ABBEVILLE COUNTY EMERGENCY SERVICES COMMUNITY PARAMEDIC PROGRAM

Transcription

1 ABBEVILLE COUNTY EMERGENCY SERVICES COMMUNITY PARAMEDIC PROGRAM

2 Objectives Understand the needs/goals that the Community Paramedic program was designed to address Understand how Abbeville County implemented their pilot program for Community Paramedicine Understand the many ways that patients were impacted by the program Understand the impact of the program from a quality and financial standpoint

3 Community Paramedic Program - Overview Identified the need for Community Paramedics in 2011 Limited primary care capacity Uninsured/underserved population Population with many chronic diseases Low socioeconomic status Began seeing patients Oct Continues to evolve...

4 Why Community Paramedic Program EMS is already strategically deployed in the community Increases collaboration and coordination among healthcare providers, non-governmental organizations, and community partners Recruitment and retention of EMS personnel Part of the FUTURE of pre-hospital healthcare

5 Implementation Start up costs Initial funding by SCORH Duke Endowment Grant Training Partnerships Abbeville Area Medical Center Outpatient practices UCMAC Free Clinic Dedicated Staff

6 Target Areas Improvement of current disease states Improvement in access to care Coordination of healthcare needs Decreased ED visits Decreased hospital readmissions Decreased healthcare system costs

7 Community Paramedic Program Patient Population Diabetics Asthmatics Co-morbidity Hypertension CHF COPD

8 Community Paramedic Program Home Visits Prevention Cardiovascular Follow-up / Post Discharge Respiratory General Home Safety Assessments Coordinate with FD for smoke/co detectors Blood Pressure trending 12-lead EKG Diabetic follow-up Post injury / illness evaluation COPD management Management of home environment Disease Education CHF Management MDI / Nebulizer evaluation Peak Flow meter education O2 Sat check Detailed physical Assessment Med. Reconciliation Weight Checks Qualify for assistance programs Insurance Align with a medical home

9 How can Community Paramedic s intervene Patients who have a clear understanding of their after hospital care instructions, including how to take their medicines, are 30 percent less likely to be readmitted or visit the emergency department. The reason? This is a culmination of several factors. Failure of the patient to understand their disease process, inability to understand discharge materials (literacy level) and, simply, in a hurry to be discharged. The solution? Educating the patient in their home has proven to show that they are more engaged in their disease process and retain the information. -Fierce Healthcare Publishing

10 Medication reconciliation The importance of an accurate and current medication list is crucial to the healthcare delivery of the patient. This should be completed anytime a patient is admitted, transferred, and/or discharged. Sources for obtaining the most accurate list: Transferring or discharging facility Primary Care Physician s office Previous hospital records Patient s pharmacy

11 Healthy Lifestyle Education Patients encouraged to utilize AAMC Wellness Center (Seniors receive a discount). Diet education given specific to patient specific diagnosis (CHF, Diabetes, etc.). Community Paramedic garden developed to provide fresh vegetables for our patients. On initial visit, current food choices are assessed while in the home and healthier suggestions/alternatives are given.

12 How can Community Paramedic s intervene Even though Community Paramedics can perform medical interventions and diagnostic testing in the field, the most effective means of improving someone s health is EDUCATION

13 Community Paramedic Program Data Collection 75 initial patients Diabetics Decrease in BGL in 85 % of patients (average 34 pts) Hypertension Decrease in BP in 72.7% of patients (average 7.5/4.0) ED usage Decrease of ED usage by 58.1% Inpatient stays: Decreased number of admission and lower LOS(2.3 days to 1.8 days) 30 days readmissions: Decreased by 41.2% 22 patients were assisted in obtaining insurance Improved Health 62 patients now have a medical home (Data collection completed by the SC Rural Health Research Center at USC)

14 Other ways CP s affect Cardiac Care The Community Paramedic s can serve as a supplemental resource when not on a home visit. In the event of a high acuity call, such as a cardiac arrest, they can be a valuable asset to the medical care delivery process. Abbeville County Emergency Services adopted the Pit Crew CPR concept to enhance survival rates throughout the community. Since this inception, numerous documented patient s have been discharged with no adverse affects. The Community Paramedic s are well versed in the Pit Crew process so they can be plugged-in to any position need during the CPR process. Often they are utilized in the Code Commander position.

15 Community Paramedic Program Expanded Staff Primary Care Physicians / CP Liaison Nurse / Community Paramedics Care Coordination Liaison Phase 1 Two Physicians were assigned to the program to provide medical oversight and patient referrals. AAMC hired CP Liaison Nurse to coordinate with the CP s to complete initial home visits, create care plans, and consult with referring Physicians. Staffing Additions Phase 2 Multiple Physicians are now referring patients to the program, with close coordination with the CP Liaison Nurse. AAMC hired an additional nurse to assist with care coordination and handle patients, primarily needing medication reconciliation / pill reminders. This allow the CP s more time to focus on patient management and medical delivery.

16 Community Paramedic Program Expanded Referrals Phase 1 Primary Care (Abbeville office) UCMAC Abbeville Area Medical Center Emergency Department Phase 2 UCMAC Primary Care (Abbeville, Due West) Home Health Surrounding Hospitals (ex. COPD admission prevention) Ambulance scene referrals Abbeville Area Medical Center Emergency Department Discharge from inpatient care

17 Contact Information Dr. Christopher Oxendine, MD Heather C. Martin, BSN, RN Care Coordination/Community Paramedic Liaison Abbeville Area Medical Center