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RESPONSIVE. RELIABLE. RESPECTED.Case Study: Mobile Integrated
Healthcare Program Reduces 30-Day
Readmission Rate
MOBILE INTEGRATED HEALTHCARE PROGRAM REDUCES 30-DAY READMISSION RATESt. Louis, Missouri
THE CHALLENGE
Hospitals face growing scrutiny from payers and governmental
oversight bodies regarding hospital readmission rates for key
diagnoses. These diagnoses, including pneumonia, chronic
obstructive pulmonary disease (COPD), congestive heart failure
(CHF) and acute myocardial infarction (MI), are particularly
common in elderly patients.
Barnes-Jewish Hospital at Washington University Medical Center
in St. Louis, Missouri cited readmission rates (and the resulting
Centers for Medicare & Medicaid Services fines) as one of its
biggest concerns when administrators met with AMR subsidiary
Abbott EMS St. Louis in late 2012.
THE SOLUTION
David Tan, MD, medical director for Abbott EMS, knew exactly
how his organization could help. “Patients needed something that
traditional health care agencies, facilities or providers couldn’t
address, but we believed that our paramedics could,” he said. “We
knew that we could play a vital role in assisting local hospitals
with focused patient populations deemed at risk for hospital
readmission but who refuse home health or don’t qualify for
home health visits.”
The Abbott EMS Mobile Integrated Healthcare program
provides personalized and goal-directed care for patients who
are discharged from the hospital with pneumonia, COPD, CHF
or acute MI. The Abbott EMS team works with hospital case
management to identify patient needs for disease education,
outpatient clinic visits and transport planning. They also strive
to help patients better understand and manage their chronic
conditions to lessen their chances of acute exacerbations leading
to readmission within 30 days.
Care is provided by six Abbott EMS advanced practice
paramedics (APPs) with outstanding customer relations records,
as well as proven clinical and communication skills.
The six APPs participated in a 60-hour training program designed
by Dr. Tan, program medical director. Sixteen to 20 hours of
training occured in the classroom, while the remainder was spent
in an urgent care clinic with a physician.
“The clinical portion of the training helps the paramedics wrap
their arms around the fact that the goal is to help the patient
stay healthy in their own home rather than transport them to
the hospital,” said Dr. Tan. “They establish a relationship with the
patient, evaluate them for stability and go through the various
decision-making processes that a physician uses to decide
exactly how sick a patient is and what next steps to take.”
Dr. Tan works directly with a Barnes-Jewish Stay Healthy
Outpatient Program (SHOP) social worker who leads the patient
screening process and assists with operational quality assurance
and quality improvement. He also provides direct feedback to Dr.
Tan. Protocol checklists and patient feedback go directly to SHOP
and into the patient’s chart.
There are currently 25 patients either enrolled or who have
completed the 30-day program, with an ultimate goal of 100.
The APPs visit the patient’s home regularly. Depending on the
patient’s diagnosis, the APP can weigh them, provide breathing
treatments, run a 12 lead EKG and/or call their physician to
discuss the next treatment steps.
Day one through 14 include close follow-up and face-to-face
interaction between paramedic and patient, while days 15 through
30 consist mostly of phone calls or as-needed contact. “Patients
are at their highest readmission risk in the first 14 days after
they’re discharged, so if we can get them through that time
period, their chances of making it to day 30 are much higher,”
said Dr. Tan.
If the paramedic notices a symptom of concern, he calls the
Stay Healthy Clinic at Barnes-Jewish and speaks with a nurse
practitioner or physician to discuss a management strategy. “The
paramedic might say, ‘I’m with this patient, here’s what she was
diagnosed with, her discharge date, and how she’s feeling today.
Do you think this warrants a trip to the emergency department?
Or I can bring her to you in the clinic or should I give her a
treatment and check in on her tomorrow?’” said Dr. Tan. “It all
depends on what the paramedic sees or hears when he talks to
the patient.”
THE RESULTS
Though the new Mobile Integrated Healthcare program is still
gaining traction, early indicators point to great success. “Our
patient exit questionnaires are overwhelmingly positive, and the
patients are saying they’ve never received such attention before,”
said Dr. Tan.
The day one patient protocol is two to three hours long, during
which time the paramedic becomes much like the patient’s
personal health coach. “Hospitals don’t have that kind of time
to spend when they discharge patients,” said Dr. Tan. “These
paramedics ensure that when they’re done working with them,
the patients are able to tell them not only what medicines they’re
taking but why and when they should be taking them.
“Many patients comment that for the first time in their lives with
their disease, they understand the disease process, and why
it’s important to take their medicines, weigh themselves and
follow up with their doctors,” Dr. Tan continues. “These patients
love their medics and the attention, and they’re extremely
appreciative.”
The APPs love the program as much as the patients. Dr. Tan was
concerned at first that low-key home health visits might not be
exciting enough for the typically action-driven paramedics.
“They’ve achieved a tremendous sense of accomplishment and
personal satisfaction seeing their patients improve over time, and
it’s a great feeling to know that they had a hand in educating
these patients on their disease process,” said Dr. Tan. “They just
truly care so much about these patients that they want to help
however they can.”
That help extends beyond patient education to perhaps even
saving lives. During a recent meeting Dr. Tan asked the six APPs
to raise their hand if they had experienced even one patient
encounter that didn’t involve some type of medication error. “No
one raised their hand,” he said. “One paramedic discovered a
patient who was taking Metoprolol (typically used to treat high
blood pressure) instead of the Metformin he needed for
his diabetes.”
The paramedics have found unique methods to help patients
stick to their correct medication regimen, including color-
coding the lids with markers. “They’ve found serious errors and
oversights, and by simply helping patients understand what the
drug is, why they take it and when to take it, compliance is much
better,” said Dr. Tan.
Of the 25 patients enrolled in the program, 80 percent remained
out of the hospital during the first 30 days after discharge.
Barnes-Jewish Hospital has responded positively to the program
as well. Nurses consistently relay to program employees how
much patients love the interaction and their visits.
“On his 30th day when he was exiting the program, one patient
even asked if we would still come visit him,” said Dr. Tan. “We’re
looking forward to enrolling more patients in the program and
making a positive difference in their lives.”
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AMR is an Envision Healthcare company.
201411 - 2113 © 12/2014 American Medical Response — All rights reserved.