Background: Community paramedicine programs utilize paramedic training and rapid access to patients in order to address non-emergent health needs. Starting in July 2017, Cleveland Clinic Medical Care at Home (a program providing in-home primary care physician services to 1,800 homebound, medically complex patients) piloted the use of community paramedics working directly with a telemedicine physician for home visits. While there are reports of operational outcomes for similar community paramedicine programs elsewhere, few analyze impacts on patient satisfaction. This study investigated the patient satisfaction scores of patients seeing a community paramedic with telemedicine physician compared to a primary care physician home visit.
Methods: The patient satisfaction survey instrument collected respondent demographics, overall provider satisfaction (0-10 scale), and validated Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS®) ratings for provider listening, respect, clarity of explanations, and time spent with the patient. A priori total sample size calculation demonstrated 80% power with 40 patients (20 per group) for a moderate effect size of 0.50. Surveys were distributed by community paramedics and home visit primary care physicians following every patient encounter during the study period. The primary outcome was difference in proportion of “top box” (highest) responses to CG-CAHPS® questions (analyzed by chi-square). The secondary outcome was difference in mean overall provider satisfaction (analyzed by t-test).
Results: There were 51 respondents in the community paramedicine group (34.0% response rate) and 39 respondents in the physician home visit group (19.5% response rate). There were no significant demographic differences between groups. There were no significant differences in top-box CG-CAHPS® score (96.3% community paramedicine, 100.0% physician home visit; p=0.248). Overall provider satisfaction was extremely high in both groups (9.8 ± 0.6 community paramedic, 9.9 ± 0.3 physician home visit, p=0.248).
Conclusion: There was no statistically significant difference in patient satisfaction with a community paramedic/telemedicine physician visit compared to primary care physician home visit for medically complex, homebound patients.