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Community Paramedic Pilot

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Community Paramedic Pilot

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Community Paramedic Pilot

  1. 1. COMMUNITY PARAMEDIC PILOT SAFER FIRE DISTRICT/WAUSAU FIRE DEPARTMENT JOSH FINKE-DEPUTY CHIEF-SAFER KELLY BECHEL-EMS DIVISION CHIEF-SAFER SCOTT HABECK-EMS DIVISION CHIEF WAUSAU FIRE DEPARTMENT
  2. 2. INTRODUCTION • Initial discussions started in 2014, was very slow to develop • Dr. Mark Mirick was the key player in pushing the program forward • SAFER and Wausau Fire worked together to have a larger target audience • Penalties for preventable readmissions could total 528 million, 108 million more than last year1
  3. 3. TOP FOUR REASONS AFFECTING PREVENTABLE ADMISSIONS • Emergency department decision making • Inability to keep appointments after discharge • Premature discharge from hospital • Patient lack of awareness of whom to contact after discharge Source-Center for Medicare Advocacy
  4. 4. KEY PLAYERS • Aspirus Wausau Hospital • Discharge planning • Home medical • Fiscal • Aspirus Health Foundation • South Area Fire District (SAFER) • Wausau Fire Department
  5. 5. COMMUNITIES INVOLVED • City of Wausau • Town of Rib Mountain, Village of Weston • The City of Mosinee, City of Schofield, and Village of Rothschild were later added
  6. 6. DELAYS IN ROLLOUT • Some delay to find funding • Access to medical records • The major delay was the development and use of LACE as a discharge tool
  7. 7. LACE • There are multiple parts of the LACE scoring tool • Length of stay • Acuity of admission • Comorbidities • Emergency Department visits
  8. 8. DIFFICULTIES ENCOUNTERED • Difficult to arrange appointments with some patients • Initially communications between the field and the hospital were challenging • Shortage of community care paramedics at times • Aspirus had initial difficulty of promoting the program to their discharge planners
  9. 9. FUNDING • Funding was provided by the Aspirus Health Foundation • Approved to visit each patient up to 3 times • Flat rate is payed per visit
  10. 10. TRAINING • Each paramedic working as a Community Paramedic received specialized training • 2 days of lecture provided by Dr. Mirick • 3 days of clinical time • All of the training was specifically focused on CHF, COPD and PN
  11. 11. MEDICAL CONDITIONS • Congestive Heart Failure (CHF) • Chronic Obstructive Pulmonary Disease (COPD) • Pneumonia (PN)
  12. 12. PATIENTS INVOLVED • 50 Patients were involved in phase 1 eligible patients met all of the following • Diagnosis of CHF, COPD, PN • Reside in the areas mentioned earlier • Did not qualify for services such as VNA etc. • Agreed to participate and singed informed consent
  13. 13. SERVICES PROVIDED • Detailed Physical Exam • Review discharge instructions, medications, activities of daily living and home safety • Coordination with the Primary Care Physician, and the Patient Centered Medical Home nurses
  14. 14. STUDY DESIGN • Initial visits were scheduled within 48-72 hours post discharge • A total of 3 visits were allowed • The paramedic determined if more than 1 visit was required • Satisfaction surveys were sent to all pateints
  15. 15. OUTCOME GOALS • Primary goal-Reduce 30 day readmission rate • Secondary outcomes • Increase patient satisfaction • Decrease morbidity and mortality • Decrease health care costs
  16. 16. FINDINGS-30 DAY READMISSION Diagnosis National Benchmark Aspirus 2015 Study Group CHF 22% 14% 25% COPD 20% 19% 17% PN 17% 12% 10%
  17. 17. FINDINGS-MORTALITY Diagnosis National Benchmark Aspirus 2015 Study Group CHF 10% 7% 0% COPD 0% PN 9% 7% 0%
  18. 18. FINDINGS-PATIENT SATISFACTION Ranking Courtesy Quality of Care Professionalism Overall Satisfaction Very Satisfied 90% 90% 85% 85% Satisfied 10% 10% 15% 15%
  19. 19. COMMON FINDINGS BY PARAMEDICS • Clarified mediations with patients • Enforced importance of follow up appointments • Obtained walkers for fall prevention through health equipment lending program • Identified and corrected hazards during home safety checks • Replaced numerous smoke and CO detectors • Assisted with obtaining basic medical supplies
  20. 20. PHASE 2 • Phase 2 of the program is currently in progress • We are now accepting patients with any diagnosis that can benefit from our program • We can also visit as many times as needed in a 30 day period
  21. 21. SUMMARY • There are clear benefits of the program • Decreased readmission rates • Decreased health care costs • Increased patient satisfaction • The amount and type of training can differ greatly depending on what services you want to provide • Customize to meet the needs of your community

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