Medic Ambulance Reduced Readmissions Project Awarded a 2016 AMBY for Best Community Impact Program

Medic Ambulance | California

Medic Ambulance Service is the exclusive ALS service provider in Solano County, a HRSA-designated medically underserved area with a physician-provider to population ratio of 81.1 per 100,000. In 2014 Medic Ambulance became aware of an opportunity to participate in a Community Paramedicine Pilot initiated through California Ste EMSA. After collaborating with LEMSA and the community hospitals, Medic Ambulance unanimously concluded that the 23% average readmission rates for each CHF and COPD patients was taking a crippling toll on the hospitals’ reimbursement and increasing Emergency Department wait times. Starting in January of 2015, Medic Ambulance Service enrolled six paramedics into approximately 300 hours of additional training focused on the biopsychosocial needs of patients with CHF or COPD. The education has continued through monthly case reviews and peer-to-peer lessons-learned where the entire team brainstorms innovative solutions to the patients’ challenges. From the beginning, Medic Ambulance Service was poised on creating a sustainable model that would persevere past the period of being a pilot or grant funding. They made this goal of preservation well-known to all stakeholders, and after quickly proving the value through low readmission rates they had established a sustainable funding source, happy to pay for Community Paramedicine Services.

Project Goals

1. Reduce the readmission rates of patients with CHF or COPD.
2. To create a sustainably funded model to ensure the project remains available to our community and is replicable in other areas.
3. Provide superior customer service.
4. Teach patients how to improve their health by appealing to the patient’s values.
5. To provide these services at a lower cost than was otherwise available.

Project Phases

• Planning Phase: The project was planned based upon the results of the community needs assessment. The findings indicated that there is a substantial difficulty within the community to access restorative medical aid. Each Community Paramedic underwent over 300 hours of focused training on the management of CHF and COPD, cultural sensitivity, and rehabilitative services.
• Implementation Phase: To ensure compliance with the strictest regard for patient outcomes and program oversight Medic’s Community Paramedicine Program is IRB approved, reports at least monthly to a Steering Committee with diverse medical and nonmedical expertise, 100% charting review by a Registered Nurse, and utilization of, EMS Survey Team, a third-party patient surveyor. These highly trained Community Paramedics began seeing patients in September of 2015 and the most common question we are asked by the local hospitals is when can we help them lower their readmission rates for patients that don’t have CHF or COPD. With a sustainable and reproducible model we intend to keep filling healthcare gaps and mold healthcare delivery to suit the needs of every community we serve!

Our goals with this project are built upon the IHI Triple AIM to improve the patient experience of care, improve the health of populations, and reduce the per capita cost of health care. We are absolutely meeting these foundational goals!

• 85 patients have been referred to the program (59 enrolled)
• 118 visits have been completed

Medic Ambulance measures and objectives reveal that the enrolled population has only a 8.5% unplanned readmission rate; as opposed to a 23% rate of those not enrolled. During home visits it was discovered that:

• 50.8% of patients had medication errors
• 48.7% of the patients that thought they were taking all their medications correctly weren’t
• 72.9% of patients needed help understanding their discharge instructions.

These enrolled patients also self identify an average overall health rating improvement of 22.8% between their pre-enrollment and post -enrollment health. During this same interval the patients’ understanding of their hospital discharge instructions has risen by 16.8%, understanding of when to take medications improved 8.3%, and understanding of their medication side effects improved by 14.1%.

EMS Survey Team, a third party patient surveyor, attempts phone contact with all enrolled patients. These scores are recorded and measured against the 128 different EMS services they contract with. This program is the #1 rated provider with a total score of 96.48/100 and 100% of all responses have been positive.

Patient Feedback

“It’s been a very good experience. She (the Community Paramedic) explained everything so I could understand.” – Patient

“There’s a lot of people out there who need this, especially those without insurance.” – Patient

“My blood pressure started going up and it wouldn’t come down. I had medication but it wasn’t helping.” – Patient who was not taking her medication at the correct frequency.

“She (a patient) feels more comfortable.” – Patient’s daughter “This is a pilot program but everyone so far is very pleased with how it is working.” – Director of case management at a referring hospital. “If I get sick I know they’re gonna be there for me and that I’m not alone.” – Patient

As a third generational, family-owned EMS provider, nothing is more important to us than the community we serve as the exclusive ALS provider. The creation of this program wasn’t created as merely a proof of concept, we continue to grow and adapt this program to meet the needs of the populations through changing the landscape of health care. The impact of this program’s success has been marked with already saving the health care system $137,000 with a projected savings of $685,000 by the end of 2017, improved health literacy in vulnerable populations, reducing overuse on the 9-1-1 and Emergency Department systems, and catalyzing positive health changes through empowerment. It is projected that over 25% of the patients enrolled into this program have a functional health literacy defined as “below basic”, the lowest possible category per the National Assessment of Adult Literacy, compared to 14% of American adults that fall into this category. At this level of health literacy the dates of appointments and clearly defined times to take medications are often understood, but the understanding of how negative lifestyle choices, such as smoking, poor diet, and recreational drug use affect their management of diseases is not universally comprehended.

Congratulations to Medic Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.