Background: Patients at high risk for 30-day readmission are a critical population to effectively manage in a value-based healthcare system. Community paramedics possess additional training in chronic disease management and have the ability to reach patients in their homes, thereby providing a new tool to utilize in post-discharge care management. In an effort to reduce 30-day hospital readmissions for high-risk patients, we piloted a Community Paramedicine program that provided three scheduled community paramedicine home visits along with standard care management services during the 30 day period following hospital discharge. This study investigated the impact of our community paramedicine pilot on the 30-day readmission rate for high-risk patients compared to the historical readmission rate of 43% for high-risk patients receiving standard care management services.
Methods: A prospective cohort of 144 high-risk patients were enrolled in the community paramedic pilot from February-April 2018. Inclusion criteria for analysis were high-risk patients with a readmission risk score of >40% (using an internally-validated readmission risk calculator) and/or already enrolled in care coordination services. Exclusion criteria were patients who did not yet complete three community paramedic visits and/or were not 30 days post-discharge (37 patients excluded for this reason). Our primary study outcome was 30-day readmission rate for the community paramedicine cohort compared to the historical rate. With a sample size of 107, we were powered to detect a difference of 0.03 at α = 0.05 and β = 0.80 using Pearson’s chi-square test. Secondary outcomes included mean time to first community paramedic visit, mean time to first primary care physician visit, and mean time to hospitalization.
Results: The 30-day readmission rate of the community paramedicine cohort was 24%, compared to the historical rate of 43% (p=0.0038). Mean time to first paramedic visit was 4 ± 2.5 days (95% CI 3.4-4.4 days). Mean time to primary care visit was 10 ± 6.5 days (95% CI 9.1-11.0 days). Of patients with a 30-day readmission, mean time to hospital presentation was 15 ± 7.8 days (95% CI 11.9-18.2 days).
Conclusion: A Community Paramedicine program is associated with a decreased 30-day hospital readmission rate (24% vs 43%; p = 0.0038) for high-risk patients.