When a person dials 9-1-1 for a medical emergency, in most cases paramedics are the first to respond on scene, regardless of the nature of the emergency. At the same time, studies have shown that up to 27 percent of patients transported to the emergency department could have been treated safely in another setting, including their homes.
Paramedics are trained to assess and assist with acute and non-acute conditions including treatment of injuries, administering medications, performing CPR and resuscitation and providing many other forms of basic, yet critical treatments. Under the community paramedicine programs, paramedics are involved in a patient’s health care in a more customized role inside the home. In most states, the standard scope of practice for paramedics will allow them to deliver non-emergency care on the spot, potentially reducing the possibility of acceleration of the patient’s ailment and preventing costly emergency department visits. Paramedics are empowered with technologies that can help assess patient requirements and give the care team the information necessary to make an informed decision about the patient’s needs. If they determine that additional medical assistance is necessary, the community paramedics can quickly get the patient to the appropriate level of care.
Community paramedicine at work
While implementation of community paramedicine programs is still in early stages, several promising success stories already exist. Among them is New Hanover Regional Medical Center, a 769-bed teaching hospital in Wilmington, North Carolina, which recently implemented a community paramedicine program that’s enabling paramedics to not only respond to emergencies, but also help prevent them.
By developing relationships with high-risk patients, paramedics can monitor patients on an ongoing basis and provide quality care at their homes. They can also help ensure that patients are adhering to their treatment plans, taking medications correctly, sticking to prescribed diets, and getting the appropriate amount of exercise. During a six month pilot program focused on reducing the readmission rates of congestive heart failure patients, NHRMC Community Paramedics worked with a group of more than 70 patients and achieved a 9 percent readmission rate, compared to a national average of 22.6 percent.
But developing a successful program did not happen overnight for New Hanover. Here are some critical factors involved in implementing a successful program:
• Identify the right patients – Hospitals need to first determine which patients could most benefit the most from a community paramedicine program. In most cases, hospitals are able to identify the high-frequency users of their emergency departments. Many of the patients in New Hanover’s program have multiple chronic diseases that require detailed treatment plans, and were identified by analyzing hospital records. These patients have shown to benefit the most from community paramedicine programs, which not only provide affordable care options at home, but also help patients adhere to their treatment plans.
• Put the right team in place – Hospitals should carefully select the paramedics who will be a part of this program. Ideal paramedics are part of their local community and are attuned to the physical, sociological and psychological needs of patients. These factors can help patients develop a level of comfort with the paramedics, which is a key component of the program’s success.
• Provide customized training – Once paramedics have been selected for the program, they should undergo comprehensive education that includes the many diverse needs that a community paramedic may become involved with. This education should capture nutrition, mental health, cardiovascular medicine, end of life care, case management, reimbursement payer models and rehabilitation. Hospitals could also consider creating programs for selected paramedics to shadow other caregivers, like home health aides and nurses working within the hospital, so that they can be better prepared for the program. Since the program requires paramedics to execute patient care, it is also important for paramedics to develop relationships with social services employees, pharmacists and other care services.
• Engage and educate patients – Patient buy-in is also a critical component for success of the program. Paramedics need to tailor their patient engagement programs specifically to the patient. These programs need to take into account not just their medical condition, but also the underlying reasons for their lack of engagement. For example, some patients may not have the knowledge base for self-care, or lack the motivation or confidence to do so. By using a combination of technology, social and educational programs and personal attention, paramedics can help encourage patients to be involved and engaged in their own health and wellness.
With the rising number of chronically ill patients requiring ongoing monitoring, and the changing nature of patients engaging in their own care, health care systems must embrace new models of care delivery to proactively manage care and improve operational efficiencies. Within the next year or two, we hope to see regulatory changes that facilitate faster implementation of newer models of care delivery – such as community paramedicine and ambulatory telehealth programs – that aim to successfully engage patients in their own care, outside hospital walls.
C. Anthony Jones, MD is the Vice President and Chief Marketing Officer at Philips Healthcare’s Patient Care and Monitoring Solutions Business Group. Dr. Jones oversees all strategic and field marketing activities, pricing, messaging, partnerships and alliances. Prior to joining Philips, Dr. Jones was the President and CEO of Next Lifesciences, a marketing strategy firm catering to healthcare and life sciences companies. Dr. Jones’ experience in healthcare information is grounded in an academic background that includes a degree in medicine from the Johns Hopkins University School of Medicine and a postdoctoral fellowship in medical informatics at Columbia University. He graduated Phi Beta Kappa from the University of Kentucky where he received his bachelor’s degree in chemistry.
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