Sussex program aims to reduce hospital re-admissions for COPD patients

GEORGETOWN — A mobile approach to health care for patients with COPD is now cleared for takeoff.

The state of Delaware, Sussex County and its EMS paramedic program, and Beebe Healthcare are set to launch in September a pilot program in which paramedics will make house calls geared to reduce hospital readmissions and enhance quality of life among COPD (Chronic Obstructive Pulmonary Disease) patients.

By a 4-1 vote, Sussex County Council approved a memorandum of understanding between the Delaware Office of EMS, Beebe Healthcare and Sussex County outlining this mobile integrated healthcare pilot program — the first in Delaware.

The initiative, about three years in the making, will extend one year, starting Sept. 1 running through August 2020.
The plan is to enroll and interact with upward of approximately 50 patients who have COPD.

“These patients are frequently readmitted either in the emergency room or into the hospital within 30 days. We feel as though we can put paramedics in their house, doing some things with them that we can reduce those readmissions and those costly readmissions,” said Robbie Murray, Sussex County EMS deputy director of administration.

“We at Beebe have talked about this for a number of years. We certainly understand that there is going to be costs involved but I think that for the benefit of the patients, the residents of the county, and our friends, our neighbors, they deserve this,” said Rick Schaffner, interim CEO for Beebe Healthcare.

“We’re very grateful for the ongoing participation of the county. These are the types of partnerships that are really going to make healthcare work going forward.”

“It’s proactive,” Mr. Murray said. “And if you think about in its simplest of terms, many years ago the fire service started with fire prevention where they went out and did education and worked to prevent fires. And that proved to be extremely successful. And that is essentially what we are doing on the EMS side of it; we are attempting to go in and through education, through working with these patients, prevent them from having relapses and going back into the hospital, having readmissions and improving quality of life.”

Three Sussex County paramedics will participate in the pilot, which is supported by grant awards from Discover Bank ($61,500) the Jessie Ball DuPont Fund ($31,500).

“Between the two of those, it will cover the cost of the paramedics participating, and other funds will be available to help offset some of Beebe’s hospitals costs as well,” Mr. Murray said.
There will be minimal cost to the county.

“Beebe Medical Foundation has certainly done the lion’s share of the work of lining up the funding and the grant money for this. They have been able to secure funding sufficient enough that it limits the taxpayers’ liability,” said Mr. Murray, adding incidental uniform costs and administrative oversight of salaried employees “are not going to be passed on to this pilot.”

But all the paramedic hours will be covered by the grants and funding “at full cost,” Mr. Murray said.

One of the biggest hurdles was current Delaware code – Title 16, Chapter 98 governing paramedic programs — does not allow for non-emergency home visits/mobile integrated health care-type programs. However, as a pilot and with the MOU agreement, permission was granted.

“It is written to allow for emergency response after 911 calls, with the understanding that patients are likely to be transported to the hospital,” Mr. Murray said. “We went before the state and we received permission to pursue the pilot program with the understanding that there would be an MOU.”

Through Beebe’s Population Health Department, the area identified for prospective patients to utilize this pilot is the 19966 ZIP code, which encompasses the greater Millsboro area.

“Anytime they look at their respiratory complaint, that Millsboro ZIP code is typically the highest where they see those COPD patients and those respiratory patients,” Mr. Murray said. “By keeping them in somewhat of a consolidated area, it will allow us to spend more time with home visits versus more time driving across the county.”

The ballpark patient number is 50. “There is a chance, depending on how these visits go – again, it is the first time for us, so we are not 100 percent how the visits are going to go – but we’re shooting for 50,” said Mr. Murray. “And if time and opportunity allow us to go even more than 50 within the budget then that is what we are going to do as well.”

According to Beebe’s 2015 data, 30 percent of the patients who were seen at Beebe with COPD were readmitted within 30 days.

“Our goal in this pilot is to reduce that number by 30 percent. In addition to that, we’d like to improve the overall quality of life of these patients that we have in Sussex County. Whether that is through reducing falls, smoking cessation or just other social service opportunities that we can look at,” said Mr. Murray.

“This will give us an opportunity to actually go out into the house before the patient needs 911 and intervene with them through patient education through different modalities.”
Paramedics will provide in-home outreach, follow-up and patient education following discharge from Beebe Hospital. Paramedic visits will include home safety inspection, medication reconciliation, quality of life assessment. Paramedics will work with Beebe’s Population Health and Advanced Care Clinic teams to meet any discovered needs.

Beebe’s Dr. Bobby Gulab will serve as the pilot program’s medical director and Dr. Paul Cowan, one the EMS associate medical directors, will serve as the liaison between Sussex EMS and Population Health, Mr. Murray said.

Typically, Sussex paramedics work four-day shifts in a work week.
“One of those shifts they will be pulled off their regular job as a paramedic and detailed to the mobile integrated,” said Mr. Murray. “Our plan is to do home visits on Tuesdays and Thursdays. We will assign one of those three paramedics to either work on Tuesday or Thursday based on schedule.”

Each of three paramedics identified about a year ago who were interested in this program have attended approximately 50 hours of training through Population Health, respiratory management and some one-on-one patient education, Mr. Murray said.

Home visits are expected to start Sept. 10. Interested patients with COPD will be enrolled through Beebe’s Population Health.
Paramedics will work closely with the Advance Care Clinic through Beebe’s Population Health. “At any time that there is a gap in service identified they will be reaching out to one of those care coordinators and working on a resolution in ensuring those patient needs are met,” Mr. Murray said.

Upon competition of the one-year pilot and assessment, data will be presented at the state level. Efforts will then be made to suggest legislative change to state code governing paramedics.
Additionally, continued funding will be sought, whether that is through the local hospital, other partners and maybe even insurance companies, Mr. Murray said.

“In the future the sky really is really the limit. In the process over the last three years of us working on this pilot we have been approached by two other local hospitals asking for us to become involved in mobile integrated health care,” Mr. Murray said. “We’ve moved them to the back burner because we really only want one pilot going on at a time.”

The era of mobile integrated health care could extend beyond COPD. Other opportunities are congestive heart failure patients who also have a frequent readmission, elderly patients who fall frequently “or just our loyal users who frequently call 911; getting out in front of them,” Mr. Murray said.

“We are very grateful for partners like the paramedic program here in Sussex County, to really work with us to move this program forward,” said Mr. Schaffner. “We think it is quite an opportunity, I think not only for ourselves but for other health care systems within the county. This particular program I think is going to prove itself forward.”
Councilmen John Rieley, Doug Hudson and Irwin G. Burton III joined Mr. Vincent in approving the MOU. Councilman Samuel Wilson Jr. voted “no”.

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