Indiana — Targeted Issue

Treat the Street: Prehospital Pediatric Asthma Intervention Model to Improve Child Health Outcomes

Sept. 1, 2013 - Aug. 31, 2016

Grant Number

H34MC26203

Project Overview

Significant gaps in care following an ED visit or hospital discharge are illustrated by repetitive ED visits among children with asthma. In addition, in-home asthma assessments have been successful in reducing repetitive ED visits or ED recidivism rates. Typically, in-home assessments are conducted by a public health nurse. However, the capacity for the public health system to absorb a large number of referrals is limited. Specialty trained community paramedics are EMS professionals that help improve health outcomes by providing clinical preventive services, acute care, and post-acute care. Therefore, community paramedics are ideal candidates to conduct the in-home assessments. The goal of this project is to utilize a novel pediatric community paramedicine program to: (1) address identified gaps in pediatric asthma care, (2) reduce ED recidivism rates for children, (3) improve pediatric health outcomes, and (4) enhance paramedic provider roles in the delivery of patient care. Objectives include to: (1) utilize EMS services to rapidly incorporate evidence-based public health prevention strategies within the existing network of care, (2) utilize a community paramedicine model to ensure that the right care is available to patients at the right time and at the right venue, (3) develop and deploy a workforce of specialty trained out-of-hospital care providers to implement various prevention and intervention strategies, (4) conduct research, analyze data, and disseminate results regarding impact of the pediatric community paramedicine model on ED recidivism rates and enhanced paramedic scope of practice, and (5) recommend reimbursement strategies for bundled community paramedicine services provided by EMS.

Institution

Indiana University

Main Contact

Andrew Stevens, MD

Award Amount

$899,700

Contacts

Name	Role(s)	Phone	Email
Andrew Stevens, MD	Principal Investigator

Products

Title	Format	Description	Published/Revised	Availability
Mobile Integrated Health Pediatric Asthma Protocol	Protocol/Guidelines		2013	Available Online Protocol

Disseminations

Title	Type	Publication/Event	Published/Presented	Identifier	Details
Pharmacist Involvement in a Community Paramedicine Team	Research Paper/Publication	Journal of Pharmacy Practice	2017	PMID: 27000138	Pharmacist Involvement in a Community Paramedicine Team Author(s)/Presenter(s) Baely M Crockett, Karalea D Jasiak, Todd A Walroth, Kerri E Degenkolb, Andrew C Stevens, Carolyn M Jung Abstract/Description Background: Hospital readmissions have recently gained scrutiny by health systems as a result of their high costs of care and potential for financial penalty in hospital reimbursement. Mobile-integrated health and community paramedicine (MIH-CP) programs have expanded to serve patients at high risk of hospital readmission. Pharmacists have also improved clinical outcomes for patients during in-home visits. However, pharmacists working with a MIH-CP program have not been previously described. This project utilized a novel multidisciplinary Community Paramedicine Team (CPT) consisting of a pharmacist, paramedic, and social worker to target patients with heart failure at high risk of readmission to assist with coordination of care and education. Objectives: This article describes the development of the CPT, delineation of CPT member responsibilities, and outcomes from pilot visits. Methods: The CPT visited eligible patients in their homes to provide services. Patients with heart failure who were readmitted within 30 days were eligible for a home visit. Results: A total of 6 patients were seen during the pilot, and 2 additional patients were seen after the pilot. Conclusion: Imbedding a pharmacist into a CPT provides a unique expansion of pharmacy services and a novel approach to address hospital readmissions. View On Pub Med
Treat the Streets	Presentation	Pennsylvania Emergency Health Services Council (webinar)	2017
Multifaceted Quality Improvement Initiative to Decrease Pediatric Asthma Recidivism	Research Paper/Publication	Journal of Asthma	2017	PMID: 28118056	Multifaceted Quality Improvement Initiative to Decrease Pediatric Asthma Recidivism Author(s)/Presenter(s) Nadia L Krupp, Cindy Fiscus, Russell Webb, et al Abstract/Description Background: Asthma is the most common chronic disease of childhood and a leading cause of hospitalization in children. A primary goal of asthma control is prevention of hospitalizations. A hospital admission is the single strongest predictor of future hospital admissions for asthma. The 30-day asthma readmission rate at our institution was significantly higher than that of other hospitals in the Children's Hospital Association. As a result, a multifaceted quality improvement project was undertaken with the goal of reducing the 30-day inpatient asthma readmission rate by 50% within two years. Methods: Analysis of our institution's readmission patterns, value stream mapping of asthma admission, discharge, and follow-up processes, literature review, and examination of comparable successful programs around the United States were all utilized to identify potential targets for intervention. Interventions were implemented in a stepwise manner, and included increasing inhaler availability after discharge, modifying asthma education strategies, and providing in-home post-discharge follow-up. The primary outcome was a running 12-month average 30-day inpatient readmission rate. Secondary outcomes included process measures for individual interventions. Results: From a peak of 7.98% in January 2013, a steady decline to 1.65% was observed by July 2014, which represented a 79.3% reduction in 30-day readmissions. Conclusion: A significant decrease in hospital readmissions for pediatric asthma is possible, through comprehensive, multidisciplinary quality improvement that spans the continuum of care. View On Pub Med
Treat the Streets	Presentation	National Association of EMS Officials Spring Meeting; MDWise (Indiana Medicaid); Anthem Insurance	2016
Treat the Streets	Presentation	CARE/SERC Regional EMS for Children Symposium; American Lung Association Lung Expo	2015
Treat the Streets: A novel community medicine program designed to reduce pediatric asthma recidivism	Presentation	NAEMSP Annual Meeting	2015
Treat the Streets	Presentation	CDC State Asthma Program Managers (2014); IRCP Annual Meeting (2014); CARE/SERC EMSC Symposium (2015); American Lung Association Expo (2015); NASEMSO Spring Mtg (2015); MDWise & Anthem Insurance (2016); PEHSC (2017)	2014-2017
Indiana program targets asthma readmissions with community paramedicine	Article	EMS World Online	2013 Article		Indiana program targets asthma readmissions with community paramedicine Abstract/Description Indiana University School of Medicine emergency medicine faculty hope to improve the way childhood asthma is medically managed in Marion County through an innovative program that incorporates the skills and flexible schedules of specially trained Indianapolis Emergency Medical Services paramedics.....
New program set to intervene to prevent readmissions, repeat ED visits due to acute exacerbations of asthma	Article	ED Management	2013	PMID: 24308071	New program set to intervene to prevent readmissions, repeat ED visits due to acute exacerbations of asthma Abstract/Description Faculty at Indiana University School of Medicine are set to launch a community paramedicine program aimed at preventing repeat hospital and ED visits for acute exacerbations of asthma in children. Under the program, all children who are treated in the hospital or ED for asthma will receive home visits by specially trained paramedics within a few days of discharge. Paramedics will conduct a comprehensive assessment and make referrals as necessary for followup care. Nearly 30% of children who have been hospitalized for asthma require readmission to the hospital not long after discharge, and as many as 25% of children who have been treated in the ED for asthma will return to the ED within 30 days for another asthma-related visit. The one-time home visits will be comprehensive, enabling EMS providers to initiate stop-gap measures so that if a child is starting to get sick, paramedics can make sure the appropriate medicines are started and that acute care needs are met. Developers will monitor 30-day, 90-day, and one-year readmission metrics among patients who have received home visits.They hope that resulting cost-savings will sustain the program beyond the initial period, which is being funded through a grant from the Department of Health and Human Services. View On Pub Med
IU School of Medicine and Indianapolis EMS target childhood asthma with paramedic housecalls	Article	INScope	2013 Article		IU School of Medicine and Indianapolis EMS target childhood asthma with paramedic housecalls Abstract/Description Indiana University School of Medicine emergency medicine faculty hopes to improve the way childhood asthma is medically managed in Marion County through an innovative program that incorporates the skills and flexible schedules of specially trained Indianapolis Emergency Medical Services paramedics....