BackgroundIn an innovative partnership between medical homes, specialists, emergency medicine physicians, and the Mobile Health Paramedics (MHP), a patient centered delivery model was created to provide the right care, in the right location, at the right time.

ResultsHeart Failure Outcomes90 day pre/post comparison of 531 Unique Patients enrolled in the MHP program revealed significant improvement.Total number of Hospital Encounters (ED Visits and Admissions) Reduced 51%Total Admissions Reduced 40% 442 Admissions SavedBed DaysReduced 56% 1,781 Bed Days Saved30 Day ReadmissionsReduced 71%

AimProvide coordinated, quality care in lower cost settings that is timely, effective and efficient.

Conclusions

This partnership provides patient-centered care with enhanced integration of care with and between providers, nursing, case management, home health and paramedicine. It also expands the reach of the providers into the community, while optimizing the skills of the paramedic profession.

Awards/Recognition

ActionsThe partnership integrates services in the care continuum. To achieve this, a flexible and nimble resource was created to meet a wide variety of patient needs including: assessment of the patient, education/support, diuresis, medication review and home safety checks.Ensuring high reliability of outcomes and service standards was paramount.Using our fully integrated EHR, the MHPs are able to receive orders in the field and document in the medical record in real time, and transmit 12 lead EKG's from the patient's home. This provides optimal information flow to the care team. The MHP program provides integration without duplication of existing programs and services.

Community Based Care: Mobile Health Paramedics David J. Schoenwetter, DO, FACEP1, Kathleen L. Sharp, MBOE, LBB2

Geisinger Wyoming Valley, Wilkes Barre, PA

20.69%

17.81%

20.69%

18.92%

2.78%

5.11%

4.00%

14.29%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

Discharge PLUS Heart Failure Medical Home Post Discharge Pilot

Readmission Rates

Pre 90 Post 90

925

150

533

242

775

454

121

171 162

333

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Total Encounters ED Only Visits ED Admits Admits Non-ED Total Admits

Heart Failure Results90 Day Pre-Post (531 Patients)

Pre 90 Days Post 90 Days

45

1781

73 88

0

200

400

600

800

1000

1200

1400

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Discharge PLUS Heart Failure Medical Home Post DischargePilot

Saved Bed Days

1,987Bed Days Saved!(541 Admissions)

Patient Satisfaction: (Response Rate 73%)

There's No Place Like Home: Paramedic Home Care for Cardiac Patients

“In a word –WONDERFUL!”

“I didn’t have to go to Emergency and wait an eternity.”

“This is a Godsend!”

1. Emergency Medicine, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA 2. Population Health Initiatives, Geisinger Wyoming Valley Medical Center, Wilkes Barre, PA 3. Hoste, B. (2015, August 18). [Geisinger Mobile Health Paramedic]. The Wall Street Journal.

Mobile Health Paramedics

Medical Home

Heart Failure Clinic

Home Diuresis

ProvenCare®

Discharge PLUS

3

3

3Medical Home SupportMHPs provide in home clinical care to community practice medical home patients as directed by the provider and case manager. MHPs provide physical assessments, medication reconciliation, IV hydration, IV diuresis, home safety checks and telephonic support.

Home DiuresisUnder a delegated practice model, the MHPs provide home diuresis to Heart Failure patients. The plan is developed with the Heart Failure Nurse Coordinator who apprises the cardiologist.

ProvenCare Heart Failure®

Follow-upGeisinger established evidence-based guidelines to reduce admissions and ED visits for Heart Failure patients. This was expanded to include training of the MHPs. The MHPs provide a series of patient phone calls on a designated schedule.

Heart Failure Clinic SupportMHPs provide diuresis in the clinic and follow up with patients in their home. Support is targeted to patients at risk of admission as result of exacerbations in their condition.

Discharge PLUSMHPs provide focused clinical follow-up to patients discharged from the ED to address a specific clinical need as identified by the emergency physician. These patients may or may not meet criteria for hospital admission. MHPs provide emergency physicians a conduit to insure that the patient will receive required outpatient management, allowing safe discharge from the ED.

45

1781

73 88

0

200

400

600

800

1000

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1400

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Discharge PLUS Heart Failure Medical Home Post DischargePilot

Saved Bed Days