2019 AIMHI Excellence in Value Demonstration or Research
Northwell Health House Calls
Northwell Health House Calls is an Advanced Illness Management (AIM) program that is a top performing CMMI demonstration project that manages an Advanced Illness population composed of the top 5% CMS utilizers that represent 50% of healthcare expenditures. Results were published in two separate scientific journals, the Journal of the American Geriatrics Society and BMJ Supportive & Palliative Care.
Description of Data & Methods
Various peer reviewed journal articles using data collected across the care continuum (IAH, EMS, EHR). Two separate studies performed and published in two different journals.
Abstract from the Journal of the American Geriatrics Society (JAGS)
Models addressing urgent clinical needs for older adults with multiple advanced chronic conditions are lacking. This observational study describes a Community Paramedicine (CP) model for treatment of acute medical conditions within an Advanced Illness Management (AIM) program, and compares its effect on emergency department (ED) use and subsequent hospitalization with that of traditional emergency medical services (EMS). Community paramedics were trained to evaluate and, with telemedicine-enhanced physician guidance, treat acute illnesses in individuals' homes. They were also able to transport to the ED if needed. The CP model was implemented between January 1, 2014, and April 30, 2015 in a suburban-urban AIM program. Participants included 1,602 individuals enrolled in the AIM program with high rates of dementia, decubitus ulcers, diabetes mellitus, congestive heart failure, and chronic obstructive pulmonary disease. Participants had a median age of 83 and an average of five activity of daily living dependencies (range 0-6). During the study period, there were 664 CP responses and 1,091 traditional EMS transports to the ED among 773 individuals. Only 22% of CP responses required transport; 78% were evaluated and treated in the home. Individuals that community paramedics transported to the ED had higher rates of hospitalization (82.2%) than those using traditional EMS (68.9%) (P < .001). Post-CP surveys showed that all respondents felt the program was of high quality. Results support the potential benefits of CP and invite further evaluation of this innovative care model.
Access the full study via the National Center for Biotechnology Information, U.S. National Library of Medicine.
Innovative Geriatric Practice Models: Preliminary Data
Providing Acute Care at Home: Community Paramedics Enhance an Advanced Illness Management Program—Preliminary Data Karen A. Abrashkin MD Jonathan Washko MBA Jenny Zhang BA Asantewaa Poku MPH Hyun Kim ScD Kristofer L. Smith MD, MPP First published: 30 August 2016
https://doi.org/10.1111/jgs.14484
Abstract from the British Medical Journal (BMJ) Supportive & Palliative Care
Objectives As the US population ages and healthcare reimbursement shifts, identifying new patient-centred, cost-effective models to address acute medical needs will become increasingly important. This study examined whether community paramedics can evaluate and treat, under the direction of a credentialed physician, high acuity medical conditions in the home within an advanced illness management (AIM) practice.
Methods A prospective observational study of an urban/suburban community paramedicine (CP) programme, with responses initiated based on AIM-practice protocols and triaged prior to dispatch using the Advanced Medical Priority Dispatch System (AMPDS). Primary outcome was association between AMPDS acuity levels and emergency department (ED) transport rates. Secondary outcomes were ED presentations at 24 and 48 hours post-visit, and patient/caregiver survey results.
Results 1159 individuals received 2378 CP responses over 4 years. Average age was 86 years; dementia, heart failure and asthma/chronic obstructive pulmonary disease were prevalent. Using AMPDS, most common reasons for dispatch included ‘breathing problems’ (28.2%), ‘sick person’ (26.5%) and ‘falls’ (13.1%). High acuity responses were most prevalent. 17.9% of all responses and 21.0% of high acuity responses resulted in ED transport. Within 48 hours of the visit, only 5.7% of the high acuity responses not initially transported were transported to the ED. Patient/caregiver satisfaction rates were high.
Conclusion Community paramedics, operating within an AIM programme, can evaluate and treat a range of conditions, including high acuity conditions, in the home that would typically result in ED transport in a conventional 911 system. This model may provide an effective means for avoiding hospital-based care, allowing older adults to age in place.
Access the full study via the British Medical Journal.
Abrashkin KA, Poku A, Ramjit A, et al Community paramedics treat high acuity conditions in the home: a prospective observational study BMJ Supportive & Palliative Care Published Online First: 04 April 2019. doi: 10.1136/bmjspcare-2018-001746
