Headline
Addressing care coordination and medication-related needs within a mobile integrated health care-community paramedicine (MIH-CP) program leads to a reduction in hospital readmissions.
Context
MIH-CP programs expand the role of paramedics and emergency medical technicians to deliver a broader range of home- and community-based services, including hospital follow-up care, primary care services, medication reconciliation, and health education. These programs have demonstrated improvements in access to care, patient satisfaction, and quality of life, while also reducing costs associated with avoidable hospitalizations.
In 2018, the Baltimore City Fire Department and the University of Maryland Medical Center launched a pilot MIH-CP program aimed at reducing inpatient readmissions by addressing health-related social needs (HRSN). The 30-day program involved an interdisciplinary team comprised of physicians, nurse practitioners, community health workers, and pharmacists, who provided targeted interventions to individuals at high risk for readmission prior to hospital discharge.
Findings
This retrospective observational cohort study examined the impact of targeted HRSN interventions within the MIH-CP program on hospital readmission rates of over 800 program participants. The study found that participants who had their medication-related needs addressed — including through medication delivery, payment, and reconciliation — experienced a 65% reduction in 30-day readmission rates compared to those whose needs were not addressed. Similarly, addressing care coordination needs was associated with a significant decrease in 30-day readmission rates. However, no other interventions within the MIH-CP program were found to significantly impact readmissions. The study also observed varying degrees of success in addressing HRSN, with low rates of resolution for needs related to environmental, housing, and utilities.
Takeaways
This study highlights the feasibility of including specific HRSN interventions within MIH-CP programs and the positive impact of care coordination and medication support on rates of hospital readmissions. Additionally, the authors note that further research is needed to understand the drivers of high readmission rates among individuals with no identified care coordination needs. They suggest that potential shortcomings of the screening process may hinder effective identification of patients’ needs.