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Abstract
Background Many patients with multiple chronic conditions have challenges in understanding, accessing and navigating the healthcare system, leading to frequent ED use, admissions and readmissions. We piloted a planned Community Paramedicine Visit Program (CPVP) to patients at risk for repeated ED visits or admissions, in an effort to reduce hospital utilization in a community safety-net hospital.
Objectives Reduce avoidable hospital use by identifying high-risk patients with patterns of high utilization and referring them to CPVP.
Methods This pilot was conducted in The Bronx, NY with a single EMS agency and a single safety-net hospital, focused on Medicaid patients as part of a NYS Medicaid waiver. Initial challenges of identifying and referring high-risk patients were addressed using PDSA ramps. Analysis looked at hospital use for each of the 43 unique patients referred into the CPVP and compared equal time periods pre- and post-referral for each patient. The analysis does not include patients who refused referral or accepted referral but refused enrollment into CPVP.
Results The cohort had 160 visits to the hospital (inclusive of emergency department visits, admissions and readmissions) in the 1 to 6 months prior to their referral. The same cohort of patients had only 65 hospital visits in the 1 to 6 months after their engagement in the CPVP; this represents a 59.4% reduction in hospital use and a 59.4% decrease in the average number of visits per patient.
Conclusions The Community Paramedicine Visit Program decreased hospital use by high-risk patients. Team-based QI efforts help engage more patients in this valuable program.