The document summarizes a community paramedic pilot program between the South Area Fire District and Wausau Fire Department. The program aimed to reduce preventable hospital readmissions through home visits by paramedics within 48-72 hours of discharge. Initial results found lower than national readmission rates for heart failure, COPD and pneumonia patients, as well as high patient satisfaction ratings. The program demonstrated the potential for community paramedics to improve outcomes and lower healthcare costs through post-discharge support in the home.

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. 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. 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. KEY PLAYERS
• Aspirus Wausau Hospital
• Discharge planning
• Home medical
• Fiscal
• Aspirus Health Foundation
• South Area Fire District (SAFER)
• Wausau Fire Department

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. 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. LACE
• There are multiple parts of the LACE scoring tool
• Length of stay
• Acuity of admission
• Comorbidities
• Emergency Department visits

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. 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. 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. MEDICAL CONDITIONS
• Congestive Heart Failure (CHF)
• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia (PN)

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. 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. 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. OUTCOME GOALS
• Primary goal-Reduce 30 day readmission rate
• Secondary outcomes
• Increase patient satisfaction
• Decrease morbidity and mortality
• Decrease health care costs

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. FINDINGS-MORTALITY
Diagnosis National Benchmark Aspirus 2015 Study Group
CHF 10% 7% 0%
COPD 0%
PN 9% 7% 0%

18. FINDINGS-PATIENT SATISFACTION
Ranking Courtesy Quality of Care Professionalism
Overall
Satisfaction
Very Satisfied 90% 90% 85% 85%
Satisfied 10% 10% 15% 15%

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. 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. 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