In January of 2015, the San Bernardino County Fire Department was chosen to conduct one of 13 pilot projects in California aimed at studying the value of community paramedicine.
Community paramedicine (CP) is an innovative model of care services that uses paramedics and emergency medical services (EMS) to treat local patients and meet their health care needs directly in their homes.
For this study, San Bernardino County Fire has partnered with Rialto Fire Department, San Bernardino County Department of Public Health, Arrowhead Regional Medical Center (ARMC), and the Inland Counties Emergency Medical Agency (ICEMA) to provide post-discharge follow-up visits to patients with congestive heart failure (CHF) in Fontana, Hesperia, and Victorville.
"Community paramedicine is the next innovation in healthcare," said Fire Chief Mark Hartwig. "The goal of this program is to augment the patient's current plan of care with resources currently established within the community which will provide the patient with the education and tools to maintain and improve wellness outside the hospital."
The pilot project's objective is to reach out to CHF patients within the first 48-72 hours of being released from ARMC and improve the quality of life for the patient by decreasing the rate of readmission to the hospital and reducing the need to access 911 for non-emergencies.
A statewide evaluation of the pilot project found that community paramedics identified 129 post-discharge patients (14 percent) who misunderstood how to take their medications or had duplicate medications and were at risk for adverse effects.
The evaluation also found that four of five post-discharge pilot projects achieve cost savings for payers, primarily Medicare and Medi-Cal due to reductions in inpatient readmissions within 30 days of discharge. Hospitals realized savings as well by lowering their risk of being penalized by Medicare for having excess readmissions.
The community paramedicine pilot projects also accumulated savings for parts of the health care system due to fewer ambulance transports, emergency department visits, and hospital readmissions.
Thus far the pilot project has shown that EMS and paramedics can facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations when they function outside their customary role as an emergency transportation service.
In preparation for this project, San Bernardino County Fire specially trained 17 firefighter paramedics in CHF patient assessment, medication reconciliation, laboratory evaluations, and home safety inspections.
State officials have extended the project through November of this year.
San Bernardino County Fire has enrolled 179 post-discharge patients since 2015 and expects to enroll up to 300 before the end of the project.
During a visit, the community paramedics perform a detailed physical assessment on the patient and ensure they are maintaining or improving their post-discharge status. They also will consult with the patient and/or caregiver to ensure the patient understands their condition, is eating properly, and knows how to take prescription medications. Visits also include a home safety check to reduce risk of accidental injury and to avoid potential emergencies.
San Bernardino County is home to one of the largest per capita populations of CHF patients in the U.S. Sufferers of this condition who are unable to properly have their disease managed depend on the emergency medical system (both 911 and emergency departments) to keep their condition in check; community paramedics help address the healthcare needs of this population.