Abstract 181: Community Paramedicine’s Impact on Readmission Reduction

Abstract

Stroke readmissions within 30 days have been identified by the Centers for Medicare & Medicaid Services (CMS) as a measure of hospital quality. Readmitted stroke patients experience greater mortality, longer lengths of stay, and higher cost per stay. This Comprehensive Stroke Center has had a follow up program since 2010 which includes a 48 hour phone nurse call, a 7 day clinical pharmacist phone call, and stroke clinic visit/phone call at 30 days and 90 days. This process produced a 50% readmission reduction between 2013 and 2018, however opportunities to further reduce stroke readmissions remain. Methods: In 2018, a process was launched where specially-trained Community Paramedicine professionals visit stroke patients at home @ 7-10 days post discharge. This visit includes education reinforcement, social evaluation and support, medical examination, and interventions. The model was previously found to demonstrably reduce heart failure readmissions. Referrals are made to this team by coordinators for ischemic and hemorrhagic patients discharged to home or rehab. Findings and needs are communicated directly to relevant health system elements. Results: From July 2018 through June 2019, CP visited 156 (23%) of the 669 patients discharged to home and acute rehab. Only 1 patient (0.6%) of those visited was readmitted, while 52 (10%) of the 513 not visited were readmitted within 30 days. During the visits, they identified key barriers such as medication errors, absence of help in the home (despite having previously reported they would have help), lack of transportation, and overwhelmed caregivers. They ensured that pill organizers were utilized, reviewed upcoming appointments, assisted with arranging transportation, and provided education and helping strategies to caregivers. Feedback from the patients has been overwhelmingly positive. Conclusion: Stroke Centers are accountable to improve stroke patients’ transitions of care at discharge to reduce readmissions and ensure optimal recovery. Community Paramedicine personnel are well-suited to positively impact readmission rates in stroke patients.