Abstract P228: Developing a Community Paramedicine Program to Reduce Stroke All-Cause Readmissions

Abstract

Introduction: According to the Centers for Medicare & Medicaid Services (CMS) readmission is a key indicator of hospital quality. Readmitted stroke patients experience greater mortality, longer lengths of stay, and higher costs. Lessening these occurrences have been challenging; but a growing Emergency Medical Services (EMS) concept- Community Paramedicine (CP) - provides a solution. The CP program is designed to provide follow-up home visits to patients after discharge. This program does not bill for services; its executive approval and subsequent expansion was instead predicated on cost avoidance. Methods: In 2018, following success in reducing readmissions in the heart failure population (which resulted in $1.38 saved over 2 years), CP was implemented in the stroke population. The intervention was modified to meet the needs of stroke patients and address key factors in stroke readmissions. The financial impact model consists of comparing readmission rates in the same primary disease category. A projection of readmissions that would have occurred for patients without the intervention is made using the rates observed in patients not seen by CP, allowing for projection of readmissions prevented through this intervention. The number of saved bed days is calculated using average length-of-stay and cost avoidance is calculated by multiplying the saved days with the average cost/day. Results: From July 2018-December 2019, CP visited 164 stroke patients, of which only 2 became a 30 day readmission (1.22%). Of the 658 stroke patients that did not receive a visit, 67 were readmitted (10.18%) in the same time period. Applying the same financial impact model, it is estimated that 9 readmissions were prevented, resulting in a cost avoidance of more than $191,029. Conclusion: Community Paramedicine is a versatile tool that decreases readmissions. During the visits, key barriers were addressed, such as medication discrepancies, absence of help in the home, lack of transportation, progressing symptoms, and overwhelmed caregivers. This successful model is replicable and well-supported by hospital leadership due to demonstrable cost avoidance. It’s a “win” for all; patients avoid readmission; the organization saves money; and patients receive optimal care.