Collaborative Effort Between Paramedics, Hospitals Paying Dividends for Patients in Missouri

The "First 100 Days" is typically a time metric reserved for elected officials, but in St. Charles County, a collaborative effort between paramedics and BJC Healthcare posted some impressive results of its own during the first 100 days. 

The Mobile Integrated Health (MIH) initiative has resulted in an estimated $149,000+ expenditure savings and vast improvements in patients' health status self-assessments. 

The program starts at Barnes-Jewish St. Peters and Progress West Hospitals, where physicians and case managers identify patients at high-risk for readmission to the hospital following an in-patient stay for certain serious health conditions: congestive heart failure, chronic obstructive pulmonary disease, acute myocardial infarction, or pneumonia. 

"Without strict adherence to care plans and medication regimens, conditions such as these can become exacerbated quickly," explains Jill Skyles, VP of Nursing for both hospitals. "They can be particularly challenging for those who are newly-diagnosed and trying to adjust to new healthcare routines."

Enter St. Charles County Ambulance District (SCCAD) advanced practice paramedics Russ Allen and Kimberlyn Tihen, who meet with the patient and BJC case managers prior to discharge. Together, the group works to identify needs and goals specific to each patient. Individuals enrolled in the MIH program receive home visits from paramedics over a four-week period, where their health condition is monitored through physical exams, medication reviews, dietary compliance discussion and disease management education. Lab and other diagnostic tests and interventions also may be performed in-home as needed, and results are reported back to enrolled individuals' physicians. The program's overarching goal is to teach patient self-management while avoiding unnecessary readmission during the 30-day post-discharge period.

From November 1 to February 15, the program enrolled 28 patients; 17 successfully completed the program and 11 were actively enrolled on Feb. 15. Of the 17 who completed the program, 13 successfully avoided readmission and four were hospitalized—a program success rate of 76.5 percent. Using data from Centers for Medicare and Medicaid Services regarding costs related to emergency department and hospital admissions, direct avoidance of 13 patients from readmission potentially saves $149,097 in unnecessary care and associated cost to the healthcare system with subsequent hospitalization.

In addition, patients indicated significant gains on health status self-assessment, with those who completed the program reporting average improvements of 46.7 percent in ability to perform usual activities and 37.7 percent in overall health status. Level of pain/discomfort, anxiety/depression, and mobility also saw notable improvements. According to those enrolled, the program's success can be attributed to those canvassing St. Charles County, visiting patients from all walks of life.

"Keep hiring the same quality of employees—people with compassion, concern, and kindness," says 88-year old Mary Walters, a graduate of the program who continues to stay in touch with Allen and Tihen.

Given the success achieved during the MIH program's pilot period, BJC and SCCAD are working closely to develop strategies for making the initiative a permanent fixture in St. Charles County.