Rural Critical Access Hospital Abbeville Area Medical Center (AAMC) and Abbeville County EMS (ACEMS) have joined forces to create a unique program in their corner of the state – a community health care service designed to reduce avoidable readmissions and unnecessary safety net ER use by focusing on home-based preventive care.
“Traditionally EMS has been emergency-driven,” said David Porter, ACEMS director. “Now we’re talking about being a little more proactive on the front end.”
Porter is working closely with AAMC Chief Quality Risk Officer Mary Margaret Jackson, CPHQ and Medical Director Keith Scott, MD to plan and implement the new program. They hope to reduce emergency department visits by 20 percent over the next two years.
ACEMS will check on patients (as requested by physician order), support them in better self-management of their chronic conditions and help them to access crucial resources. The team may also do home safety checks. For instance, they might make sure there is food in a diabetic’s refrigerator or determine a patient needs a smoke detector and figure out how to get one donated for him.
This type of pre-emptive care can absolutely prevent the overuse of emergency services.
“Community paramedics (CPs) are able to act as a physician’s eyes and ears regarding the everyday environmental and social factors present in patients’ lives,” said Porter. “This is critical because these factors can greatly impact disease processes.”
Along with easing the burden for hospitals, more responsibility and an increased capacity to assist vulnerable patients may also help boost job satisfaction and reduce turnover among EMS staff who become CPs.
Eventually the techs hope to work in visits to individuals who experience difficulty accessing care due to socio-economic status. These patients may not have reliable transportation or family support, or may lack the literacy level necessary to complete basic forms.
To help tackle readmissions among patients identified as “frequent users”, ACEMS will arrange a home visit soon after discharge, where the community paramedic will be able to help clarify physician orders, go over medication lists and compliance or address other needs with the patient and family members.
Porter acknowledged this expanded role in patient care will be a new experience for his agency. “It’s not what paramedics have typically concentrated on. It’s a different mindset,” he said.
They have been well trained for the challenge. Three ACEMS community paramedics recently traveled to Fort Worth, Texas for ride alongs and immersion with the “boots on the ground” of MedStar Mobile Healthcare. Medstar developed a robust Community Health Program in 2009 and subsequently saved $3.3 million in health care expenditures and decreased targeted 9-1-1 usage by more than 86 percent.
Paramedicine models have also been launched in North Carolina, Colorado and Minnesota. Colorado’s successful Western Eagle County program in particular served as a model for the Abbeville team.
The three levels of training necessary to become a CP include a 15-week didactic college-level course, hands-on lab sessions and 100 hours of clinical rotations.
The overall goal of the course is to broaden understanding of the health care system and local community with a focus on how the CP’s role can best integrate into both.
Initial planning for Abbeville’s service began in 2012 when ACEMS received a training grant from the SC Office of Rural Health (SCORH). The motivations for SCORH were to increase access to health care and deal with the many challenges of an aging population.
“Community paramedics are well-positioned to have a demonstrative impact on the primary care services available to the safety net community in rural areas of our state,” said Melinda Merrell, director of quality & hospital programs for the SCORH. “This innovation in bolstering existing resources to fill gaps in access to care is an excellent example of how small and rural communities are putting the Triple Aim into practice.”
The program also recently secured a substantial two-year grant from the Duke Endowment. Project leaders will continue to seek additional sustainability funding.
ACEMS has formed relationships with numerous regional agencies to build and strengthen the program, including the Abbeville Family Medicine Associates (a Rural Health Clinic), Welvista, the Area Agency on Aging, United Christian Ministries and even the local Rotary club.
Porter envisions a compassionate and cost-saving system where ACEMS CPs have the opportunity to establish a strong regional network and teach at-risk residents how to take better care of themselves.
“We’re not trying to do it all…and we can’t be the best at everything,” he explained. “But what we can do is efficiently deliver helpful community resources to patients when they need them the most.”