Administration and Leadership, Mobile Integrated Healthcare

How MedStar’s Mobile Integrated Healthcare Program Restored Patient’s Hope

Issue 7 and Volume 39.

Mobile integrated healthcare (MIH)—sometimes referred to as community paramedicine—programs have demonstrated improvements in patient outcomes and reduced costs of care with their ability to educate patients and connect them to resources that help them better manage their healthcare. But one voice that you may not have heard from is that of the patient.

Antoine Hall is a patient who graduated from MedStar’s MIH program in 49 days. Antoine lives in the Fort Worth, Texas, MedStar service area and was referred to the program by a caring case manager at one of the local hospitals. He suffers from gastroparesis as a result of his diabetes. For the 90 days prior to enrollment into MedStar’s MIH program, Antoine had eight ED visits from eight 9-1-1 ambulance responses. Of the ED visits, two resulted in an inpatient admission. During Antoine’s 31-day MIH enrollment, his ambulance utilization reduced to three, and his visits to the ED reduced to four. Since graduating from the MIH program, and as of March 31, Antoine hasn’t called 9-1-1, hasn’t visited the ED and hasn’t been admitted to any hospital.

In addition to the dramatic improvement in his overall health, the change in Antoine’s health status has saved the healthcare system nearly $123,000 in charges, returned over 72 bed hours to local EDs and freed up an additional 11 unit hours to the Fort Worth EMS system. (See Table 1.) Imagine the impact these programs can have to 10 similar types of patients—what about 100, or 1,000?

Antoine’s story helps demonstrate the true benefit of MIH. He wanted to share his experience, so we sat down and I let him tell his story.

MedStar: Tell us about your life before this program.
Antoine: Before I became sick, my life was a very active and spiritual one. I worked out daily, and worked a full-time job. I attended church and bible studies on a regular basis, played the guitar, played with my children every day, laughed and lived life to the fullest. After becoming sick, life took a huge slam on the brakes. The disease left me disabled, beginning in my late 20s. First to go was my athletic ability, my muscle mass, and then weight. Losing the ability to live an active life pushed me into depression. At the beginning, I became bedridden because of my symptoms and was unmotivated to even test my blood sugar or take my insulin, let alone attempt to force food down my throat.

Now, I can say that my prayer life grew with acceleration, because things had gotten to a point where that was all I could do; but after losing my job and being mentally tortured with the thought that I couldn’t support my family, my social life collapsed. I stopped going to church and stopped visiting my family. I cut off communication with the outside world. It was at this state that the most important part of my life collapsed: my spirituality. When I gave up in spirit, all else followed suit. My visits to the hospital went from monthly to bi-weekly, then to weekly and to daily. The hospital visits began to become extended—two days, three days, one week, a week and a half and so on. I had accepted and prepared for death. I had to hold my tears back every time I was stuck in bed and laid eyes on my daughters, especially when their tiny, gentle voices would ask me if I was alright. I would lie and tell them I was. Little did I know that hearing that I’ll be alright and telling myself I’m alright has became part of my arsenal in overcoming this sickness.

Antoine Hall hasn't visited the ED and hasn't been admitted to any hospital since graduating from MedStar's mobile integrated healthcare program.

Antoine Hall hasn’t visited the ED and hasn’t been admitted to any hospital since graduating from MedStar’s mobile integrated healthcare program.

What About this program was most helpful for you?
Education and application. One biblical verse that comes to mind is: “Faith without works is dead.” In this case, education played the role of faith, because you need to know what you believe in and why you believe it, and application plays the role of work. Ignorance is not bliss—it nearly cost me my life. Being educated, especially by John and Marisa [Peace], brought a revelation to this sickness—I can stop episodes right in their track.

It’s a given that I am going to be symptomatic having a chronic disease. However, just because I have symptoms doesn’t mean it has to turn into an episode, meaning every time I feel pain or vomit, doesn’t necessarily mean I have to end up in the hospital. Although my admission rate was pretty high, it didn’t have to be. Although I was taking very frequent trips to the hospital—so many I was labeled a drug-seeker and sometimes not even treated—I didn’t actually have to go so much.

I learned from John the importance of hydration—what certain temperatures do to your muscles—and since the stomach is a muscle, this was very vital. I learned the warning signs, dangers and effects of high blood pressure from Marissa. These factors helped me utilize my body like a machine: what to do, when to do it and what to look out for. And from both of them, I learned the signs and symptoms of an actual physical addiction to pain medication. Until someone took the time to explain these signs and symptoms to me, in a way I could relate and in my environment of comfort, I had no idea that I was addicted to pain medicine. Mine wasn’t an addiction to pain medicine I bought on the street, but an addiction to the medicine the doctor gives to you because they truly believe it’ll help you. Once I realized I was addicted, I was able to reach deep inside my spirit and wean off of pain medicine completely. I haven’t had pain medicine in almost four months, not even over-the-counter.

The education I was provided was more in-depth and beneficial than any doctor or hospital ever provided to me. Instead of constantly going to the hospital and being processed by very busy staff, I was treated like a friend by the paramedics—they were genuinely concerned about my well-being. I was able to use what they taught me to empower myself to make the life changes I needed to.

What changes have you made?
I’ve learned that you can’t do everything in one fell swoop. The infrastructure of the human body is broken down into four blocks. From strongest to weakest, they are: the spirit, the heart, the mind and, lastly, the body.

The first change was for my spirit. I fortified my spirit with the Holy Spirit of Jesus Christ. Even if I couldn’t get out of bed, I made sure I studied the Bible and I prayed constantly. This kept me from giving up and entertaining suicidal thoughts. This made me not only want to survive, but live.

Once my spirit became strong, my heart followed. I no longer believed I was going to be plagued with this for the rest of my life—chronic or not. Diabetes is a lifetime disease, but today, if you met me in person and I didn’t tell you I was diabetic, you’d never know.

Mobile integrated healthcare emergency service and utilization profile

After my proverbial heart got stronger, I began asking questions. This is the mind. I wanted to know facts about the body and my complications. I wanted to be educated on what to do when I’m suffering instead of lying there dying, waiting for my vitals to get to the point where I need medical attention. I made my mind strong with education and desire. That education and desire turned to commitment and action.

This led to the final block—the body. After the spirit, heart and mind became strong, the body had no choice but to get in line. I had Jesus and the Holy Spirit, I had the belief that I could defeat this, I had the tools and knowledge concerning the science of my body and how to apply it, do it and commit.

Commit, commit, commit. After four years of being tortured with this disease, my stomach had shrunk in size—on the inside anyway. I had to commit to having self-control about how much I ate, what I ate, and when I ate. I had to commit to not overlooking warning signs of symptom onsets, and I had to commit to address issues that arise.

And the most important, I had to commit to my bodily operations, even when I am feeling good. I’ve gone from eight or nine medications down to two and I haven’t been in the hospital in months. Just like when I first became a diabetic and had to learn how to live with it, this paramedics doing this program taught me how to live with gastroparesis.

What’s something you used to not be able to do that you can now?
Praise Jesus, everything. With the exception of taking it slow on some physical activities and food consumption, I can do everything again. I’ve even felt hunger pains after years of not feeling them; the first time it happened was startling. I was like, what is this? It feels weird. I’ve never felt this type of pain before, this is new.

What have you Learned about your symptoms?
Before I was enrolled in the program, I had no idea what was what. All I knew was I was hurting all the time. I was vomiting all the time. When symptoms would become active, I knew it was just a matter of time until I was back in the ED. Now I recognize my symptoms and can do something about it before it’s too late.

Mobile integrated healthcare expenditure savings summary

The other night I was feeling bad—real sluggish—and had frequent urination. I just knew my glucose had to be too high, and I was going to give myself insulin without testing because I was so “sure.” Tim, another paramedic who works in this program, and who is a type 1 diabetic as well, emphasized how important it was for me to test. I’ve had diabetes for 30 years with no problems, but these last four years of this serious complication have basically left me “numb” to my blood sugar level. In between extreme highs and extreme lows, I can no longer “finger where I’m at.” There was a time before when I could guess and only be a few units off of my actual reading. Not anymore. I decided that it would be a good idea to check first before I inject away. I checked and it was 86. That made me think about what else it could be, and then I remembered everything Marisa taught me about high blood pressure, which led to another revelation: I forgot to take my blood pressure medicine that day. So I immediately took my blood pressure medicine, and within an hour and a half, my symptoms dissipated and everything returned to normal. Had I just taken the insulin, I’m pretty sure that would’ve led to an insulin reaction, probably resulting in a seizure in my sleep that I may have not awakened from.

Is there anything else you would like to share about this program?
At my lowest point, I prayed to Jesus with my loudest spiritual voice. Most people who know anything about Jesus or the Bible have come to this thinking that your prayers are answered with some giant angel with magnificent wings hovering above you and touching your forehead. The truth is, like it is in the Bible, answered prayers sometimes come in the form of people. The EMTs of this program did more than just visit my home twice a week and check my vital signs. They encouraged me to the point of having hope again; and though hope is frail, it’s hard to kill. Receiving the care, the concern, the knowledge, the practicality of what was necessary helped me recover and begin to live again. Jesus was, and is, the foundation that got the wheels turning, and the individuals in this program were the axle. I had been written off as a drug-seeker and was left to die like I was a useless street fiend. They came into the picture, asked me if I wanted to get better, offered the tools and a helping hand, and I’ve been standing—no, running—with stride ever since. If a program like this were to go national, I know the death rate, hospital stays, and constant trips to the emergency room would decline drastically.

More MIH-CP from