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MISSION COMMUNITY CARAMEDICS PROGRAM
THE PROBLEM WE ARE SOLVING When a patient is in the hospital, we have tremendous knowledge about them - their vital signs, their medication roster, their fluid intake, and the safety of their environment. When that same patient is discharged, we lose the essential information necessary to ensure that the patient recovers or maintains a reasonable health status. While many patients have excellent home environments and are well-supported by knowledgeable and supportive families or caregivers, there are many patients who are discharged from the hospital and emergency room that do not enjoy a safe and stable residence. These patients lack the advantage of necessary support from family, and many do not qualify for home health services. Those fortunate enough to be granted home health services are sometimes granted this assistance for a very short period of time, and are left to provide for themselves afterwards. The lack of necessary support negatively impacts patients in many ways, including the following: • • • • • •
Poorly understood or misunderstood discharge instructions Poorly understood prescription additions, deletions, or changes in dosing, as well as inability to fill prescriptions due to different barriers An unsafe living environment due to clutter, fire hazards, slip and fall hazards, inadequate means of ingress and egress from the residence, as well as sanitation concerns and nutritional needs Inadequate food supplies supportive of the patient’s overall care plan: low-salt, diabetic-friendly, allergen-safe, etc. Deterioration of overall state of health, resulting in frequent ER visits and readmissions to the Hospital Overall poor quality of life and general dissatisfaction with their healthcare
THE SOLUTION WE HAVE DEVELOPED The Mission Community CaraMedics Program is a highly effective resource capable of filling gaps, both in care and information. Our CaraMedics are experienced and well qualified to address the patients’ unique needs and assist the patient in developing the necessary capabilities for managing their health at home. In-home visits by Critical Care Paramedics with enhanced community paramedicine training creates a tremendous advantage over typical delivery of care. While in the home, they assess the patient’s resources and abilities to take care of their condition, then perform field tests such as laboratory work and offer advice for home care, wound management, walking assistance, fall prevention, medication review, and nutrition.The CaraMedics are able to observe real-time patient conditions and make connections to community resources to support patient needs. They provide improved understanding and adherence to discharge instructions, improved medication compliance, nutrition, personal health monitoring, and an improved understanding of appropriate utilization of EMS and Emergency Department services. Equally important, this network of support is integrated into the patient’s Electronic Medical Record (EMR) to facilitate communication among providers and enable better patient care and outcomes.
THE SOLUTION WE HAVE DEVELOPED Community CaraMedics also facilitate safe care transitions for newly discharged patients in a domestic setting, reducing the likelihood that the patient suffers an event requiring readmission. The team also supports patients who are dealing with complex medical diagnoses and those at high risk for hospitalization. Using experienced critical care paramedics with community paramedic training allows us to assess patients holistically, evaluating the physical, social, psychological, and spiritual aspects of the patients’ needs at home. This provides an opportunity for the patient to think through their needs and, together with their healthcare team, make a plan for achieving optimal care goals of care. It helps patients to participate and self-manage their conditions. Community CaraMedics serve as the eyes and ears for the primary care physician and care managers in the home, helping the team to target support and care delivery by making appropriate and informed decisions for effective care coordination. Community CaraMedic visits prevent avoidable hospital and Emergency Department readmissions while improving the quality of life for the patient at home with friends, families, and spouses.
REQUIREMENTS TO ENHANCE AND FURTHER DEVELOP THE PROGRAM The training, vehicles, and general equipment required for this program are modest considering the value that the program provides. Community CaraMedics aim to transform the home into a viable care space for patients among family and friends, while also freeing up Emergency Department and EMS resources for true emergencies. Community CaraMedics will assist in realizing the following goals: • • •
Decreased hospital readmission rates Decrease in unnecessary EMS calls Decrease in unnecessary Emergency Department visits
In a recent case study, our Community CaraMedics saved $181,000 by preventing unnecessary readmissions for a renal patient. Other long-standing programs have had many of these cases. For example, in Wilmington, North Carolina, a Community Paramedic program helped reduce the chronic heart failure readmission rate for their hospital to 9.3% when the state average for the same period was 23.9% for all Medicare patients. In Eagle County, Colorado - the site of one of the original community paramedic programs - they had an average savings of $4,451 per patient. They prevented 2.5 doctor visits per patient, and prevented an ambulance transport and or emergency room visit in 36% of patients. From a strategic perspective, this all combines to aid in decompressing critically overcrowded Emergency Departments and improving overall hospital bed availability, leading to reduced costs and a better experience for all patients visiting Mission Health System. Funding Needs
Equipment
$151,898
Training
$159,220
Uniforms
$2,000
Lease of two compact SUVs and Insurance ($1,500/month)
$18,000
Fuel ($3,668/month)
$44,016
Supplies ($2,500/month)
$30,000