They Make House Calls

Alameda’s community paramedics reduce readmission rates and frequent 911 users.



Alameda firefighter paramedics Patrick Corder, left, and Armando Baldizan, check their equipment in their response truck before heading out on calls.

Photo by D. Ross Cameron

Patrick Corder, a firefighter and paramedic with the Alameda Fire Department and Emergency Services, doesn’t wait for people to call 911. He calls them first. On a typical Monday morning in late March, his call list was growing quickly. There was the 81-year-old woman with chronic obstructive pulmonary disease who needed help getting in to see a primary-care physician, and the 46-year-old man with pneumonia who had been discharged from the hospital on Friday but had not picked up his antibiotic yet, plus the 73-year-old man recently hospitalized with sepsis, a life-threatening infection, who had fainted at home the week before due to a medication side effect.

Most critical this day, Corder wanted to locate a 56-year-old homeless man with a host of chronic disorders including congestive heart failure. There had been a fire in a transitional housing unit in the city over the weekend, a place where this man sometimes stayed, and Corder wanted to be sure he was safe.

Corder and his colleague Armando Baldizan work full time as Alameda’s community paramedics and are part of a statewide initiative that is studying ways the paramedic’s role can be expanded to facilitate better use of emergency care resources and improve the delivery of primary-care medicine to underserved populations. “It’s a complete shift in our job function,” said Corder. “In the 911 setting, we react and transport to the ER. As community paramedics, we are proactive. The focus is prevention. We meet with patients where they are.”

Corder, Baldizan, and three other members of the department started training as community paramedics in January 2015. Since June 2015, they have enrolled 184 patients in the program. They focus on two groups: “Familiar Faces” are patients who call 911 frequently—over 20, 50, even 200 times a year; and “The Chronic Six”—are patients who are discharged from Alameda Hospital with acute myocardial infarction (a heart attack), congestive heart failure, chronic obstructive pulmonary disease, pneumonia, diabetes, and sepsis, which are all disorders with a high risk for complications. The goals of Alameda’s program are to reduce the frequent callers’ use of emergency services and curb hospital readmissions.

They quickly identified about 60 familiar faces in Alameda at the start. “We know these folks from dealing with them, sometimes almost on a daily basis,” said Baldizan. Mostly men, homeless, with unaddressed health problems like cirrhosis, heart failure, HIV, hepatitis, and skin conditions from living out in the elements, like psoriasis and cellulitis, often mentally ill and abusing alcohol. Often the 911 call and trip to the ER are not what’s needed, explained the paramedics. The patients need to visit a primary-care physician or help with managing medications and dealing with substance abuse. The lack of housing for these individuals is a big contributing factor to their health-care needs, too, the paramedics said. Since the community paramedics have started reaching out and working with this group directly, the number of frequent 911 callers in the city is down to about 25.

As Corder and Baldizan talked about the city’s new model for community paramedicine, the fax machine in their office repeatedly spit out paper, referrals from the social workers at Alameda Hospital, who identify several patients each week who may live alone, may not have anyone checking in on them, and need support managing their health care. Patients leave the hospital with a care plan, but putting the plan in place can be hit or miss without help, said Corder. “Our goal is to do a home visit in 72 hours of discharge.”

On the first visit, the paramedics reconcile the patient’s medication, provide education about the patient’s diagnoses, and make sure follow-up appointments are made. Plus, they do a home safety check—if the client, for example, needs grab rails in the bathroom, they make a referral to a senior fall prevention program. Medicare and Medicaid don’t provide reimbursement for hospital readmissions within 30 days of discharge, so the cost of treating these patients is a significant factor to the health system. So far, only seven patients in the program have been readmitted to the hospital within 30 days of discharge, a readmission rate of less than 4 percent.

The two-year Community Paramedicine program was originally funded through Alameda’s Measure A and Alameda County EMS. The program has been extended though November 2017 and Alameda Health System, Alameda City EMS, and the city of Alameda have also contributed to the $1.25 million annual cost. Although he can’t say how this will happen just yet, Chief Rick Zombeck of the Alameda EMS said he hopes to get authorization for the Community Paramedicine program to continue. “Our paramedics have clearly demonstrated that they can handle this expanded role,” said Zombeck. “This gives the paramedic the opportunity to do more, to be of greater service. And we’ve seen already the benefit it provides our community.”

 

Published online on May 10, 2017 at 8:00 a.m.

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