Community Paramedic Pilot

1. COMMUNITY
PARAMEDIC PILOT
SAFER FIRE DISTRICT/WAUSAU FIRE
DEPARTMENT
JOSH FINKE-DEPUTY CHIEF-SAFER
KELLY BECHEL-EMS DIVISION CHIEF-SAFER
SCOTT HABECK-EMS DIVISION CHIEF WAUSAU FIRE DEPARTMENT

2. INTRODUCTION
• Initial discussions started in 2014, was very slow to develop
• Dr. Mark Mirick was the key player in pushing the program forward
• SAFER and Wausau Fire worked together to have a larger target audience
• Penalties for preventable readmissions could total 528 million, 108 million more
than last year1

3. TOP FOUR REASONS AFFECTING PREVENTABLE
ADMISSIONS
• Emergency department decision making
• Inability to keep appointments after discharge
• Premature discharge from hospital
• Patient lack of awareness of whom to contact after discharge
Source-Center for Medicare Advocacy

4. KEY PLAYERS
• Aspirus Wausau Hospital
• Discharge planning
• Home medical
• Fiscal
• Aspirus Health Foundation
• South Area Fire District (SAFER)
• Wausau Fire Department

5. COMMUNITIES INVOLVED
• City of Wausau
• Town of Rib Mountain, Village of Weston
• The City of Mosinee, City of Schofield, and Village of Rothschild were later added

6. DELAYS IN ROLLOUT
• Some delay to find funding
• Access to medical records
• The major delay was the development and use of LACE as a discharge tool

7. LACE
• There are multiple parts of the LACE scoring tool
• Length of stay
• Acuity of admission
• Comorbidities
• Emergency Department visits

8. DIFFICULTIES ENCOUNTERED
• Difficult to arrange appointments with some patients
• Initially communications between the field and the hospital were challenging
• Shortage of community care paramedics at times
• Aspirus had initial difficulty of promoting the program to their discharge planners

9. FUNDING
• Funding was provided by the Aspirus Health Foundation
• Approved to visit each patient up to 3 times
• Flat rate is payed per visit

10. TRAINING
• Each paramedic working as a Community Paramedic received specialized training
• 2 days of lecture provided by Dr. Mirick
• 3 days of clinical time
• All of the training was specifically focused on CHF, COPD and PN

11. MEDICAL CONDITIONS
• Congestive Heart Failure (CHF)
• Chronic Obstructive Pulmonary Disease (COPD)
• Pneumonia (PN)

12. PATIENTS INVOLVED
• 50 Patients were involved in phase 1 eligible patients met all of the following
• Diagnosis of CHF, COPD, PN
• Reside in the areas mentioned earlier
• Did not qualify for services such as VNA etc.
• Agreed to participate and singed informed consent

13. SERVICES PROVIDED
• Detailed Physical Exam
• Review discharge instructions, medications, activities of daily living and home
safety
• Coordination with the Primary Care Physician, and the Patient Centered Medical
Home nurses

14. STUDY DESIGN
• Initial visits were scheduled within 48-72 hours post discharge
• A total of 3 visits were allowed
• The paramedic determined if more than 1 visit was required
• Satisfaction surveys were sent to all pateints

15. OUTCOME GOALS
• Primary goal-Reduce 30 day readmission rate
• Secondary outcomes
• Increase patient satisfaction
• Decrease morbidity and mortality
• Decrease health care costs

16. FINDINGS-30 DAY READMISSION
Diagnosis National Benchmark Aspirus 2015 Study Group
CHF 22% 14% 25%
COPD 20% 19% 17%
PN 17% 12% 10%

17. FINDINGS-MORTALITY
Diagnosis National Benchmark Aspirus 2015 Study Group
CHF 10% 7% 0%
COPD 0%
PN 9% 7% 0%

18. FINDINGS-PATIENT SATISFACTION
Ranking Courtesy Quality of Care Professionalism
Overall
Satisfaction
Very Satisfied 90% 90% 85% 85%
Satisfied 10% 10% 15% 15%

19. COMMON FINDINGS BY PARAMEDICS
• Clarified mediations with patients
• Enforced importance of follow up appointments
• Obtained walkers for fall prevention through health equipment lending program
• Identified and corrected hazards during home safety checks
• Replaced numerous smoke and CO detectors
• Assisted with obtaining basic medical supplies

20. PHASE 2
• Phase 2 of the program is currently in progress
• We are now accepting patients with any diagnosis that can benefit from our
program
• We can also visit as many times as needed in a 30 day period

21. SUMMARY
• There are clear benefits of the program
• Decreased readmission rates
• Decreased health care costs
• Increased patient satisfaction
• The amount and type of training can differ greatly depending on what services
you want to provide
• Customize to meet the needs of your community