Arizona Fire District Tests Community Paramedicine Program

Golder Ranch Fire District tests new program to reduce emergency calls


 
 

KIMBERLY MATAS, Arizona Daily Star | | Tuesday, September 2, 2014


A northwest-side fire department is testing a new program that seeks to lessen the number of emergency medical calls by providing some patients with in-home visits from specially trained paramedics.

The goal of the Golder Ranch Fire District "paramedicine" program is to cut costs for hospital emergency rooms while providing added services to residents in its coverage area.

Golder Ranch Fire District includes the communities of Oro Valley, Catalina, SaddleBrooke and southern Pinal County. The district is one of several departments in Southern Arizona offering such a program.

In January, the Rio Rico Fire District was the first in the state to start a community integrated paramedic program, Chief Les Caid said.

Over the last 15 years, fire departments worldwide have been gradually adding paramedicine programs, he said.

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Though each Southern Arizona program is slightly different, they all encourage in-home visits by paramedics who consult with patients in an attempt to reduce the frequency of emergency room visits.

Caid is organizing a study of multiple fire departments in Southern Arizona to gather statistics to evaluate the success rate of community-integrated paramedics.

"If the hospitals are seeing a drop in rates of readmissions, ... some sort of compensation can be considered, but first we have to prove, through this study, that it improves health, improves patient outcomes and reduces patient readmissions," Caid said.

Currently, Rio Rico and Golder Ranch are paying for the services, which are free to patients. "There are some studies that show even a phone call after a hospital visit decreases hospital readmissions," Caid said.

Golder Ranch is in the second month of a three-month trial of its Community Integrated Healthcare Program in partnership with Oro Valley Hospital and its medical group, Northwest Allied Physicians.

The fire district is paying for the program during the pilot period in the hope that the cost savings to the hospital will be significant enough that it will fund the program going forward, said Dr. Joyce Honorof, medical director of Northwest Allied Physicians.

Medicare now fines hospitals when patients with certain medical conditions are readmitted within 30 days.

"We figured we could do a pilot program with our group and Oro Valley Hospital, ... run it for a few months and see if it made any difference in the better transition of care, reduction of hospital readmissions and enhanced community service," Honorof said. "Our goal as a hospital is if they show us they save us money on penalties, it might be something we might fund in the future."

The concept of community paramedicine was appealing to Golder Ranch because 94 percent of the district's calls are medical in nature, Battalion Chief Josh Hurguy said.

"The medical industry in the United States is changing. Everything about health care in the United States is changing. We need to be part of that change, because many times we see the patients for the first time," said Golder Ranch Fire Chief Randy Karrer.

During the Golder Ranch pilot program, patients about to be discharged from Oro Valley Hospital with any of five conditions -- congestive heart failure, heart attack, pneumonia, diabetes or chronic obstructive pulmonary disease (COPD) -- are given the option to participate for free, Hurguy said.

"Almost 25 percent of our patients have a history or symptoms related to diabetes, congestive heart failure and COPD, and 15 percent of those were back (in the ER) within 30 days. That was a significant chunk of our patients," Hurguy said.

When Fire District officials approached Northwest Allied Physicians about the paramedicine program, doctors asked them to include patients who had suffered heart attacks or had pneumonia.

Once in the program, participants receive at least six house calls in 30 days from specially trained paramedics who conduct a patient assessment that includes: checking vital signs; performing an electrocardiogram test to check for heart problems; measuring the amount of oxygen in the patient's blood; testing lung capacity in patients with breathing difficulties; checking blood-sugar levels; and evaluating the patient's home for potential hazards.

The paramedics also make sure each patient understands the hospital discharge instructions, takes prescribed medication and makes follow-up appointments with their doctors.

Seven patients have so far been enrolled in the Golder Ranch program, and four paramedics have received specialized training. At the current staffing level, Hurguy estimates the district can care for up to 60 patients a month in its paramedicine program.

Paul Lockwood, 70, learned about the Golder Ranch Community Integrated Healthcare Program when he was discharged from the hospital after suffering a bout of pneumonia. Lockwood has COPD.

A paramedic, Capt. Michael Lamanda, brought a copy of Lockwood's hospital discharge papers to their first appointment and went over the instructions with Lockwood and his wife before giving Lockwood a thorough examination.

"I hadn't had a physical that good since I went into the service," Lockwood said. "They are more thorough in their questioning than even my wife has been. We only have to tell them what we want to tell them, but the more open and honest we are with them, the better they will be able to help you."

After several appointments with Lamanda, Lockwood said: "I'm maintaining what I am supposed to maintain. My levels are good. I'm actually doing the medication correctly and not being hardheaded about this."

Lamanda said seeing a patient over the course of a month -- instead of for a few minutes during a rush to the ER -- gives him a better overall picture of their health and allows him to assess whether a visit to the ER or a doctor's office is necessary.

"We monitor, and when there's something we see that's out of the ordinary, we call the physician," Lamanda said.

Hurguy anticipates the next stage in the Golder Ranch program is developing the capability to video-

conference with the patient's doctor in real time during home visits.

"We're still in the pilot phase, but I can't imagine we wouldn't keep this program," said Anne-Marie Braswell, spokeswoman for the Fire District. "The program is in its infancy, but the demand for it is so great. This is not something that's going to go away. It's something that's only going to grow."

Paramedicine by the numbers

Golder Ranch Fire District has started a Community Integrated Healthcare Program that offers recently discharged hospital patients with specific ailments the chance to receive in-home visits from specially trained paramedics. The goal is to improve a patient's health while reducing ER visits.

$1,200 -- Average charge for emergency transport to a hospital.

$750 -- Initial emergency room visit.

94 -- Percentage of Golder Ranch Fire calls that are medical in nature.

25 -- Percentage of Golder Ranch patients with a history or symptoms of diabetes, congestive heart failure or COPD.

15 -- Percentage of Golder Ranch patients transported to the ER who required a return visit within 30 days.

SOURCE: Golder Ranch Fire District

Community Integrated Healthcare Program

Golder Ranch Fire District has started a Community Integrated Healthcare Program that offers recently discharged hospital patients with specific ailments the chance to receive in-home visits from specially trained paramedics. The goal is to improve a patient's health while reducing ER visits.

During the pilot program, patients about to be discharged from Oro Valley Hospital with any of five conditions -- congestive heart failure, heart attack, pneumonia, diabetes or chronic obstructive pulmonary disease (COPD) -- are given the option to participate for free.
August 31, 2014
 

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