8 minute read
Community Paramedicine Program
from FOCUS MAGAZINE Winter 2018
by Centra
The Centra Community Paramedics Program team, L to R: Tom Sheppard, Lincoln Barnes, Jimmy Mitchell, Melinda Leebrick, Diron Martin
Healthy at Home
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The Centra Community Paramedics Program makes a positive impact and a lasting impression
Centra has taken another step forward in providing healthcare that meets patients where they’re at — literally. When people are sick or injured, they’re accustomed to visiting their healthcare providers for medical care. However, there are some patients who could benefit from a different approach. These individuals either frequent the hospital or their condition presents an obstacle to going out and getting the care they need. Patients now have an option that brings medicine and long-term care right to their homes.
The Centra Community Paramedics Program serves those in the community diagnosed with any of four chronic diseases or those who have had multiple admissions to the hospital in a 12-month timeframe.
The four diseases include:
• Chronic obstructive pulmonary disease (COPD)
• Congestive heart failure
• Hypertension
• Diabetes
The Community Paramedics Program officially launched in January 2018 and addresses issues preventing a patient from being successful with their at-home care.
Potential candidates for this program are contacted during one of their hospital visits. A member of the community paramedics team will stop by and share details about the program, and those who wish to participate can expect a weekly visit from a paramedic for four to six weeks. During that time, the community paramedics identify and address specific aspects of the patient’s home life that have caused the most issues leading to their hospitalizations. These participants have access to community paramedics 24/7 if they have a question or need assistance.
One of the great benefits to this program is that it’s offered at zero cost to the patient or their family. Centra also does not bill insurance for their visits.
Developing the Program
This program is funded by Centra and the Centra Foundation — with startup costs of $300,000. It was developed over a 40-month period, with 18 months of that time conducting a community needs assessment of a Centra’s 9,200-square-mile coverage area to build the most effective plan. This plan was based on research conducted on other community paramedicine programs across the country. Dedicated to the best possible community health initiatives, Centra’s program is the first hospital-based community program operating in the state of Virginia.
After researching other programs and determining the needs of central Virginia, the team began a pilot program in January 2017 to ensure the plans were the most effective before applying them to a larger number of patients. During that year, they served 12 patients before officially launching the program in 2018. Since that time, the team has had 460 patients in the program, each of who stays enrolled for an average length of three and a half weeks.
The Paramedics Team
The program is led by Jimmy Mitchell, supervisor of training for Centra, and includes four nationally registered paramedics. Combined, the community paramedics team brings over 68 years of paramedic experience. Additionally, each of the four employees have been part of the Centra family for over 10 years. Jimmy, a firefighter for 25 years, credits their past experience in emergency medicine for helping shape the program to what it is today.
Jimmy Mitchell
When asked why this work is so important to him, Jimmy, with tears in his eyes, said, “This program gives me the ability to provide the care to the community that I would want provided to my family. Knowing you’re not just concentrating on a 30-minute medical emergency and that you are caring for someone in their daily life — not just an immediate need — is an incredible feeling.”
During the home visits that Jimmy and the others perform, anything that keeps a patient from being successful in their home is addressed over the course of those four to six weeks. From grocery store trips and nutritional planning to medication and moving rugs so patients don’t fall, Jimmy and his team break those barriers down. Jimmy says that no solution is off the table.
Each patient has a tailored plan to help them succeed. When the team found out a bilateral amputee was having trouble getting down his concrete stairs, they jumped into action. This gentleman loved sitting outside under his old oak tree, and since his hospitalization, he hadn’t been able to do so.
Since that day, the paramedic team has built six more ramps at homes to ensure patients can come and go safely and comfortably.
“We help them learn to selfmonitor their conditions, so they know when something changes — they know when to call for help before it turns into an emergency,” says Tom.
Dr. Kayla Long, medical director of the Community Paramedics Program and emergency room physician with Centra, further explained that the program helps to bridge the disconnect between a patient’s hospital visit and their return home.
“After a patient is discharged from the hospital, it can be a confusing time,” said Dr. Long. “They have survived this hospital ordeal, have new medications, and likely have to find new ways of adapting their everyday life.”
Melinda Leebrick, the newest member of the Community Paramedics Program, echoed that sentiment, saying, “Participants of this program have an extra set of eyes on them. Being recently discharged from the hospital can be overwhelming, and we’re there to give them the peace of mind that they are doing the right things.”
Lincoln Barnes, a community paramedic and Lynchburg City firefighter, sees the home visits as impactful to a patient’s care. He said, “Sometimes a patient just needs a little help when they first get home — someone to point them in the right direction.”
Benefiting the Patient
This impact is clearly seen, as the Centra Community Paramedics Program currently has a 93 percent success rate in keeping patients out of the hospital and at home. The national average is only 30–45 percent. Hospital readmission rates have been a hot topic since their inception in 2010 as part of the Affordable Care Act.
A hospital readmission occurs when a patient who had been discharged from a hospital is admitted again within a specified period of time (regardless of their diagnosis). Readmission rates have increasingly been used as an outcome measure in health research and as a quality benchmark for health systems.
One of the reasons that preventing readmissions is beneficial for the community is because it decreases any financial penalty the health system could face from Medicare, freeing up Centra’s resources to assist more patients with their needs.
Expanding the Program
Currently, the community paramedics see patients who live in Altavista, Amherst, Brookneal, Bedford, and Lynchburg. However, the next phase of expansion for the program will include Farmville and its surrounding area.
The plan is to eventually expand the program to Centra’s entire coverage area, which stretches from Farmville to Bedford, Amherst, and Danville. While the timeline for this expansion is still being determined, the coverage area is expected to double in size within the year.
The paramedics team travels to these areas in a vehicle that’s been outfitted to function as a mobile ambulance. They have medical equipment on board that allows them to treat emergency situations and conditions as well as perform advanced assessments on the spot if needed.
During a routine visit, the team will check vital signs, go over medications, check for home safety issues, and determine if there are additional needs that are unmet.
Community Relationships
Through the program, patients are also connected with various community resources. Tom explained, “We are always looking for agencies to partner with to provide the care our patients need.” These resources can range from ensuring patients have home-cooked meals, nutrition counseling for their chronic condition, delivery of their pharmacy needs, and transportation to and from appointments.
Additionally, the program can offer home repairs or modifications that are needed to ensure safety. The service is specifically designed around long-term solutions that keep the patient in mind and help them achieve their at-homecare goals.
This program takes them to a patient’s home, where they can truly get to know one another. This connection is exactly what Ray Martinez, a current bariatric patient in the program, characterizes.
Lincoln Barnes and Diron Martin check a patient’s blood pressure from the comfort of his own home.
Ray and Kathy Martinez
Ray and his wife, Kathy, have been married for over 40 years and are high school sweethearts. Soon after marrying, they moved to Lynchburg. They raised two children and have three beautiful grandchildren. Watching them with each other, you can instantly tell they’ve been together for a long time.
Kathy has the innate ability to know Ray’s needs before he even realizes them, and Ray has the ability to keep Kathy smiling and laughing. Together, they make a wonderful team.
As of May 2018, Ray had not left the house since March 2017. He developed a rash in February 2018 and needed to see a physician. Since Ray was bedridden, getting him out of the house and into a clinic was challenging.
Ray said after he called several clinics and was met with one obstacle after another, he finally called his insurance, Piedmont Community Health Plan (PCHP), and they were able to connect him with the Community Paramedics Program.
Dr. Long came out with the paramedics one afternoon and assessed Ray in his home. She was even able to call in his prescriptions without him having to leave his home. Since then, the paramedics team has been out to see the Martinez family several more times. The team is also able to safely transport Ray to his doctor’s appointments, giving him the peace of mind that he had been looking for.
Ray said the program takes the pressure off him and his wife and adds security. “You know they’re there for you. They will come by or call and check on you,” explained Ray. “I am incredibly grateful for the program. It keeps me from getting frustrated.”
Kathy agreed, saying, “To have a person call you or come see you is invaluable — it’s that personal contact.” The couple hope other people take advantage of the program and stay informed about the resources out there.
In order to continue helping as many patients as possible, the team is expanding its services. The Centra Community Paramedics Program hosts free monthly classes for friends, families, and caregivers. For more information, visit CentraHealth.com.
