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Article
"House Calls" by Mobile Integrated Health Paramedics for Patients with Heart Failure: A Feasibility Study.
Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
  • Bruce Feldman, DO, Lehigh Valley Health Network
  • Orlando E Rivera
  • Christopher J Greb
  • Jeanne L Jacoby
  • Jennifer Nesfeder
  • Paul Secheresiu
  • Mahek Shah
  • Deborah W Sundlof
Publication/Presentation Date
9-28-2021
Abstract

Background: Early readmissions following hospital discharge for heart failure (HF) remain a major concern. Among the various strategies designed to reduce readmissions, home evaluations have been observed to have a favorable impact. We assessed the feasibility of integrating community paramedics into the outpatient management of HF patients. Methods: Selected paramedics completed an educational HF curriculum. These Mobile Integrated Health Paramedics (MIHP) performed scheduled home visits 2- and 15-days post-discharge for patients with Stage C HF (Phase I) and patients with Stage D HF (Phase II). Facilitated by a Call Center, a process was created for performing urgent MIHP house calls within 60 minutes of a medical provider’s request. A HF specialist, with an on-call emergency department command physician, could order an intravenous diuretic during home visits. During each phase of the study the incidence of 30-day HF readmissions, 30-day all-cause readmissions, emergency room evaluations, unplanned office encounters, as well as any adverse events were prospectively documented. Results: Collaborative relationships between our hospital network and local EMS organizations were created. There were 82 MIHP home visits. Eight patients received urgent home evaluations within 60 minutes post-request, 1 requiring transport to an ED. The incidence of all-cause 30-day readmissions in 20 Stage C and 20 Stage D patients was 15% and 40%, respectively. There were no adverse events attributable to the MIHP house calls. Conclusions: It is feasible to integrate MIHPs into the outpatient management of HF. Signals of effectiveness for reducing early readmissions were observed. Obstacles to creating an effective paramedic “House Calls” program were identified. A randomized trial is required to assess the value of this care process and its impact on early readmissions in patients with Stage C and Stage D HF.

Disciplines
PubMedID
34505798
Document Type
Article
Citation Information

Feldman, B. A., Rivera, O. E., Greb, C. J., Jacoby, J. L., Nesfeder, J., Secheresiu, P., Shah, M., & Sundlof, D. W. (2021). "House calls" by mobile integrated health paramedics for patients with heart failure: A feasibility study. Prehospital Emergency Care : Official Journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 1–9. https://doi.org/10.1080/10903127.2021.1977439