Paramedics are to hospitals like pawns are to chess.
The first line of defense and underestimated by novices for their strength and role in the larger picture.
Trinitas Regional Medical Center identified an untapped strength of paramedics to help reduce unnecessary hospital visits by Elizabeth’s most vulnerable population.
Individuals in the lower socioeconomic strata or those who are uninsured have a higher chance of being chronic emergency room users. Paramedics, who often respond to emergencies and bring in these very same individuals, have been successful in reducing readmissions within 30 days — a benchmark used by the Centers for Medicare and Medicaid Services to evaluate hospitals’ efficiencies.
The hospital is currently working on its second iteration of a grant-funded CHIP, or community health integrated provider, program.
“It’s a creative way to provide an assessment of what’s going on in the community,” Trinitas CEO Gary Horan said. “(Paramedics are) used to going into homes and seeing environments people live in. But they are typically going in for an episodic situation and don’t pay attention to their surroundings.
“Now, with this program, they are particularly looking at the surroundings. And looking to see if there is food in the refrigerator and (residents) are taking their medication.”
Joseph McTernan, senior director of community and clinical services, said the program began with seed money from Verizon in 2014 and focused on heart failure patients in response to the problem of patients being readmitted within 30 days of being discharged.
After successfully reducing the readmissions for patients who agreed to participate in the program, Trinitas is now focused on certain neighborhoods where the hospital has identified many of its patients are coming from.
The CHIP program has created a new level of health care workforce. It has long been established that what happens to patients outside the hospital is as important to recovery as how they are taken care of inside. Closing this gap was the goal of the program.
Traditionally, paramedics are thought of as a bridge between the hospital and the patient, but now, the newly trained workers are a bridge between the community and all avenues of health care, McTernan said.
The community health workers are general members of the community who have received education on basic patient issues.
What Trinitas did was conduct a gap analysis of the paramedics’ curriculum and that of a community health worker. From that, it identified how to create a job description and training focused on enhancing the clinical knowledge and experience of the workers, according to McTernan.
This included understanding patient psychological and behavioral needs, chronic needs management and ensuring there was food in the fridge and patients were filling and taking prescribed medication.
“What we identified was (a) larger than expected (number of) patients had visits to the emergency room.”
Joseph McTernan, senior director of community and clinical services,
Trinitas Regional Medical Center
In addition, the CHIP workers would also be well-versed in the resources available to act as community health navigators.
Five individuals were selected to act in this role for the first round.
The program initially identified 53 patients, based on internal medical records, who were frequenting the emergency room and were heart patients.
Of those, 43 agreed to be participants in the program for follow-up visits from the CHIPs.
The workers would show up, in a hospital vehicle rather than an ambulance, and assess the needs of the patient. They had light, portable gear to document blood pressure, weight, listening to lungs with a stethoscope, and other medical screening methods.
With the help of the workers, Trinitas saw only 7 percent of readmissions, compared with its baseline of 24 percent of its overall population, McTernan said.
Knowing this was so effective, the hospital began working out the kinks for Round Two.
The second round of funding came from a combination of Verizon and The Nicholson Foundation. The grand total of all funding for the project (both iterations) is $75,000.
Currently, Trinitas is in the sixth week of the second round, so there are no results yet. But the project now has a different focus.
Trinitas partnered with the housing authority in Elizabeth and identified a housing project one mile away from the hospital that had a large number of residents with frequent emergency room visits.
“What we identified was (a) larger than expected (number of) patients had visits to the emergency room,” McTernan said. “We saw that a strong percentage of the visits were for less-acute issues. So, issues like upper respiratory infections.”
The hospital also noticed that the ages ranged from pediatric care to adults.
So Trinitas sat down with several members of the community and discussed what was going on with health needs and what were the barriers to health, and got a better sense of what the patients needed.
It restructured the program to include CHIPs being able to screen for depression and substance abuse, as well as find resources to help patients sign up for health insurance or find primary care physicians.
While the results of the new iteration of the project are yet to be tallied, both Horan and McTernan said this is the way hospitals are headed.
It’s more than just population health; it’s about fulfilling the mission and creating a stronger bond with the community, Horan said.
McTernan said that, after the first round, one of the patients said something that stuck with both him and the members of the program.
“What the patient said was, ‘I’ve never felt so cared for in my life,’” McTernan said. “That rang through from a real humanistic perspective of what we are looking to do.”
Asked whether or not the program is sustainable without the aid of grants, Horan said no.
He is hoping that with continued positive results comes interest from insurers, CMS and other entities who can partner with the hospital to ensure the program continues.
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