1. James Pierson, VP/COO Medic Ambulance Service

2. Medic Introduction Family Owned and Operated since 1979
CAAS Accredited (First in Northern California)
ACE Accredited
52,000 calls p/year (38,000 – ALS/9-1-1)
1,800,000 Miles traveled
80 Emergency Vehicles
285 Employees
1 of 30 Organizations in the world to have CAAS and ACE. Neither were contractual mandates.

3. Gaps In Health Care
Solano County is a HRSA- designated medically underserved area.
Historic 30-day rate of readmission over 20% in patients with Heart Failure or COPD.
Use of and ED rising faster than the growth rate of the population.
Difficulty in navigating and understanding discharge plan.

4. Foundation of Current Program
We were approached by the Kaiser Group in 2013 to submit a pilot to EMSA.
Needed Local EMSA approval.
Local EMSA wanted all local hospitals to be offered the opportunity to participate in pilot.
NorthBay and Kaiser confirmed, Solano EMS approved, and all submitted letters in support of our pilot submission.
Steering Committee established.

5. Building Sustainability
Many wonderful CP demonstrations stop due to not having a continuing funding stream.
Hospital payor built into our program from the beginning.
Remain agile to meet the needs of the patients through the addition of a healthcare deliverer not a replacement option.
We didn’t want to help 100 people and pat ourselves on the back. It is very important for us to help as many people as we can for years to come.

6. Solano CP Goals. 2 Main Goals of the pilot:
Reduce re-admissions for 30 days post discharge for COPD/HF patients.
Improve patient overall health and disease process understanding.

7. Current Process
NorthBay Complex Case Managers identify and contact eligible patients.
Medic schedules two visits or more as needed.
At the visits the CP educates the patient about their discharge instructions, disease process, reviews all medications, home safety assessment, obtains vitals, and assists in healthcare navigation.

8. Results We started seeing patients in September 2015.
281 Patients referred to the program.
184 Patients have been enrolled.
100 for COPD
84 for HF
363 Visits have been conducted.

9. Results
We have only had 13 unplanned readmission for any reason, 7.1% (55.7% reduction)
Compare at 16.0%
For HF or COPD, 5 readmissions, 2.7% (73.6% reduction)
Compare at 10.3%

10. Results
Enrolled, If the patients do readmit, than the average days readmitted for is 4.2 days (44.5% reduction)
Compare 7.6 days
Emergency Department/9-1-1 use for enrolled 23.4% (24.3% reduction)
Compare 30.9%

12. Survey Patients EQ-5D-3L Self Health Assessment
Discharge Understanding Questionnaire
Home assessment tool
EMS Survey Team, third-party company
97.02/100 highest overall score in the company database. (40% of patients surveyed)

13. In Home Findings We expected to need more skills interventions.
Over 3 out of 4 patients, 75.5%, need help understanding their discharge instructions.
53.3% of patients have medication errors.
Spacer supply, usage, and directions identified issue
Medical equipment often is not being used or is not used correctly.
Nebulizers while lying down, spacers not understood, maintenance resp meds used

14. Results Patients self identified improvements first visit to last:
Overall health improved 14.3%
Understanding of DC instructions improved 11.1%
Understanding of when to take meds improved 5.0%
Understanding of med SE improved 11.9%
Anxiety/depression improved by 8.1%

16. EMS Survey Team in 19 states.

22. What our Patients Say
“Its been a very good experience. She (the CP) explained everything so I could understand.” – Patient
“My blood pressure started going up and it wouldn’t come down. I had medication but it wasn’t helping.” – Patient (was not taking her medication at the correct frequency)
“If I get sick I know they’re gonna be there for me and that I’m not alone.” - Patient

23. Next Steps Continue operating under HWPP #173
SB 944 Community Paramedicine Act of 2018
AB 1795 Alternate Transportation Bill for Community Paramedicine

24. Questions?