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Community Paramedicine Brings Emergency Care into Patients’ Homes, Could Increase Clinical Laboratory Specimens Collected In These Settings

Pathologists and clinical laboratories should be watching for the arrival of community paramedicine programs in their communities

Studies reveal that a sizeable proportion of 911 medical emergency calls result in an ambulance ride and emergency room visit for a medical condition that is relatively simple and not truly urgent. Recognizing this fact, some innovative health systems are creating a mobile “emergency room” service that can go to the patient’s home, provide appropriate care, and save the time and costs of the ambulance transport and emergency room (ER) visit.

This care model is being called “community paramedicine.” Pathologists and clinical laboratory managers should see this as a new example of how the traditional provision of healthcare services is being rethought. The goal is to combine modern workflow redesign techniques with new information technologies (IT) and medical laboratory tests to improve patient care while eliminating unnecessary cost.

The concept of bringing the ER to the patient’s home is consistent with the US medical industry’s shift toward offsite healthcare, which can include telehealth, to accommodate the growing population of geriatric, house-bound, and remote location patients. That is why programs are being created that allow patients to receive ER care in the comfort of their own homes.

Healthcare organizations are discovering that paramedics and emergency medical technicians (EMTs) can provide a considerable amount of care in a patient’s home without a physician present and without transferring the patient to a hospital.

SUVs versus Ambulances

Community Paramedicine (CP) is sometimes called Mobile Integrated Healthcare (MIH), and it is spreading in communities around the nation. Several programs now dispatch qualified medical professionals to private homes to provide on-site emergency care for individuals that would traditionally have gone to the ER.

One such program is called House Calls. It’s operated by Northwell Health in New York City and is part of the nationwide Independence at Home program run by the Centers for Medicare and Medicaid Services (CMS).

During a one-year period between June 2013 and May 2014, House Calls treated 357 patients in their homes at a cost savings of 17.4%, according to a Northwell Health press release.

Paramedics involved in the House Calls program are required to complete the usual paramedic studies along with an additional 40 hours of training. They often travel in SUVs instead of ambulances.

Community paramedics bring live saving healthcare to the patient’s home, reducing stress on patients while lowering costs to health systems, according to Northwell Health in New York City. (Photo copyright: Alberta Health Services.)

Community paramedics bring live saving healthcare to the patient’s home, reducing stress on patients while lowering costs to health systems, according to Northwell Health in New York City. (Photo copyright: Alberta Health Services.)

Many of the patients utilizing CP are elderly or individuals with multiple chronic health conditions that require recurrent attention.

“We know our older, chronically ill patients want to live at home as long as possible,” said Kristofer Smith, MD, Senior Vice President, Population Health Management at Northwell Health, in the Northwell press release. “Our House Calls practice delivers patient-centered care to our frail elderly patients that improve outcomes, reduces the cost of care, and alleviates pain and suffering for patients in the community by preventing unnecessary emergency department visits or hospitalizations.”

House Calls Safer for Elderly, Frail Patients

Patients involved in programs like House Calls receive coordinated care they would typically receive only through a visit to their doctor, a clinic, or the ER. Provided services include but are not limited to:

• Ultrasounds;

• Radiology;

• Lab work;

• Physical exams;

Electrocardiograms (EKGs); and

• Administration of intravenous solutions.

House Calls team members are available on a 24/7 basis to respond to questions from patients and arrange any critical services.

“A lot of what’s been done in the ER can safely and effectively be done in the home,” said Karen Abrashkin, MD, Internal Medicine with the House Calls program, in a New York Times article. She added that for frail patients with multiple health issues “the hospital is not always the safest or best place to be.”

For years, geriatricians have cautioned that hospitalizations can accelerate physical decline in elderly patients. They are more vulnerable to hospital-acquired infections (HAIs) and often require physical rehabilitation upon release due to deconditioning during hospital stays. Delirium also is reported in about half of the hospitalizations for older patients.

In 2009, there were only four emergency services in the US that had a community paramedicine program. In 2014, the National Association of Emergency Medical Technicians announced there were more than 100 CP services in the country. Today, the association recognizes 260 such programs nationwide.

Community Paramedicine Benefits Clinical Laboratories

An increasing number of people recognize the value of community paramedicine. It’s gaining popularity in urban, rural, remote, and underserved regions of the country. And, that growth could accelerate if Medicare and Medicaid covered the costs affiliated with the programs. Nevertheless, the programs have become so important, some states and communities are working to ensure reimbursements for community paramedicine services from public and private insurers.

The continued evolution of community paramedicine could ultimately benefit clinical laboratories as well. Healthcare professionals treating patients in their homes will often need to perform medical lab tests and receive test results remotely. Coordinated care between attending physicians, pathologists, clinical laboratories, and paramedics in the field could be a significant source of revenue for the medical laboratory industry and an opportunity to add value to a new and expanding practice of healthcare.

—JP Schlingman

Related Information:

Going To the Emergency Room Without Leaving the Living Room

Community Paramedics Help Medically Complex Homebound Avoid Hospitalization

Innovations in Care, Research, Policy Fueling Future Progress for 46 Million Older Adults at 2016 AGS Annual Scientific Meeting

Beyond 911: State and Community Strategies for Expanding the Primary Care Role of First Responders

Paramedics Step Up to Cut Hospital Readmissions

The Role of EMS in Community Paramedicine

Medical House Calls Program Improves Care, Lowers Costs of Treating Frail Elderly Patients at Home

The Dilemma of Delirium in Older Patients

New Outpatient Treatment Paradigm Spurs Construction of ‘Bedless Hospitals;’ Trend May Reshape Clinical Pathology Laboratory Testing

‘Thinking Small’ May Be Next Big Innovation in Healthcare Delivery as Microhospitals Spring Up in Metropolitan Areas Across Multiple States

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