Community paramedicine heart failure transition of care model evaluation

Background and Purpose: More than 5 million adults live with the chronic progressive condition of heart failure (HF) in the United States. After age 40, there is a 20% risk of developing HF, where roughly 50% of the population diagnosed with HF dies within 5 years of their initial diagnosis. Transitional care presents a particularly unique opportunity to improve patient outcomes as evidenced in the literature. The aim of this project was to provide supporting evidence of effectiveness for an innovative community paramedicine model of care in reducing 30-day readmissions for patients with HF. Methods: An outcomes research study using a retrospective cohort design was the method used to evaluate the effectiveness of a model of care intervention, the paramedic home visit post hospital discharge, intended to meet the needs of HF patients at high risk for readmission and achieve the desired outcome of reduction in 30-day all cause readmissions. Results: Statistical testing did not support the hypothesis that: Patients with heart failure who have a paramedic home visit post discharge would have a lower rate of unplanned readmissions within 30-days of discharge than those without a paramedic home visit (p=.288). The reduction in 30-day heart failure readmission rates from 26.9% in 2012 to 19.2% in 2015 however was statistically significant (p=.006). Relative risk of readmission for heart failure in the post implementation period was less likely, RR 0.839, 95% CI [.733, .960] than that of readmission in the baseline line period. Gender was the only covariate that was significant as a predicator for readmissions. Clinical Implications and Recommendations: Community paramedicine is an emerging model of care that warrants further review. The results of this study begin to close the gaps in knowledge related to home visit effectiveness and the role of community paramedicine in transitions of care model designed to reduce 30-day readmissions.