeholders. They met Christine Packer, MEd, a Qualis Health consultant early on. She provided them with key contacts and ensured that they were active participants in Treasure Valley’s care transitions coalition. “Christine really helped us get the word out. She is so intimately knowledgeable about all the resources in the community and helped us leverage that,” Babson said.

“It’s important to know the gaps and not reinvent the wheel,” he continued. “The specific needs of a community may vary, but one constant is that paramedicine has been under-utilized…. It’s exciting to see the proof of concept coming together.”
 

Learn more about Qualis Health's work through the Communities for Safer Transitions of Care project.