Making A Difference In The Community: Community CaraMedic Program

Posted on Dec 29, 2015

Mission Health has recently been ranked No. 2 in lowest readmissions by a medium-sized hospital according to Modern Healthcare. If efforts toward lowering readmissions are successful, as early indicators show they will be, we hope to lower our rate even more.

One of the newest such efforts is the Mission Community CaraMedic Program, with services provided by Mission Health Partners. Community paramedicine is a new and evolving model of community-based healthcare in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations. The Mission Community CaraMedic Program provides in-home visits by specially trained paramedics to support patients in managing their health at home — helping assure the right access to the right level of care at the right time, facilitating the patient’s best care and peace of mind, ultimately assisting them to be well, get well and stay well.

Mission has been piloting this program since August in support of our Affordable Care Organization (ACO), Mission Health Partners’ (MHP) patient population, which includes nearly 60,000 enrolled patients. All indications are that this program will make a significant impact on lowering the readmission rate, and perhaps more importantly, changing the lives of some of our most vulnerable patients.

There are already several success stories of the pilot program.  For example, on the initial visit by a community Caramedic to a 73-year-old female’s residence, the community Caramedic finds the patient lives in a 10-by-14-foot camper trailer.  This patient has a history of using the ER frequently for exacerbations of chronic obstructive pulmonary disease (COPD).  The community Caramedic finds the patient lives with 3 dogs and 3 cats that are on leashes and unable to fully get out of the house.  The metal fold-out camper stairs are slick and bent down from years of use. There are no handrails near the stairs.

Upon entrance to the camper, the community Caramedic reports it is obvious that the patient heavily smokes inside.  Multiple oxygen lines and extension cords crisscross the floor.  The floor is littered with animal feces, animal food and multiple types of insects.  Patient’s kitchen is cluttered with dirty dishes and piles of trash bags.  The patient is nice, but the community Caramedic reports it is obvious she has not showered in a few days.  Per her care manager, patient needs education with all of her medication uses, her diabetes care and her COPD regime.  Patient has many questions about her medications.  Patient is able to show the ability to take her blood sugar reading with a glucometer but does not properly clean her finger and uses a stylet that she has already used.

Patient is gently coached on proper cleaning before taking her reading.  She is also reminded to not reuse her stylet.  Patient states she does this because they are so expensive.  Patient is asked to reduce the tripping hazards by raising her oxygen lines and placing her extension cords behind furniture and out of her walking path.  The patient tells the community Caramedic she has no way to check her blood pressure, so she is given an automatic blood pressure cuff from the Mission Health Partners supply and educated on how to properly use the machine.   Patient tells the community Caramedic she would like to have more visits from a community Caramedic and states she will document her vitals in a notebook for review on the second visit.

The community Caramedic returns a few weeks later and finds the patient has made huge strides in cleanliness.  Patient has showered and has on cleaner clothing.  Though there is still animal litter on the floor, and the home is less cluttered.  The patient has raised the oxygen lines off the floor and removed the extension cords from the walkway.  Also the stairs to the entry of the home have been reinforced and leveled.

Patient shows the community Caramedic her logs of blood sugar, blood pressure and heart rate.  She had logged her vitals for the past 18 days, showing a great sample of daily data, which would be valuable to her primary care physician.  She also demonstrated she is able to take her own blood pressure.  With the help of her care manager, patient has been able to find a glucometer that has strips and stylets that are more affordable.  The community Caramedic states that the patient is in much better spirits, telling him that having a visitor other than her family is something she looks forward to.

Three months later, the patient has been seen in the ER only once for exacerbation of COPD.  She was hospitalized for 3 days for pneumonia and was released.  She has been logging her vitals almost every day since the she was given the automatic blood pressure cuff.  Patient shows competency with taking her blood sugar and tells the community Caramedic she now understands her medications and that she feels well.  Though her home is still cluttered, she is able to maintain her own cleanliness.  Patient is currently looking into other housing options.  Patient tells the community Caramedic that she feels much more in control of her medical issues, that she is appreciative of her new grasp on life, and that she attributes her successes to her care managers and the Mission Community CaraMedic Program.

As author and motivational speaker, Leo Buscaglia (deceased), had said, “Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment or the smallest act of caring, all of which have the potential to turn a life around.”  The Mission Community CaraMedic Program is evidence of that.

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